Piriformis syndrome is a pain in the butt, literally. This condition is caused by compression of the sciatic nerve, which causes pain and numbness in the buttock and the back of the legs; so it is common to feel more pain when walking.
The piriformis is a small muscle that runs from the sacrum at the bottom of the spine to the top of the femur in the thigh. It is a very important muscle that helps to externally rotate the hip and is crucial for walking activity by providing stability to the sacrum and sacroiliac joint while moving.
What is piriformis syndrome?
The syndrome occurs when the piriformis muscle compresses the sciatic nerve, which runs under it. The sciatic nerves (you have two) are the longest and largest nerves in the body, traveling from the lower spine through the gluteus and down the legs to the feet. The function of the sciatic nerve is to send signals between the muscles and the skin of the legs and feet.
Like any muscle, the piriformis can shorten and tighten, which can cause it to squeeze or pinch the sciatic nerve. This causes the nerve to become irritated and inflamed. And, although it is not common in the general population, it affects more women than men.
Is it the same as sciatica?
Piriformis syndrome is not the same as sciatica, although the terms are often used interchangeably. Sciatica is not a medical diagnosis in itself; Rather, it is a collection of symptoms, similar to those of piriformis syndrome, caused by another problem, such as a lumbar disc herniation, that affects the sciatic nerve. Sciatica, or lumbar radiculopathy, originates in the lumbar spine, while piriformis syndrome originates in the buttocks.
What are the causes?
The sciatic nerve running through the piriformis muscle automatically increases the risk of nerve compression and piriformis syndrome. Overwork is the main reason for the syndrome. The piriformis muscle is overloaded when there is dysfunction, weakness, or poor mechanics in another area of the body to which it connects. For example:
- Sacroiliac or hip joint dysfunction
- Weakness of the deep stabilizing hip muscles
- Overpronation or collapsing arch of the feet
Muscle can also overwork due to prolonged bouts of physical activity, such as running a marathon.
Other causes of piriformis syndrome include:
- Muscle spasms caused by irritation of the piriformis muscle or a neighboring structure, such as the sacroiliac joint or hip.
- Piriformis muscle injury.
- Bleeding in the vicinity of the piriformis muscle causing irritation.
- Assume positions that externally rotate the legs for long periods of time.
- Hyperlordosis or an exaggerated lumbar curve.
As we said before, this syndrome affects more women than men due to the difference in body mechanics of a wider quadriceps muscle angle at the hip, which makes the joint angle wider.
Piriformis syndrome symptoms
Pain in the buttocks is the main symptom. You may also have pain that spreads down the back of your thigh and down your calf and foot. This can be accompanied by tingling and numbness in the buttocks.
Any movement that involves hip activity can aggravate the pain, so walking can be challenging and uncomfortable when you have the syndrome. Piriformis pain when walking may be worse when climbing stairs or an incline.
Other signs and symptoms include:
- Difficulty putting weight on the affected buttock.
- Piriformis muscle spasms.
- Shooting pain in the buttock and back of the leg when turning the hip outward against resistance.
- Pain that worsens when sitting.
How is it diagnosed?
A direct cause cannot always be identified, and there is no test for piriformis syndrome. Your doctor will take a history and ask questions about any injuries that may have caused your symptoms or the intensity and duration of your exercise activities.
He will also perform a physical exam, evaluating pain caused by certain movements. Radiological tests, such as MRIs, may be done to rule out other causes of the symptoms.
Exercises to recover from piriformis syndrome
The first line of treatment for piriformis syndrome is a physical therapy program, which includes specific exercises and stretches. These exercises should help reduce the pain of walking.
Because the causes of piriformis syndrome differ from person to person, the exercises your doctor or physical therapist recommends will be specific to you. However, some common examples include:
Piriformis stretch
Lie on your back with your knees bent and your feet flat on the floor. Bring your right knee inward and clasp your hands around the top of your shin. Pull your knee toward your shoulder and hold it for 30 seconds. Let go and switch sides.
Hamstring stretch
Lie on your back with both legs extended. Raise one leg and wrap a towel or strap around the sole of your foot. Keeping your leg extended, pull it until you feel a gentle stretch in the back of your leg. Hold for 30 seconds; then switch sides.
Griddle
Lie on your stomach with your forearms on the floor parallel to each other. Tuck in your toes and lift your hips so your body is in a straight line. Hold for 15 seconds, working up to 60 seconds. Repeat three times.
Side plank
Lie on one side supported on your elbow. Stack your feet on top of each other and lift your hips so that your body forms a straight line. Hold for 15 seconds, working up to 60 seconds. Change sides and repeat three times.
