Physiopedia Piriformis

[Vickiana Sconyers]

Thetruth is, piriformis syndrome is very rare (if it even exists), and I am not convinced how likely piriformis syndrome is to exist. Having said that, it is a well-known diagnosis and commonly advised to patients with sciatica.

There is however one major flaw with this diagnosis, why do we not see it on a scan such as an MRI scan? Ultimately because sciatica is most commonly caused from a trapped nerve in the back, and not at the piriformis. However, there are research articles supporting piriformis syndrome, as a recently interviewed physiotherapist sent me after I failed his interview for what I can only describe as this physio talking nonsense.

1. Foam roller Glute and Piriformis Stretch: Lay a 4 inch (10cm) diameter foam roller on the floor. Lie on the roller so the roller is situated under your buttocks. Bend your knees. Simply lie there and move the roller backward and forward to create a stretch to the buttock (gluteal) muscle. Its normal for your back to arch slightly. Progress to a 6 inch (15cm) diameter roller.

2. Spikey Ball Piriformis Stretch: Sit down on the floor, and place a spiky ball under your right buttock. Straighten your right leg, while your left leg remains bent. Use your hands to support your body, and to control movement over the ball in a circular direction. You will feel the ball massaging deep into your gluteal (buttock) muscles.

3. Glute Stretch Lying: Lie on your back, and bend your knee to 90 degrees (i.e. pointing straight up). Place your ankle across your knee. To make the stretch stronger, pull your ankle towards you, while pushing away with the opposite knee (the side getting stretched). You should feel a stretch in your bottom.

5. Modified Pigeon Stretch: Adopt the four point kneeling position, and bring your knee under your body, resting against your stomach, while your leg turns inwards. Now slowly lean forwards to create a stretch in the buttock muscle. Place your opposite leg to an Oblique angle to the side. Hold this position, and when you are ready, come back to the start position. Alternate each side. This will stretch your piriformis muscle.

Whatever your view is on piriformis syndrome, doing exercises like the ones mentioned above can help relieve pain in your button, and can feel good to stretch. They can also help improve mobility in your hip and lower back. Overall, doing exercises can help most musculoskeletal conditions so try them to see if they help you.

If you are a therapist and like the exercises and information in this document, please go to www.rehabmypatient.com and sign up to this amazing exercise prescription software. If you are a patient and need some advice, treatment or a consultation, please go to www.surreyphysio.co.uk/bookonline. We provide virtual and face-to-face appointments with our expert team.

When refering to evidence in academic writing, you should always try to reference the primary (original) source. That is usually the journal article where the information was first stated. In most cases Physiopedia articles are a secondary source and so should not be used as references. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article).

Piriformis is a flat muscle and is one of the hip lateral rotators. The origin is on the anterior side of the sacrum and has an insertion at the superior aspect of the greater trochanter of the femur. The piriformis muscle is running over the top of the sciatic nerve. This muscle has the function of external rotation, abduction, and extension in the hip and it also plays an important role to stabilize the hip joint. The piriformis muscle is innervated by the direct branches from the sacral plexus (L5-S2).

Sciatic nerve or also named as N. Ishiadicus passes behind the hip joint to the muscles lying underneath. Above the knee joint, the sciatic nerve splits into two branches: Tibialis nerve and the Common Peroneal nerve. The sciatic nerve passes over or under the piriformis muscle but it is also possible that the sciatic nerve passes, partially or whole, through the piriformis muscle. This depends from person to person.

The piriformis test is used to screen the piriformis muscle and to detect tightness of the muscle or other discomforts of the sciatic nerve as it passes through or under the Piriformis muscle. Because this is a muscle and neurological test.

