Anatomy

The piriformis muscle (the main muscle that causes piriformis syndrom) originates at the inner surface of the sacrum and inserts at the superior border of the trochanter of the femur. It passes through the greater sciatic notch and is the landmark to most of the nerves and vessels that pass from the pelvis to the gluteal region.

These are the piriformis muscles, nerves, and vessels that surround it.

Piriformis syndrome (PS) is caused by excessive contraction of the piriformis muscle (PM) for a long period of time. It occurs due to sciatic nerve entrapment at the level of the ischial tuberosity. Because of its anatomy, making it close to the sciatic nerve, PS reveals symptoms that include buttocks, hips, and lower legs pain.

Cause of Piriformis Syndrome

In most patients, there is no identifiable cause. However, the most common causes are:

• Previous gluteal trauma
• Spasm in PM itself or surrounding muscles
• Hypertrophy of PM leading to compression on the sciatic nerve which will reveal symptoms
• Prolonged sitting
• Predisposition to nerve compression by congenital variations of the sciatic nerve or piriformis syndrome.

Symptoms

• Tenderness of the PM found on external palpation over the greater sciatic notch
• Tenderness on internal palpation per vagina or rectum
• Tenderness of tonic external rotation of the hip
• Aggravating pain with prolonged sitting position or walking
• Gluteal/buttock pain
• Low back pain
• Tingling and numbness of the lower limbs
• Discomfort

Special Tests( As reproductive and inhibitory tests):

• Freiberg: Passive internal rotation of the hip in extension reproduces pain
• FAIR = flexion, abduction and internal rotation of the hip
• Pace and Nagle: The clinician provides resistance to hip abduction by holding the sitting patient’s knee; reproduces pain
• Lasegue’s Maneuver: patient supine, hip flexed 90 and the knee extended: reproduces pain

Treatment:

Conservative treatment is considered the first line for Piriformis Syndrome. However, in chronic cases where this intervention fails, physicians’ resort to surgery.

-Physical therapy interventions: (you will see a detailed video that shows the exercises at the end of the article)

• Deep tissue massage for the piriformis syndrome.
• Lifestyle modifications.
• Active and Passive exercises, here are some:

1-Pigeon Stretch:

Get down on your hands and knees and bring your right knee forward and out to the right side.

Slide your left leg back, lower your torso, bend your arms and place your elbows on the floor.

2-Foam Rolling Glutes:

Start in a semi-seated position with a foam roller underneath your glutes. Support the movement with your arms then proceed to roll over the foam roller.

3-Crab walk:

Apply a resistance band above your knee. Perform a quarter squat with your hands extended in front of you. As you maintain this position, start moving laterally to one side moving one leg at a time.

4-Hip thrust weighted double-legged on bench:

Place the upper part of your back below the scapula on the bench with your legs separated hip level. Elevate your hips and squeeze your glutes. Apply weights on your hips for more resistance.

5-Squats:

Place your feet at hip level. Move in a downward motion moving from a standing to a sitting-like position simultaneously moving your arms up (shoulder level) as you move down. Draw your hips back and downward keeping your chest up.

6-Double mid bridge isometric bodyweight:

Lay on your back with one leg flexed and the other extended. Elevate your glute from the floor while being on your heel.

7-Donkey kicks Body Weight:

Get on all fours, with your hand under your shoulders and your knees under your hips. Kickback with one leg and squeeze the glutes while engaging your core.

These are simple ones, that can be done at the gym. Bear in mind that sometimes these exercises need a follow-up with your therapist especially when the pain is unbearable, or you are going through an acute inflammation. listen to your body, don’t push if any of the exercises given are triggering your pain.

Here is a video from our page that can help you with your piriformis syndrome pain:

https://www.instagram.com/p/CHN5DG_prOV/?igshid=YmMyMTA2M2Y%3D