The Piriformis muscle lies deep in the buttocks. It starts on the edge of the sacral bone, runs across the buttocks and attaches to the hip. It functions by turning the hip outwards. The muscle is often referred to as the double devil as it can cause two different scenarios. One directly from the Piriformis muscle and one when the tight Piriformis muscle squashes the sciatic nerve up against the pelvic bone.
Symptoms of Piriformis Syndrome may range from moderate to severe pain in the affected buttock, which may radiate down the back of the leg, and in severe cases into the foot. This pain is usually felt as a deep ache or a burning and is aggravated by straightening the leg, walking, coughing and other movements of the legs or spine. (See fig 2)
The muscle may go into spasm after a period of overwork (long mountain/beach walk), super cooling (running in the rain), walking over uneven ground, trauma to the area (such as fall), and occasionally is the result of injections into the buttocks. Other causes include ankle, knee or hip problems which force a patient to walk differently thus overloading the muscle resulting in spasm.
Effective treatment must include assessment of the foot, knee and hip to rule out, or correct problems. If these structures are not assessed and treated, the patient will usually suffer a relapse within a short period of time. Other sources of pinching on the nerve (such as disc bulge) also needs to be ruled out. Treatment is directed at the muscle may include massage, stretching, pressure point or acupuncture therapy and electrical stimulation. Manipulation of the ankle, knee, hip, pelvis and spine may be required to normalize the patients walking style. A home program of self-stretch is essential to the outcome and supplementation with magnesium and vitamin B’s may be of benefit.
The outcome of treatment is usually very good with total resolution of the pain providing the home exercise program is followed and the Piriformis is the only source of nerve compression.
Do your prescribed exercises regularly as shown above. Supplement your diet with vitamin B’s and magnesium. Keep the muscle warm and always warm up before exercise. When driving a car try not to let your foot flop outwards as this may aggravate the condition. You can also try compressing the muscle for 5 minutes at a time by lying on a tennis ball putting pressure directly over the tender point in the muscle. Always follow this with a stretch routine.
If you are unsure about any aspect of your condition or treatment, please don’t hesitate to contact Dr Michael Rees DC at First Chiropractic.