The piriformis muscle is situated in the buttock originating from Anterior (front) surface of the sacrum and inserting on the Greater Trochanter of the Femur bone. This relatively small muscle (compared to other bulky muscles working on the hip) rotates the hip Laterally (outward).
What characterizes this muscle is its relation to the Sciatic Nerve. The course of the nerve has 2 variations:
- Passes underneath the Piriformis Muscle.
- Pierces the Piriformis Musce ( it’s seen in about 17 % of patients) (1).
When this muscle undergoes spasm or shortens it presses against the Sciatic Nerve or strangles it resulting in signs and symptoms that mimic those of Sciatica ( compression of the L5-S1 nerve root by a disc prolapse \ protrusion).
Symptoms of Sciatic Nerve entrapment include pain and\or numbness radiating down the distribution of the Sciatic nerve reaching below knee and involving toes.
This condition is overlooked and therefore mistreated. Treatment of Piriformis Syndrome involves refraining from the causative and aggravating factors.
The Piriformis muscle tends to tighten up after activities that include repetitive stresses such as running, cycling or climbing uphill.
Physiotherapy treatment includes:
- Avoiding causative and aggravating factors.
- ICE application in the acute cases.
- Myofascial release techniques which help to relax the muscle.
- Ultrasound waves.
- Neurodynamic techniques which flosses the Sciatic Nerve along its course thus improving the nerve’s mobility.
- Stretching exercises that targets the muscle to keep it lengthened and maintain the improvement gained.
