Do you have Sciatica?
It could be Piriformis Syndrome!
The common complaint “Sciatica”can often be misdiagnosed and can be Piriformis Syndrome. A condition easily treated by Physiotherapists.
Pain is commonly in the buttocks and can refer pain into the lower spine, along the back of thigh and down the course of the sciatic nerve down the leg.
Anatomy of the region
- The Piriformis muscle is deep to the gluteal muscles
- It comes from the sacral spine (posterior) and attaches to the greater trochanter (the bony part of your hip)
- It rotates the hip outwards and abducts the hip(lifts it out to the side)
- And in fact the sciatic nerve passes under the piriformis muscle- so its very close to it!
- In 15 % of the population the Sciatic nerve passes through the Piriformis muscle!
Causes
- Overuse or strains in the muscle
- Acute/ chronic injury can cause the muscle to swell and so irritate nerve
- Inactive gluts/extensors
- As stated in 15 % the sciatic nerve passes through muscle
What actually happens in the tissues? (pathophysiology)
- Abnormal mobility of the sacroiliac joint can cause compensatory changes in gait, and altered piriformis activity.
- Injury could cause hematoma (bruising) formation and can cause scaring over the muscle and therefore cause thickening around the sciatic nerve.
- Over pronation of foot causes the knee to rotate medially so the piriformis activates to prevent this (as it’s a lateral rotator) – making it tight and overused
- Hypertrophy if the muscle is overused, or has to play a role it’s not used to especially due to prolonged sitting, inactivation of gluts so piriformis compensates for this.
So, what can Physiotherapists do?
Treatment options:
- Specific Stretching of piriformis- into medial rotation and adduction
- Can also stretch hamstrings and other hip muscles
- Deep tissue Massage and Trigger point release
- Dry needling
- Joint mobilisations and manipulations to restore more normal movement
- Strengthen core muscles to reduce strain on piriformis
- Ice- useful immediately after activity (eg. climbing stairs)
- Ultrasound- speeds up healing
- Gait (walking/running) correction- for less use of piriformis so it can relax-over pronation of foot must be corrected
- If these fail- injection of corticosteroids into the muscle (anti-inflammatory)
Prognosis
- Good if…Appropriate treatment is performed and things like gait and other functional problems are corrected.
