What Can Be Done About Piriformis Syndrome?

Piriformis syndrome is an uncommon and painful neuromuscular condition that causes the piriformis muscle to compress or irritate the sciatic nerve, resulting in spasms and buttock pain. People with piriformis syndrome often experience discomfort, tingling, or numbness in the buttocks, all of which can be severe. When the piriformis muscle starts to spasm and compress the sciatic nerve, pain can extend down to the foot.

Here are the most common symptoms:

• Tenderness of the buttocks muscles
• Numbness and tingling in the buttocks
• Discomfort when sitting
• Increased pain after sitting for long periods of time
• Buttock and leg pain that worsens with activity

Location of the Piriformis Muscle

The piriformis muscle is a flat, pyramid-shaped band of muscles parallel to the back margin of the gluteus medius and deep behind the gluteus maximus muscle in the hip area. It starts from the sacrum (base of the spine) and connects to the upper trochanter of each femur (thigh bone). The piriformis works as a hip adductor when in flexion and an abductor when in extension. It stabilizes the hip joint and allows us to walk, shift our weight from one foot to another, and maintain balance.

Causes of Tight Piriformis Muscles

The exact causes of piriformis syndrome remain unknown. However, some of the suspected factors causing piriformis pain include:

• Overworked piriformis muscle due to excessive exercise
• Repetitive activities that use the legs (running, walking, jogging)
• Prolonged period of sitting
• Extensive stair-climbing
• Lifting heavy objects

Additionally, certain injuries can damage the piriformis muscle, causing irritation to the sciatic nerve. Injuries that can cause the syndrome include:

• Twisting the hip suddenly
• Bad fall
• Vehicular accident
• Penetration wound that injures the piriformis muscle
• Sports injuries

Diagnosing Piriformis Syndrome

There is no definitive clinical test to confirm if you are suffering from piriformis syndrome. A physiotherapist can review your medical history, symptoms, and any possible causes of the pain to determine if piriformis syndrome is a possibility. A variety of manual manipulations and physical tests are conducted to see what triggers pain in the piriformis. In some cases, the physical exam can detect a contracted piriformis muscle. Some physiotherapists will also perform clinical tests including:

• Freiberg – This range of motion (ROM) test involves lying on your back while lifting and internally rotating your leg.
• Lasègue – Also call the “straight leg test,” this is another supine ROM test in which you raise one leg up to a 90 degree angle at the hip.

• Pace’s Sign – In this ROM test, the physiotherapist will have you lie on the unaffected side and move your hip and leg through different motions.
• Sciatic Notch Palpation – This test does not involve range of motion. Sciatic notch palpation is a manual test where the physiotherapist will ask you to lie down while the sciatic notch is pressed and released.

Because some symptoms are similar to sciatica, radiologic tests (e.g. CT scan, MRI, EMG, and ultrasound) are used to rule out other conditions that replicate piriformis syndrome, like a herniated disc. If the results indicate you are suffering from piriformis syndrome, the physiotherapist will recommend behavioural changes that help alleviate the symptoms, like avoiding prolonged sitting, heat or cold compress, rest, mild prescription pain relievers, and physical therapy.

Exercises to Alleviate Piriformis Syndrome

Piriformis syndrome can last a long time if not treated immediately. Fortunately, there are several stretches and strengthening exercises for the piriformis muscle, hip extensors, and hamstrings to alleviate pain and restore range of motion.

Here are a few ways to stretch and strengthen your piriformis muscle:

• Sit Cross-Legged – Taking a few minutes helps to sit cross-legged on the floor for  stretch the piriformis muscle and glutes and will keep the hips open. When comfortable in this position, place the soles of your feet together and press your hands down gently on the knees.

• Chair Stretch – This piriformis stretch is beneficial for people who sit for long periods of time every day. While seated in a chair, place one ankle to rest on the opposite knee. Lean forward slowly until you feel a mild stretch in the hips. Switch feet and do the same for the other leg.

• Lying Piriformis Stretch – While lying on your back with feet flat on the floor, cross your right ankle over the left knee. Reach behind your left knee and gently pull it toward you while applying light pressure to the inside of the right knee. Hold this position for about 20 to 30 seconds, and then repeat on the other side.
• Pigeon Pose – A more advanced stretch is called “pigeon pose.” This deep hip and pirif
• ormis stretch engages the piriformis muscles, IT band, and hip rotators. Be cautious when getting into and out of this pose.

• Begin in a downward-facing dog position with feet hip-distance apart.

• Bring your right foot forward and place it at the back of your left wrist. Allow the outer edge of the right shin to rest as close to parallel with your body as your range of motion allows. The more parallel your shin is, the deeper the stretch, so if you feel any discomfort, move the heel in closer to the groin. Always keep your right foot flexed to protect the knee joint. Slowly bring your hips to the floor, allowing your back leg to rest straight behind you.

• Fold your torso forward and lower yourself to the point where you feel a deep stretch in the right buttock and hip. Let your head rest either on the floor or your hands, depending on your flexibility.

• Take several breaths while maintaining equal weight on your hips.

• To come out of the posture, lift your torso and roll your hips to the left. This will allow you to release and straighten the right leg as you step it back into downward-facing dog. To alleviate tension from pigeon pose and get a deep stretch in the right front hip, bring your right leg up and bend the knee, reaching the toes toward the left side of the body. Repeat the process with your left leg.

Physiotherapy can help prevent debilitating pain and improve your quality of life. It is considered one of the key treatments for patients suffering from piriformis syndrome.

For a wide selection of physiotherapy services in Oshawa, Mississauga, Whitby, and other locations, call Physiotherapy and Rehabilitation Centres of Ontario at (905) 579-9938.