PIRIFORMIS SYNDROME

Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Who is having or maintaining wrong postures they can get this Piriformis syndrome.

Causes

It is usually overuse which causes the pirofirmis muscle to go into spasm resulting in pressure on the sciatic nerve. The piriformis muscle is one of the small muscles deep in the buttocks that rotates the leg outwards. It runs from the sacrum bone at the bottom of the spine and attaches to the thigh bone or femur roughly near the outside crease of the buttocks. The sciatic nerve runs very close to this muscle and in around 10% of the population it actually passes straight through the muscles fibers. If the piriformis muscle becomes tight it can compress the sciatic nerve and cause pain which can radiate down the leg, commonly known as sciatic pain.

It has been suggested that this condition would be better referred to as piriformis impingement due to the impingement of the sciatic nerve. A common cause of piriformis syndrome is tight adductor muscles on the inside of the thigh. This means the abductors on the outside cannot work properly and so put more strain on the piriformis muscle.

Pathophysiology

The piriformis muscle is flat, pyramid-shaped, and oblique. This muscle originates to the anterior of the S2-S4 vertebrae, the sacrotuberous ligament, and the upper margin of the greater sciatic foramen. Passing through the greater sciatic notch, the muscle inserts on the superior surface of the greater trochanter of the femur. With the hip extended, the piriformis muscle is the primary external rotator; however, with the hip flexed, the muscle becomes a hip abductor. The piriformis muscle is innervated by branches from L5, S1, and S2. A lower lumbar radiculopathy may cause secondary irritation of the piriformis muscle, which may complicate diagnosis and hinder patient progress.

Many developmental variations of the relationship between the sciatic nerve in the pelvis and piriformis muscle have been observed.  In approximately 20% of the population, the muscle belly is split, with 1 or more parts of the sciatic nerve dividing the muscle belly itself. In 10% of the population, the tibial/peroneal divisions are not enclosed in a common sheath. Usually, the peroneal portion splits the piriformis muscle belly, although in rare cases, the tibial division does so.

Involvement of the superior gluteal nerve usually is not seen in cases of piriformis syndrome. This nerve leaves the sciatic nerve trunk and passes through the canal above the piriformis muscle.

Symptoms of Piriformis Syndrome

Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:

A dull ache in the buttock

Pain down the back of the thigh, calf and foot (sciatica)

Pain when walking up stairs or inclines

Increased pain after prolonged sitting

Reduced range of motion of the hip joint 

Symptoms of piriformis syndrome often become worse after prolonged sitting, walking or running, and may feel better after lying down on the back. 

What’s the Physiotherapy Treatment for Piriformis Syndrome?

After a thorough assessment of your back, pelvis and hips, your physiotherapist will determine the cause of your pain. Your physiotherapist will  tailor exercises and treatment according with your condition

Once your diagnosis is established, treatment could involve any of the following:

• Pelvis and spine re-alignment techniques(Postural correction exercises) 
• Joint mobilisation to restore normal joint mobility, range of motion and function 
• Electrotherapy to help decrease pain and spasm in your piriformis and increase blood flow plus soft tissue extensibility.
• Stretching program for muscle length and flexibility, mainly piriformis, hamstring and addctor muscles
• Dry Needling to reduce muscle tightness around the buttock.
• Deep core stability and hip strengthening exercises to stabilise your hip, pelvis and spine.
• Foot orthotics or exercises, if indicated by your physiotherapist or podiatrist, to help restore foot and lower extremity alignment.

The therapist can also give several tips to avoid an aggravation of the symptoms. This includes:

Avoid sitting for a long period

Stand and walk every 20 minutes

Make frequent stops when driving to stand and stretch

Prevent trauma to the gluteal region

Avoid further offending activities.

Daily stretching is recommended to avoid the recurrence of the piriformis syndrome.

• The patient can also perform several exercises and treatments at home including:
  • Rolling side to side with flexion and extension of the knees while lying on each side
  • Rotate side to side while standing with the arms relaxed for 1 minute every few hours
  • Take a warm bath
  • Lie flat on the back and raise the hips with your hands and pedal with the legs like you are riding a bicycle
  • Knee bends, with as many as 6 repetitions every few hours. So do treatment according to your physiotherapists decision, It will make you get recover soon. thanking you