• Andy Wong

Piriformis Syndrome : Symptoms, causes and home exercises.

Piriformis Syndrome is a painful musculoskeletal condition, which leads to peripheral neuritis (nerve inflammation) of the branches of the sciatic nerve caused by an abnormal condition of the piriformis muscle, such as injured or irritated muscle. The symptoms are characterized by buttock or hip pain. Alternately, Piriformis Syndrome is also known as deep gluteal syndrome and extra spinal sciatica. Women are more likely to have piriformis syndrome with a female to male ratio of 6:1. This ratio can be explained by the bigger Q-angle (the angle that the pelvis and thigh makes with the shin) in women.





Function of the piriformis muscle

  • External rotation of the hip

  • Abduction and partial extension of the hip.


Epidemiology

There are two types of piriformis syndrome (according to Boyajian- O’ Neill L.A et al) :


Primary Piriformis syndrome has an anatomical cause, which may be a result of split piriformis muscle, split sciatic nerve, or an abnormality in sciatic nerve path. Fewer than 15% patients suffer from this type of piriformis syndrome. However, currently there is not much evidence that supports the abnormality of sciatic nerve causing piriformis syndrome.


Secondary Piriformis syndrome occurs due to macrotrauma, microtrauma, and local ischemia (restriction of blood flow). 50% cases are known to be caused due to macrotrauma to the buttocks, leading to inflammation of soft tissue. It can also be caused by shortening of the muscle due to altered biomechanics of the lower body, lower back or the pelvic region.


Clinical Presentation

Patients typically have symptoms that consist of persistent and radiating low back pain, buttock pain, numbness, difficulty with walking and other functional activities such as sitting, squatting, standing, or bowel movements.


Diagnostic tests

Observation : Patients may present with gluteal atrophy (reduced muscle size) as well as limb shortening on the affected side. In chronic cases, there is muscle hypotrophy (decrease in muscle cells) on the affected side.


Palpation : Sensitivity during palpation at the greater sciatic notch. It is possible to detect this by deep palpation.




Home Remedies

  • Take a warm bath

  • Lie on the back and raise the hips with your hands and pedal with the legs like you are riding a bicycle.

  • Bend knee, with as many as 6 repetitions every few hours.

  • Rotate side to side while standing with arms relaxed for 1 minute every few hours.


Book in with one of our physiotherapists for a detailed physical assessment and neurological history, for an accurate diagnosis and treatment.


References

Boyajian-O'Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and management of piriformis syndrome: an osteopathic approach. The Journal of the American Osteopathic Association, 108(11), 657-664.


Probst, D., Stout, A., & Hunt, D. (2019). Piriformis syndrome: a narrative review of the anatomy, diagnosis, and treatment. PM&R, 11, S54-S63.


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