Often termed sciatica, piriformis syndrome can go undiagnosed and untreated. The piriformis is a muscle that sits deep to the gluteal muscles. It helps us to externally rotate (pointing toes outwards with a straight leg) and abduct (moving a straight leg out to the side) the thigh.
What is Piriformis Syndrome?
Tightness, injury, or inflammation of the piriformis can cause irritation or compression on the sciatic nerve resulting in sharp or achy pain in one side of the buttock, and may include a numbness, tingling and sometimes a burning sensation down the back of the leg (where the sciatic nerve runs).
Common Causes and Risks
• When the piriformis muscle isn’t engaged during daily exercise it can become weak and lengthened. Lengthening in the piriformis muscle results in pulling of the fibres and the muscle becomes taut – this puts compression on the sciatic nerve.
• Spasm or contracture in the piriformis muscle can cause irritation to the sciatic nerve
• Local traumas to the area of the buttocks, such as a fall
• Repeated mechanical stressors such as running or cycling can cause the piriformis muscle to become hypertrophic or inflamed – compressing the nerve.
• Excessive local pressure caused by such as prolonged sitting on hard surfaces, or sitting with a wallet/ keys in a back pocket
• Pelvic instability is a very common cause of piriformis syndrome, and can result in “loading” of the muscle (usually on one side only). Chronic strain placed on the piriformis causes an imbalance in the muscle tone and compression or entrapment of the sciatic nerve results.
What can help?
Remedial Massage: Through the use of passive and active stretches (if piriformis is short and tight), joint mobilisation, myofacial release, and trigger point therapy the piriformis muscles can be released resulting in the pressure being taken off the compressed nerve. Muscle energy techniques can also be used in remedial massage to allow for the clients internal rotation of the hip to be increased pain free.
Remedial massage is a great way to reduce the pain and discomfort of piriformis syndrome by warming the muscles, stretching and lengthening those that are tight while strengthening the weaker muscle groups.
Pilates: Pilates and remedial massage therapy are a great combination if the cause of the piriformis syndrome is due to weakness or pelvic instability. Pilates instructors take clients through a range of activities while ensuring all correct muscles are engaged, with a lot of focus on the buttocks and pelvic floor. These exercises help to strengthen the piriformis, and gluteal muscles while keeping the pelvis remains level and stable.
What you should hope to achieve from your treatments
• Reduction or complete elimination of pain
• Increased strength and normalisation of posture
• A greater range of motion in the hip and thigh
How to prevent Piriformis Syndrome?
Get moving and stretch! Prolonged sitting can really exacerbate the irritation in the muscle, standing up and walking frequently during a working day help to reduce the chances of the muscle seizing (also a great excuse for a toilet/ water break).
Warming up properly before an intense exercise such as running and climbing hills helps the muscle to stretch and lengthen. After strenuous exercise stretching and allowing the muscle to rest and recover is highly recommended.
Anita Barnett BcExSc, Massage Therapist.
Huber, L. & Palmer, E. Clinical Review: Piriformis Syndrome. (2013) Cinahl Information Systems, CA.