Piriformis Syndrome and Physiotherapy Intervention
The term “sciatica” is a common term that happens when one has a slipped disc (in medical terms, it’s called disc herniation), and the disc presses onto the sciatic nerve, causing sciatica, which is a pain that shoots downwards from the buttock to the leg.
Okay, here’s the thing, sciatica can be caused by more than one factor such diseases to/of the lumbar spine such as slipped disc like we mentioned earlier, long-standing tendinitis of the hamstrings as well as fibrous adhesion of the sciatic nerve by nearby surrounding tissues. Sometimes in athletes, the piriformis muscles may irritate the sciatic nerve, causing pain in the buttocks and pain (direct or referring) along the length of the sciatic nerve.
This pain, termed as sciatica, often travels down the back of thigh and into the lower back. Patients who have this syndrome generally complains of a deep pain or tenderness in the buttocks, which is aggravated by sitting, climbing stairs or doing squats/squat-like exercises. Our piriformis muscles helps us in abducting our thighs (bringing outwards) and externally rotating our thighs (rolling upwards, as in sitting cross-legged).
With this information, imagine this: while balancing on your left foot, move your right left directly sideways away from your other thigh and rotate your right thigh such that your right toes points towards the ceiling. Done it? That is the ability and action of your right piriformis muscle.
Stretching the muscle almost always duplicates the pain. To stretch the piriformis, there are two methods:
#1: The Complicated But Complete Way:
Lie on your back and bend your affected hip and knee. To make things easier to understand, let’s assume that you have a right-sided piriformis syndrome. So you will be lying on your back and your right hip and knee will be bent. Use your left hand to hold onto the back of your right knee and pull your right knee towards your left shoulder.
This causes your right piriformis to adduct and flex. Not letting go yet, use your right hand to grab your suspended right ankle and rotate the ankle outwards. What this does is that it causes your hip to go into internal rotation to complete the stretch. Why I term this complete because gravity and body weight causes you to fully stretch your piriformis.
#2: Shorter Quicker Way:
Stand on your left foot and place the right foot on a chair or low but firm table, your right knee and hip needs to be bent at about 90 degrees. Using your right hand, press your right knee towards the left side of the body whilst keeping your ball of your right foot on the same spot on the chair
What causes the piriformis syndrome?
The piriformis muscle lies deeper below the buttock (gluteal) muscles; it starts/originates from the spine of the sacrum and extends to attach to the greater trochanter of your femur, which is the bony bulge on the outside and top of your thigh. Usually the sciatic nerve is located underneath the piriformis muscles, but in about 10-20% of the population, the sciatic nerve passes through the muscle. Common understanding is that acute injuries or long-term injuries to the piriformis causes swelling that squeezes/irritates the sciatic nerve, causing sciatica. People and patients who falls into this 10-20% are more predisposed to this condition.
The piriformis syndrome is usually diagnosed based on clinical history review, identification of symptoms and by manual, physical examination. Although there are no exact tests that can accurately confirm and pinpoint the diagnoses, but often X-rays, nerve conduction test and MRI may be utilized to exclude other problems/issues. As mentioned above, other causes of sciatica include lumbar spine diseases such as slipped disc, long term tendinitis of the hamstring and fibrous adhesions of other tissues/muscles around the sciatic nerve. That being said, there are two well-described tests that have been clinically validated, which are:
Once accurately diagnosed, step-by-steps treatments are provided:
If these all don’t work, you may want to consider getting injections of corticosteroid into the piriformis muscle. A caring and good sports medicine doctor and physician with clinical experience caring for athletes with piriformis syndrome will help to direct appropriate physiotherapy management. With accurate diagnosis and treatments, this syndrome is easily managed.
Where to next?