What is Piriformis Syndrome?
The piriformis muscle is a small muscle, that when inflamed, can affect the sciatic nerve. This can lead to pain and decreased mobility, and needs to be treated by a doctor or orthopedic specialist. Taking certain preventative measures can help minimize the possibility of developing piriformis syndrome, such as supplementation with B-12.
The Piriformis Muscle
The piriformis muscle is a roughly pear-shaped, or pyramidal muscle in shape, that is located within the gluteal region of the body, near where the trunk connects to the lower limbs in humans. It is one of the muscles that forms the lateral rotator group. The muscle is relatively flat and generally runs parallel to a portion of the gluteus medius.
Understanding the piriformis origin and insertion, helps to understand its function. The piriformis muscle originates from the front portion of the sacrum, which is the lower portion of the spine, as well as from a portion of the greater sciatic notch. This muscle exits the pelvis via a foramen, or hole, known as the great sciatic foramen, and it inserts on the greater trochanter, a region of the femur, via a rounded tendon. The tendon of the piriformis muscle often joins up, with the ends of other muscles in the region, including the obturator internus, and inferior gemellus muscles. The piriformis muscle is positioned so that it lies partly within the pelvis, and partly at the back of the hip joint.
The piriformis action is largely related to its function as one of the lateral rotators of the hip. It works in conjunction with muscles, such as the quadratus femoris and obturator externus. The piriformis muscle rotates the femur laterally when the hip is extended, and it abducts the femur when the hip is flexed. This small muscle is important in walking, because abduction of the flexed thigh allows the body to shift its weight to the opposite side, from the foot that is being lifted when walking, which keeps you upright and not falling over. When your hip is flexed to 90 degrees or more, the piriformis reverses its primary function and internally rotates the hip.
Piriformis Syndrome and Diagnosis
You might be wondering what is piriformis syndrome. This uncommon syndrome is a neuromuscular disorder that occurs when the piriformis muscle actually compresses, and puts pressure on the sciatic nerve. Located near the top of the hip joint in the buttocks, this muscle helps to stabilize the hip joint, as well as lifting and rotating the thigh away from the body. It is a small but mighty muscle, when playing sports, as most activities require lifting, and rotating the thighs.
The sciatic nerve is one of the largest nerves in vertebrate animals such as humans. In fact, in people, this nerve is the single longest, and widest nerve, found within the body, and it runs from the top of the leg to the foot. This nerve provides innervation to most of the skin of the leg, as well as the muscles of the back of the thigh, leg, and foot.
The sciatic nerve runs alongside the piriformis muscle, or actually runs through the muscle belly, before it runs down the back of the leg, branching into smaller nerves in the feet. This nerve can be compressed when the piriformis muscle gets inflamed, or more commonly, when the piriformis muscle spasms.
When you develop piriformis syndrome, the most common initial signs are pain, or tingling, in the region of the buttocks, although some people have numbness. While the pain can be down part of the sciatic nerve, it most commonly extends down the length of the nerve, and can be quite severe. This is referred to as sciatica. The pain occurs because the piriformis muscle is compressing the nerve, such as occurs when sitting in a car seat for long periods of time, or running. Other triggers for pain in this area include when climbing stairs, or if applying firm pressure over the region of the piriformis muscle. The pain typically gets worse when you undergo an activity that causes the piriformis muscle to put pressure on the sciatic nerve, which is unfortunately many activities, including walking, climbing stairs, running, and sitting. It is important to note, that most cases of sciatica are not due to piriformis syndrome; it remains a relatively uncommon disorder in the scheme of things.
Unfortunately, there is no concrete test to determine if a person is suffering from piriformis syndrome. In most cases, a thorough history reveals that there has been a trauma to the site, prolonged sitting, or a repetitive and often vigorous activity, such as running for long distances. Diagnosis of the problem is usually made through a combination of taking a history, and a thorough physical exam. Physicians may evaluate a variety of movements, in an attempt for the patient to note pain over the piriformis muscle. At times, it is possible to palpate a contracted or tender piriformis muscle during an exam.
While taking a careful history, and performing a good physical exam are key to diagnosing piriformis syndrome, the symptoms can be similar to other disorders. As such, diagnostic testing may also be needed to rule out other potential causes of sciatic nerve compression. These potential disorders can include a herniated disc, which is usually much more severe than piriformis syndrome.
Piriformis Syndrome Treatment
If you are looking at ways of healing piriformis syndrome quickly, you are probably already in some level of discomfort. The immediate way to reduce pain from piriformis syndrome is avoiding positions, or activities, that exacerbate the discomfort. If your pain is triggered when you sit or run, you should try and avoid these activities while you are getting treatment. If you have to sit for a long period of time, such as at work or on an airplane, it is best if you take periodic breaks to carefully move around, such as walking down the aisles every hour or so.
Conservative management approaches to piriformis syndrome include rest, and applying ice or heat to the area that is uncomfortable. Generally you should start by applying a cold pack to the affected area for about 15 minutes at a time, several times each day for the first few days. Then you should use a warm pack, or a heating pad, for a few minutes several times each day. If the discomfort persists, you can alternate between using a cold pack, and a warm pack.
