Piriformis Syndrome

Piriformis syndrome refers to sciatica symptoms not originating from spinal nerve roots and/or spinal disk compression, but involving the overlying piriformis muscle.

In 15-30% of the population the sciatic nerve passes through the piriformis muscle, rather than underneath it. These people have been reported by some studies to have a greater incidence of piriformis syndrome than does the general population. The piriformis muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle

Inactive gluteal (buttock) muscles can lead to piriformis syndrome. A major cause for inactive gluteals is when someone sits with hips flexed, as in sitting all day at work. This deprives the gluteals of activation, and the synergists (helpers) to the gluteals (hamstrings, adductor magnus, and piriformis) then have to perform extra roles they were not designed to do. The resulting spasm of the piriformis produces the typical symptoms.

Overuse injury resulting in piriformis syndrome can result from activities performed in the sitting position that involves strenuous use of the legs as in rowing/sculling and bicycling.

Runners, bicyclists and other athletes engaging in forward-moving activities are particularly susceptible to developing piriformis syndrome if they do not engage in lateral stretching and strengthening exercises.

Treatment

When piriformis syndrome is caused by weak abductors combined with tight adductors, a highly effective and easy treatment includes stretching and strengthening these muscle groups. An exercise regimen targeting the gluteus medius and hip adductor muscle groups can alleviate symptoms of piriformis syndrome within days.

The spasm of the piriformis muscle can be reduced by massage, deep compressive muscle inhibition (using the elbow).

Dry needle medical acupuncture can reduce the muscle spasm.

Muscle energy hold release treatment can stretch the piriformis.

Together these methods are usually effective in reducing the spasm in the piriformis and releasing the entrapped sciatic nerve. Patient will often enjoy a quick recovery from what initally apears to be a more serious type of nerve injury mimicing a herniated disc.

Generally, conditions of this type are referred to as nerve entrapment or as entrapment neuropathies;