The patient may complain of pain in the piriformis muscle region or the gluteal region, The pain may increase suddenly and there could also be a pain in the posterior aspect of the thigh. This indicates that the pain is because of the piriformis muscle tightness and the sciatic nerve is not directly involved by the lumbar disc herniation. There could be pain in the buttock and throughout the course of the sciatic nerve that is the posterior part of thigh and leg then this indicates that the sciatic nerve has become pinched by the piriformis muscle. The positive result of the test indicates Piriformis syndrome. Although the pain could be because of both the piriformis muscle and a lumbar disc herniation which can be identified by performing the Straight Leg Raising Test. The Freiburg sign also stretches the piriformis muscle where, in the supine lying position, the hip is passively medially rotated and extended. There is burning pain felt in the gluteal region and also throughout the course of the sciatic nerve signalling that the sciatic nerve has been irritated by the pinching of the piriformis muscle. This is also an indication of Piriformis syndrome.[3] In this syndrome, we speak of pain or numbness in the buttock and posterior thigh with occasional radiation into the foot. Another possible cause for the clamping of the sciatic nerve are trigger points in the piriformis muscle.

The piriformis test has been proved to be reliable and valid as a clinical test for sciatic nerve entrapment in the gluteal region by a study conducted by Hal D. Martin et al.[4] There are other combination studies also available that determines the piriformis test is reliable and valid for the diagnosis of Piriformis syndrome.

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Piriformis syndrome is a fairly uncommon condition in which the piriformis muscle, located in the buttock region, causes buttock pain. The piriformis muscle compresses and irritates the sciatic nerve which can cause pain, numbness and tingling along the back of the leg and into the foot.

The piriformis can be a large generator of pain and also be very sensitive due to its close proximity with the sciatic nerve. It usually happens on just one side of your body, but can sometimes occur on both sides concurrently.

It is important to mention at this point that most buttock and leg pain is not due to piriformis syndrome and is far more likely to be related to your lower back or hip joint. The most common cause of buttock and leg pain is due to irritation of the sciatic nerve by a disc in the lower spine, more specifically the region known as the lumbar spine.

The piriformis muscle is a fairly small, flat, triangular shaped muscle, located deep in the buttocks near the top of the hip joint. It starts at the lower spine (sacrum) and connects to the upper surface of the femur (thighbone).

The piriformis muscle is important in almost all lower body movements. This is because it stabilises the hip joint, assists in lifting and rotating the hip and helps turn the leg and foot outward. This enables us to walk and maintain our balance as we shift our weight from one foot to the other.

The sciatic nerve is thick and is the longest nerve in the body. It travels from the spinal cord in your lower back and typically passes underneath, or, in some people, through the piriformis muscle. It then continues down the back of the leg and eventually branches off into smaller nerves that end in the feet.

The piriformis gets a workout every day; any movement or activity that requires us to stand or move our legs will activate our piriformis muscle. However when the muscle is overused or put under excessive stress or load, it can go into spasm.

A typical patient with piriformis syndrome complains of sharp, severe, pain in the buttock, with radiating symptoms down the back of the leg and into the thigh, calf, and foot. These symptoms often become worse after prolonged sitting, walking or running long distances, and may feel better when lying down on your back.

Therefore, piriformis syndrome is normally a diagnosis of exclusion, where all other conditions are ruled out. Piriformis syndrome mimics other, potentially more common conditions, such as intervertebral disc issue, sacral joint dysfunctions, trochanteric bursitis, femoroacetabular impingement and proximal hamstring pain.

A quick and accurate diagnosis is vital in order to ensure the condition does not lead to more chronic dysfunction and compensatory changes. Our physiotherapists at Complete Physio are highly skilled diagnosticians, who will be able to assess and recognise signs and symptoms that are unique to piriformis syndrome, therefore enabling the best and most appropriate treatment.

At your initial assessment your expert physiotherapist will take you through a clinical interview, to build up a picture of your pain and symptoms. They will ask questions about your past health, progression of symptoms and what aggravates and eases your pain, as well as what your normal daily activities and exercise routine is.

After your consultation, the specialist will complete a series of clinical tests and a physical examination to help develop a diagnosis. This may include:

This process is often all that is required to make a diagnosis of piriformis syndrome. However where symptoms are chronic or if the diagnosis is still unclear, specialist imaging/scans may be required to fully confirm the diagnosis and exclude other causes or pathology.

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