The Piriformis Muscle and Its Syndrome

The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum (lower region of the spine) to the top of the femur (thigh bone) and aids in external rotation (turning out) of the hip joint.

As you can see from the diagram to the right, there are many muscles and tendons that make up the hip and buttocks region.
The diagram shows the posterior (rear) view of the buttock.
The piriformis is the horizontal muscle in the center of the picture running over the top of the sciatic nerve.

What Causes Piriformis Syndrome?
Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

• Exercising on hard surfaces, like concrete;
• Exercising on uneven ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise intensity or duration too quickly;
• Exercising in worn out or ill fitting shoes; and
• Sitting for long periods of time.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

• Poor running or walking mechanics;
• Tight, stiff muscles in the lower back, hips and buttocks;
• Running or walking with your toes pointed out.

Symptom of Piriformis Syndrome
Pain (or a dull ache) is the most common and obvious symptom associated with piriformis syndrome. This is most often experienced deep within the hip and buttocks region, but can also be experienced anywhere from the lower back to the lower leg.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of piriformis syndrome. Even tingling and numbness in the legs can be experienced.

Piriformis Syndrome Treatment
Piriformis syndrome is a soft tissue injury of the piriformis muscle and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.