Piriformis syndrome

8/11/2018

Piriformis syndrome is a condition which is believed to result from compression of the sciatic nerve around the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. Often symptoms are worsened with sitting or running.

Causes may include trauma to the gluteal muscle, spasms of the piriformis muscle, anatomical variation, or an overuse injury. Few cases in athletics, however, have been described.

Signs and symptoms
The signs and symptoms include gluteal pain that may radiate down buttock and the leg, and that is made worse in some sitting positions.
Pathophysiology
When the piriformis muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Generally, conditions of this type are referred to as nerve entrapment or as entrapment neuropathies; the particular condition known as piriformis syndrome refers to sciatica symptoms not originating from spinal roots and/or spinal disc compression, but involving the overlying piriformis muscle.
It has been theorized that people who regularly exercise by running, bicycling, and other forward-moving activities may be more susceptible to developing piriformis syndrome if they do not engage in lateral stretching and strengthening exercises. When not balanced by lateral movement of the legs, repeated forward movements can lead to disproportionately weak hip abductors and tight adductors.

Treatment
Conservative treatment usually begins with stretching exercises, myofascial release, massage, and avoidance of contributory activities such as running, bicycling, rowing, heavy lifting, etc. Some clinicians recommend formal physical therapy, including soft tissue mobilization, hip joint mobilization, teaching stretching techniques, and strengthening of the gluteus maximus, gluteus medius, and biceps femoris to reduce strain on the piriformis.