The piriformis muscle is a small muscle that sits deep in the buttock. Everyone’s anatomy is slightly different, and for some people the sciatic nerve actually pierces the muscle itself. For other people, the nerve just runs nearby. In either case, when the muscle is tight, it can irritate the nerve. This causes the usual symptoms of sciatica, and is known as Piriformis Syndrome.
Like any other muscle, piriformis can become tight when we ask it to do more than it is used to. Things like picking up a new sport or going for longer runs than normal could do this. Spotting the symptoms in the early stages might mean that you can adapt your exercise. This might be as simple as adding in a better warm up or stretching routine.
Piriformis Syndrome is also associated with pregnancy. General water retention can make nerves more susceptible to irritation- we see more Carpal Tunnel Syndrome in pregnancy too. We also expect the buttock muscles to be working harder as pregnancy progresses. There are two reasons for this:
Is My Piriformis Muscle To Blame For All Of My Buttock Pain? — Andrea Trombley Physical Therapy And Yoga
Neither of these points are things we can change, but we can help relax the muscles involved. It may also be appropriate to think about strengthening exercises or changing your posture to a more energy-efficient one. We can help with these.
The main job of piriformis is to outwardly rotate the hip. This means that when it is tight, it will try to hold the hip in that turned-out position. In order to stretch it, we need to do the opposite, so your osteopath may recommend exercises to help. You might also expect your treatment sessions to involve direct work onto the muscle itself.
Irritated nerves are not always the most straight forward things to manage. When a nerve sends a pain signal to the brain to alert it to danger, the brain might order nearby muscles to tighten up in an attempt to protect the area. Unfortunately, for cases like this, that will only make it worse.
The Drawing Shows The Proximal Course The Sciatic Nerve Passing...
With this in mind, your osteopath will work to release the muscle and calm down the nerve at the same time. Once the cause of the tightening is determined, it’s usually quite simple to relax off the muscle. The nerve might be more complicated, especially if symptoms have been going on long enough to make the nerve excessively reactive. A combination of hands on treatment and exercises for you to do at home will likely be enough to get back on top of your symptoms.Sciatica is just a symptom, but it has a very specific definition. Your leg pain is only sciatica if it follows the sciatic nerve. That means sharp shooting pain in the front of the thigh or in your arm is not sciatica.
The course of the sciatic nerve is from the lower back and into the buttock, then down the back of the thigh. After the knee it splits into two smaller nerves that run down the back and side of the calf. It is unusual to have symptoms along the whole nerve- often they are just focused to one portion and recede with treatment.
The sciatic nerve is formed from a number of nerves leaving the spine. They come together to make the thick sciatic nerve before they exit the pelvis.
The Diagnostic Anatomy Of The Sciatic Nerve
The top two nerves that make up the sciatic nerve are vulnerable to nerve root irritation. The discs at L4/5 and L5/S1 can catch them if they bulge. Similarly, tight muscles or local inflammation can irritate the nerve roots in this area too.
The image above also shows a spondylolisthesis. This is a rare cause of sciatica. This is a condition in which one of the bones in the spine moves forwards or back compared to the others. This may be traumatic and associated with a fracture, or it could be due to being born with unusual anatomy. Because of the slippage, the nearby nerves can be pulled and irritated. It may be possible to see or feel a dip in the back and your osteopath will likely send you for a scan if they identify it for the first time in an appointment. Nerve pain after an injury should also be investigated at hospital before you see your osteopath.
Once the sciatic nerve has started to form from the smaller nerves, it runs close to a deep muscle in the buttocks. For some people, the nerve actually runs through the piriformis muscle.
Piriformis Syndrome, A Real Pain In The Butt!
If the muscle gets tight it can compress and irritate the nerve. One common response to pain is further muscle tightness, which causes more compression and can be a hard cycle to break on your own. Luckily it’s an easy muscle to treat and there are some simple exercises you can do at home to calm the whole area down.
With any cause of sciatica, one big indicator of how long it will take to heal is how long the pain has been there. It can take a long time to get through the medical system and start making progress, so get in early with your osteopath. Osteopathy will not interfere with any intervention your GP might want to do.
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Small Muscle Causes Big Pain: Relieve Piriformis Syndrome With Chiropractic Care
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Injection For Piriformis Syndrome
Piriformis syndrome is a condition in which the piriformis muscle compresses the sciatic nerve, causing symptoms of sciatica into the lower extremity.
Figure 16. Relationship of the sciatic nerve to the piriformis. (A) The usual relationship is for the sciatic nerve to emerge from the internal pelvis into the gluteal region between the piriformis and the superior gemellus. (B, C) Sometimes, part or all of the sciatic nerve exits through the piriformis or above the piriformis, between it and the gluteus medius. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis – A Clinical Orthopedic Approach. 2015.
Normally, the sciatic nerve exits from the internal pelvis into the buttocks between the piriformis muscle and the superior gemellus muscle. However, approximately 10% to 20% of the time, part or all of the sciatic nerve either exits through the piriformis, or above it, between the piriformis and the gluteus medius (Fig. 16). Regardless of the relationship of the piriformis and sciatic nerve, if the muscle is tight enough, the nerve may be compressed, resulting in sciatica. This condition is often said to cause “pseudo sciatica”; however, this term does not make sense and shows a bias toward bony or disc impingement on the nerve. If compression of the sciatic nerve occurs and symptoms of sciatica are experienced, then regardless of the cause, it can be correctly termed sciatica.
A Minimally Invasive Surgical Approach For The Treatment Of Piriformis Syndrome: A Case Series
The piriformis muscle can become tight due to overuse. The piriformis acts as a lateral rotator of the thigh at the hip joint as well as a contralateral rotator of the pelvis at the hip joint (contralateral rotation of the pelvis occurs when planting and cutting [planting the foot and pivoting to change directions] during sports). The piriformis is also functionally important toward stabilizing the sacrum at the sacroiliac joint and stabilizing the hip joint.
Because piriformis syndrome is a condition of muscular origin, it makes sense that it will respond well to soft tissue manipulation. Moist heat, massage, and stretching are all very beneficial. Pin and stretch technique is particularly effective when working on the piriformis. Click here for more on manual therapy treatment of Piriformis Syndrome.
This blog post article is the seventh in a series of twelve articles on musculoskeletal conditions of the low back (lumbar spine) and pelvis.
Is My Lower Back Pain Piriformis Syndrome?
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