You can also take a pain reliever to decrease inflammation and discomfort of the piriformis muscle and its surrounding tissues. Some of the types of medication include a non-steroidal anti-inflammatory drug, also known as an NSAID. Examples of this include ibuprofen, which comes as generic, or Advil, as well as aspirin or naproxen, which is branded as Aleve. You can also take the pain reliever acetaminophen, which is the drug Tylenol. Remember to always speak with your physician about the different types of medications, and what you should take, before you take it, as some medications can have harmful side effects, especially in combination with other medications you may be on.
If the pain persists for several days, you should seek medical care with a physician, or a sports medicine specialist. They may prescribe different pain medications, or even muscle relaxers such as robaxin, or they may suggest treatment that involves massage therapy, or combining other treatment modalities such as exercises, to strengthen the area and reduce the compression of the sciatic nerve. Seeking care from a chiropractor or osteopathic specialist, can also help align the pelvis, and reduce discomfort and issues with the piriformis muscle.
Unfortunately, for many cases of piriformis syndrome, it can take weeks, or months of therapy, to reduce the pain and discomfort caused by the compression of the piriformis muscle on the sciatic nerve. More aggressive therapies include piriformis injections. Your healthcare provider may recommend an injection into the piriformis muscle, with a corticosteroid, or an anesthetic to help provide relief, which is injected at the point where the piriformis muscle meets with the sciatic nerve. Still other physicians perform botox injections. These piriformis muscle injections involve injecting botulinum toxin into the piriformis muscle, which makes use of the paralytic properties of the botulinum toxin. It is used to relieve muscle tightness, as well as sciatic nerve compression, which helps to minimize pain.
As a last resort, surgery may be warranted to treat people with piriformis syndrome that have not responded to other treatment modalities.
Preventing Piriformis Syndrome
Preventing piriformis syndrome usually involves practicing good form, and minimizing repetitive stress injuries, as most cases of piriformis syndrome are related to movement that stresses the piriformis muscle, including activities such as running or lunging.
When you are exercising, you should warm up properly before any activity. Especially if you have been having issues with your piriformis muscle, you should increase the intensity of your work outs gradually, rather than rapidly, so that your body has time to adapt to the activity.
When you are running, whether you have piriformis syndrome or not, you should minimize running on a slanted surface or hills, as well as avoiding uneven surfaces as much as possible. Running on these types of inclines or surfaces can stress the piriformis muscle, and tilt the pelvis in an abnormal position, making piriformis syndrome more likely to develop.
A main way to help prevent piriformis syndrome is to practice good posture at all times, whether you are sitting, running, walking, or exercising.
Your health care provider should be able to walk you through piriformis stretches to help your pain and discomfort. These stretches are generally designed to help with sciatica, and include resting on your back, pulling your thigh towards your chest, and holding the position for several seconds, repeating on the other side.
Piriformis massage can also be hugely beneficial to people suffering from piriformis syndrome. Some of the benefits include helping to relax the piriformis muscle, which can help reduce the pressure on your sciatic nerve, by preventing spasming. The massage can also prompt your body to release pain-relieving endorphins, which can help reduce your feelings of pain.
When you are moving, if pain starts, you should stop the activity and rest until the pain subsides. If pain continues to occur, you should seek the care of a health care provider, such as a physician, or a sports medicine practitioner.
Other methods of helping to prevent piriformis syndrome involve avoiding positions such as laying down, or sitting for long periods in a position that puts too much pressure on your buttocks, which can compress the sciatic nerve and cause piriformis syndrome. You should also avoid certain activities, such as not lifting by bending over. Instead, you should lift objects by bending your knees and squatting to get the object. When you lift, you should avoid twisting your body, which can put additional stress or strain on your back. In addition, to minimizing the risk of piriformis syndrome, lifting carefully can help minimize the possibility of developing back injuries.
Several supplements may also help with piriformis syndrome. Certain musculoskeletal disorders are a result of a Vitamin D deficiency, while lacking in Vitamin B-12 affects the body’s ability to heal itself. Calcium and magnesium are also important for proper functioning of the musculoskeletal system, with calcium allowing proper absorption of magnesium, which helps with a variety of chemical reactions within the body.
Questions to Ask Your Doctor About Your Pain
When dealing with pain that is likely piriformis syndrome, you should discuss all of your options with your physician. Talk to them about what the likely causes of your pain are, and if any tests are needed to confirm whether or not you are suffering from piriformis syndrome.
Definitely speak with your health care provider about exercise. Are there specific exercises that you should do, and is it safe to exercise without causing potential damage. Will activities such as yoga and stretches, or massage therapy, help relieve some of the discomfort. Finally, what are your options if the pain does not go away.
If you have pain from piriformis syndrome, it is important that you discuss your options with your health care provider. Stretching and health supplements can help prevent symptoms of piriformis syndrome, while treatment options include massage and medication therapy.
These statements have not been evaluated by the Food and Drug Administration. Products discussed are not intended to diagnose, treat, cure, or prevent any disease.