Piriformis Syndrome

One of the most common complaints that chiropractors address is sciatica. Sciatica is the term used to describe the pain occurring along the path of the sciatic nerve. The sciatic nerve is the largest nerve in your body and travels from the lower back down through the buttocks and along the back of each leg. The most commonly perceived cause of sciatic pain is pressure to the sciatic nerve via a herniated disc (also referred to as a bulging disc, ruptured disc, or slipped disc). However, there is a muscular problem which causes sciatic or leg pain. This condition is called Piriformis Syndrome. Piriformis syndrome is quite common and is often misdiagnosed because it can mimic other problems such as disc herniations. The good news is that once diagnosed, the prognosis is quite good.

What is the piriformis?

This is a tiny muscle located deep in the buttock, underneath all the Glute muscles. This muscle is responsible for external rotation of the hip. (If you would like an illustration of what an externally rotated hip feels like, lie on your back with your feet pointed towards the ceiling and rotate your foot outwards to the side.) As the sciatic travels down the leg from the spine it passes underneath the piriformis muscle. Problems arise when this muscle becomes tight because it will often compress the sciatic nerve resulting in pain into the distribution of the nerve, hence sciatica.  
    

The signs and symptoms of piriformis syndrome are not only specific to pain down the leg but may include a deep aching pain in the buttock and thigh on the affected side and low back pain. The pain usually does not travel beyond the knee. The condition is often aggravated by activities such as sitting, squatting, or walking. It tends to be more common in females.

What can be done?

Since the condition arises due to a tight muscle one must stretch the piriformis. An easy way to stretch this muscle can be achieved while in the seated position. To stretch the right piriformis cross your right leg over your left knee as in a figure 4 position. Next lean your body forward. As you lean forward you will feel a stretch at the buttock area. Hold this for 30 seconds. Most patients find relief from stretches alone. If stretching is not enough, then there may be other issues such as improper pelvic and foot mechanics. The pirifomis muscle is attached to the sacrum, thus poor pelvic mechanics will directly influence this muscle. Fortunately, this can be easily rectified by specific chiropractic adjustments, postural changes, and/or orthotics.