This quarter we are looking at the Piriformis muscle, and how it can affect the sciatic nerve.

Piriformis

Piriformis (meaning pear-shaped) is a muscle in the gluteal region of the lower limb. It is one of the six muscles that laterally (to the side) rotate the hip. Its function is to rotate the femur when the hip is extended and abduct (away from the midline) the femur when the hip is flexed.

The Sciatic Nerve

The sciatic nerve is the longest and widest single nerve in the human body. It begins in the lower back and runs through the buttocks and down the posterior aspect of the lower limb to the foot.

The piriformis can sometimes irritate the sciatic nerve as it runs into the gluteal region beneath the muscle.

Piriformis Syndrome – compression of the sciatic nerve

The cause of the problem is not always known, but we do know that the following circumstances can contribute:

• Irritation of the muscle causing spasm.
• Tightening of the muscle in response to injury.

The symptoms experienced vary, but patients have described:

• A dull ache in the buttock.
• Pain down the back of the thigh.
• Increased pain after prolonged sitting.
• Pain when walking up stairs.
• Decreased range of motion in the hip joint.

Let’s look at an example …

Joe arrives at the clinic complaining of pain in his buttock which radiates down the outside of his right leg. The pain is burning in character and related to activity. He has seen his GP who diagnosed sciatica and he was sent for an MRI of his lower back. Joe came away disappointed as the scan result was negative.

He is examined by an osteopath who finds full range of movement in his lumbar spine; however, when the practitioner presses on the piriformis muscle at the right hip joint the symptoms were reproduced down his right leg.

A diagnosis of piriformis syndrome is made, and Joe’s osteopath chooses to inhibit the muscle, and articulate the hip joint and pelvis to maintain the movement. This gives Joe immediate symptomatic relief.

Our duty is to find out why Joe’s piriformis has decided to tighten up and why it is only on the right hand side. To answer these questions Joes whole body biomechanics must be assessed.

We found that Joe’s right leg was slightly shorter than his left leg, and in an attempt to lengthen the leg, he constantly stimulates the piriformis which attempts to compensate for the difference. In addition, his right knee was slightly twisted inwards compared to his left and the piriformis is working harder in an attempt to reverse this condition.

Whilst inhibiting the piriformis itself gave instant relief, the symptoms would reoccur if the underlying maintaining factors were not addressed. Looking at the biomechanics of the whole lower extremity gave a much more permanent solution.

After four treatments Joe responded very well and visited us again following training for the Abbey Dash. He could feel a hint of symptoms coming back, as loading from the knee to the piriformis was amplified. Joe responded well to quick treatment and was back up and running.

You may also like to try …

• Massage – enhances healing by increasing blood flow to the area and decreases muscle spasm.
• Cold pack – 20 minutes, repeated every 2 to 4 hours.
• Heat therapy – you may find it helpful to alternate cold with heat.
• Acupuncture/dry needling – this has been shown to reduce muscle spasm and hypertonia, which in turn will reduce the pressure on the sciatic nerve.

 

If you would like to be seen by one of our practitioners or if you have any further questions, then please get in touch with us. You can call us on 0113 237 1173 or email info@goodhealthcentre.co.uk, and we will get back to you promptly.