The Piriformis Muscle and Syndrome

Description of The Piriformis Muscle

The piriformis is a flat, pyramidal in shape muscle that lies on the surface of the deep gluteal muscles. Its located in the buttocks near the top of the hip joint. It is a part of the six short external hip rotator group muscles;

[obturator internus, superior and inferior gemilli, quadratus femoris, obturator aternus]. 

The muscle passes from the pelvis to the gluteal region by passing through the greater sciatic notch and inserts on the medial side of the superior aspect of the greater trochanter of the femur [femur is the bone of the thigh or upper hindlimb, articulating at the hip and the knee].

Moreover, its pyramidal shape lies almost parallel with the posterior margin of the gluteus medius.

Functions of the Piriformis Muscle 

Let us now take a look at the functions of the piriformis muscle. This muscle is crucial in the lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This function enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs. In short, almost every motion of the hips and legs.

The piriformis muscle rotates the femur during the hip extension and abducts the femur during flexion of the hip. It also aids slightly in tilting the pelvis laterally and posteriorly by pulling the sacrum down towards the thigh. 

Furthermore, the piriformis muscle is very relevant clinically because it helps in locating the sciatic nerve. It serves another vital function as this muscle divides the gluteal region into superior and inferior parts. Therefore, it determines the name of the vessels and nerves that supply the area.

What is the sciatic nerve?

Now learning all this information about this specific muscle in our body leads us wandering regarding the sorts of complications that can arise from this muscle, which we’ll soon learn.

However, let us tackle the sciatic nerve first.  

The sciatic nerve originates near the base of the spine, where nerve roots exit the bony opening of the spine and join into a single, large nerve and leaves a bony arch called the sciatic notch. The sciatic nerve travels through the pelvis, passing under the front surface of the piriformis muscle as it travels through the pelvis.

It then cuts into two branches before going down each leg, branching out at the back of the knee to divide into the tibial and peroneal nerves, both of which supply the lower leg and foot. The sural nerves branch off from the tibial and peroneal nerves, terminating in the foot.

The sciatic nerve is responsible for bending the knee, bringing the thighs together (adduction), and flexing and extending the ankles and toes. It also provides sensation to the back of the thigh, the entire lower leg, the ankle, and the sole.

Now let us talk about some of the complications that can arise from the piriformis and sciatic nerve.

A detailed view on the Piriformis Syndrome

Piriformis syndrome (PS) is a painful musculoskeletal condition identified by a combination of symptoms comprising buttock or hip pain. This syndrome occurs when the piriformis muscle spasms and irritates or compresses the sciatic nerve. It often causes symptoms similar to sciatica, though this isn’t a cause of a spinal problem like sciatica is. Furthermore, the Piriformis syndrome (PS) is also commonly known as a deep gluteal syndrome, extra-spinal sciatica, and wallet neuritis. More women are diagnosed with Piriformis syndrome than men, with a female to male ratio of 6:1. Now, this is due to the quadriceps femoris muscle angle being wider comparatively in the os coxae of women.

Symptoms of the Piriformis Syndrome 

Patients with piriformis syndrome have many symptoms that typically consist of

  •  persistent and radiating low back pain
  • (chronic) buttock pain
  • numbness
  • paraesthesia

Patients also experience difficulty walking and other functional activities such as; pain with squatting, standing, bowel movements, and dyspareunia in women. Moreover, pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods.

In severe cases of piriformis syndrome, the pain in your buttocks and legs can be so severe it becomes disabling.

Causes of Piriformis Syndrome

The piriformis gets used every day. We use it for walking, turning our lower body, and even shifting our body weight from one side to the other. Hence, this muscle can also get injured and irritated due to excessive exercise or long periods of inactivity. 

Some common reasons for piriformis condition include: 

  • abuse from unnecessary exercise 
  • running and other monotonous activities using the legs 
  • sitting for expanded periods 
  • lifting weighty items 
  • broad step climbing 
  • wounds can likewise harm the muscle and cause it to push down on the sciatic nerve. 

Piriformis injury causes include: 

  • an unexpected twist of the hip 
  • a terrible fall 
  • an immediate hit during sports 
  • a vehicle mishap
  • an entrance wound that arrives at the muscle

What puts us at risk for this syndrome?

People who sit for long periods, for instance, people who incline to sit at their desks all day or perhaps in front of a television for extended periods, are at a higher risk of experiencing piriformis syndrome. They are also at increased risk if they participate in frequent and rigorous lower-body workouts.

The Diagnosis for the Piriformis Syndrome

Attaining a proper diagnosis of piriformis syndrome is vital when considering treatment for low back and leg pain.

You should immediately book an appointment with a doctor if you experience pain or numbness in your buttocks or legs that lasts more than a few weeks. Your doctor appointment will include a review of your medical history, your symptoms, any illness, injury, or surgery.

A physical exam might take place as well, in which you will be going through a range of movements to tell what positions cause pain. The doctor might also order you to get blood tests or X-rays done. Moreover, some other tests that can help pinpoint the cause of your pain are:

  • CT scan
  • MRI
  • Nerve blocks
  • Discography
  • Myelogram
  • EMG
  • Bone scans
  • Ultrasound imagining

Treating Piriformis Syndrome

Several stretches for the piriformis, hamstrings, and hip extensors play a big part in healing the painful symptoms along the sciatic nerve and return the patient’s range of motion.

Piriformis Muscle Release (Stretches)

There are many ways to release one’s piriformis muscle. Two simple ways include:

Lie on the back with both feet flat on the floor and make sure both knees are bent. Pull the right knee up to the chest and grasp it with the left hand. Then pull the knee towards the left shoulder and hold the stretch. Afterward, repeat for each side.

Lie on the back with both feet flat on the floor while both knees bent. Rest the ankle of the right leg over the knee of the left leg. Pull the left thigh toward the chest and hold the stretch. Repeat for each side.

Each piriformis stretch should be held for 5 seconds to start and then gradually increased to hold for 30 seconds and repeated three times each day.

Physical Therapies

In addition to basic stretching, physical therapies or exercise programs also help, depending on the patient’s situation.

A physical therapist, physiatrist, chiropractor, or qualified health practitioner can develop a customized program for stretching and range of motion exercises to help stretch the muscle and decrease spasms.

Deep Massage Therapy

Deep massage therapy (manual release) is also a way of treating piriformis syndrome. A qualified specialist can enhance healing by increasing blood flow to the area and decreasing muscle spasms.

Heat Therapy 

Lastly, placing a heating pad on the painful area for up to 20 minutes is helpful when it comes to treating piriformis syndrome. However, avoid falling asleep on a heating pad, as this may lead to skin burns.

Treating serious cases

In some severe cases of piriformis syndrome, you may need injections of corticosteroids to help relieve inflammation of the muscle. A local anesthetic and corticosteroid may be injected directly into the piriformis muscle to help decrease the spasm and pain. The purpose of the injection is usually to reduce acute pain to enable progress in physical therapy.

Preventing Piriformis Syndrome

We can easily prevent this syndrome by making few additions to our daily routine, as this is an uncommon diagnosis. We know that vigorous workouts can sometimes cause piriformis syndrome but working out on a regular basis can help reduce your risk since muscles need exercise to stay strong and healthy. You can also start making these habits to further prevent this syndrome

  • warm-up and stretch before you run or engage in a vigorous workout
  • frequently getting up and moving around so you’re not sitting or lying down too long without some activity

Conclusion

Piriformis syndrome is an uncommon condition. It can be treated with some rest and physical therapy, just stay active and healthy.