Piriformis Syndrome - What is it and How to Treat

What Is Piriformis Syndrome?

Piriformis syndrome (PFS) is a pain and discomfort condition much like sciatica, except due to a very dissimilar source. Piriformis syndrome is sometimes referred to as back pocket disease. People that keep a wallet in their back pocket and sit on it throughout the day often develop symptoms of pain in the rear and down the leg. In this ailment, the sciatic nerve is compressed by the piriformis muscle. Piriformis Syndrome is an entrapment neuropathy in which a tight and/or inflamed piriformis muscle compresses the sciatic nerve, the largest nerve in the body, producing radicular type of symptoms. There are many causes of this problem to altered foot biomechanics to poor hip joint function. PFS occurs when part of the sciatic nerve becomes entrapped, compressed, or irritated by this muscle. The syndrome can be very persistent and painful. It is estimated that six percent of all patients with sciatica have piriformis syndrome.

The existence of piriformis syndrome has been doubted for years, but with the power of the Internet the reality of this syndrome has finally reached a tipping point. Previously, it was not even considered as a diagnosis, in others it was quickly ruled out. Chiropractors note that PFS seems to occur most in those people who don't stretch adequately before exercise. People who are obese, or who spend much of their time sitting (as on workdays) and then are active on the weekends might be prone to the condition.

Located deep within the gluteal (buttock) muscles PFS can reek havoc with the body, causing extreme discomfort, pain and inconvenience in general. This muscle is deep inside the body, under the gluteals. The sciatic nerve passes directly under the piriformis muscle. Tension in the soft tissue of the piriformis, gluteal and other related muscles is usually the cause behind it. Such tension may be caused by incorrect posture, sports, and improper exercise.

Women may be affected more frequently than men, with some reports suggesting a six-fold incidence among females.
PF syndrome also causes sciatica. Its treatment is much less invasive and severe than the treatment of herniated lumbar disks.

How To Diagnose Piriformis Syndrome -

Diagnosis of piriformis syndrome is mostly clinical and requires a high suspicion for the diagnosis as many of the symptoms can be somewhat vague. Patients are often tender over the attachments and length of the muscle especially at the greater trochanter on the thigh bone or femur. It includes an empirically-based interactive means to determine the probability that a given case of sciatica is due to piriformis syndrome.

If it hurts to touch a point that's in the middle of one side of your buttocks, you probably have piriformis syndrome. This chronic condition is very difficult to diagnose, because other injuries may produce exactly the same symptoms.

In PFS, you feel pain, tingling and a numb sensation in your buttock region. You can feel ache in the mid butt area that radiates through the whole of back legs. Trying to stretch the piriformis muscle has been suggested as a way of diagnosing the problem - if it hurts to stretch it, you may have piriformis syndrome. The instructions for stretching it are: Lie flat on your face on a bed. The prognosis for most individuals with piriformis syndrome is good. Once symptoms of the disorder are addressed, individuals can usually resume their normal activities.

Symptoms of PFS -

The first symptom suggesting piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing a bursitis.

How To Treat Piriformis Syndrome -

Diagnosis and treatment of Piriformis syndrome should be carefully and extensively done. Multimodality treatments should be considered before jumping into surgery or the like. Therapy for piriformis syndrome often begins with progressive stretching exercises that are simple to do at home or the office and require no equipment. One easy exercise, for example, involves standing with the left foot flat on the floor and the right foot flat on a chair so that the right knee is at a 90 degree angle with the floor.

Targeting the piriformis is done with a single knee to the chest with painful side cross-over. The stretching exercises are performed three times a day, five times each time, maintaining the stretch between 5-10 seconds. If the muscle pain is causing altered gait, slow down and start therapy before causing additional end injury.

One of the main ways a person can treat piriformis syndrome without seeing a doctor, according to SportsInjuryClinic.net, is to apply heat to the buttocks region. Patients should also work to stretch the muscles in the buttocks and hips to help relieve the spasm and inflammation. A person with piriformis syndrome has irritation and inflammation of the sciatic nerve. Usually people with piriformis syndrome do not like to sit. When they do sit down, they tend to sit with the sore side buttock tilted up rather than sitting flat in the chair.

There are a number of preventative techniques that will help to prevent piriformis syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities.

Besides stretching, there a couple of therapies that can greatly assist in treating piriformis syndrome. Ultrasound can be used to provide an anti-inflammatory effect to a swollen piriformis. Stretching is not only a treatment but also a preventive.

Patients with piriformis syndrome may also find relief from ice and heat. Ice can be helpful when the pain starts, or immediately after an activity that causes pain. If pain is persistent during stretching then a combination of warm moist therapy with Infrex treatment during and after exercising may be most beneficial. The thermal effects of warm moist heat have limited residual pain relief, however the carryover pain relief from interferential therapy may provide total comfort extending from one stretching session to the next.

The warm moist heat also attracts blood to the area and the interferential treatment goes deeper into the human tissue structure due to decreased electrical resistance.

Inactive and weak gluteal muscles can also be a predisposing factor of the syndrome. The Gluteus maximus is important in both hip extension and in aiding the piriformis in external rotation of the thigh. Most patients also need gluteal strengthening. Try to maintain flexibility in the hip joints, including the iliopsoas, iliotibial band (ITB) and gluteal muscles. This will help prevent injuries caused by friction.