• Robin R Varghese, PT.

Pain in the Butt!!!!! Is the pain in your gluteal area bothering you?

Piriformis Syndrome


Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

The piriformis muscle is a small pear or fan shaped muscle located deep in the buttock (behind the gluteus maximus).

Piriformis and Sciatic nerve

The Piriformis muscle or PM is functionally involved with external rotation, abduction and partial extension of the hip.

The sciatic nerve generally exits the pelvis below the belly of the muscle; however, many congenital variations may exist.

The relationships between the PM and sciatic nerve have been classified using a six category classification system. An anomalous relationship would be labelled between type ‘‘B’’ through type ‘‘F’’ since type ‘‘A’’ is considered to have a normal relationship between the PM and the sciatic nerve

Variations in the relationship of the sciatic nerve to the piriformis muscle shown on the diagram above:

a) The sciatic nerve exiting the greater sciatic foramen along the inferior surface of the piriformis muscle; the sciatic nerve splitting as it passes through the piriformis muscle with the tibial branch passing;

d) The entire sciatic nerve passing through the muscle belly;

c)Superiorly

d)The entire sciatic nerve passing through the muscle belly;

e) The sciatic nerve exiting the greater sciatic foramen along the superior surface of the piriformis muscle. The nerve may also divide proximally, where the nerve or a division of the nerve may pass through the belly of the muscle, through its tendons or between the part of a congenitally bifid muscle.


Causes of Piriformis Syndrome

  • Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip.

  • Tightening of the muscle, in response to injury or spasm.

  • Swelling of the piriformis muscle, due to injury or spasm.

  • Bleeding in the area of the piriformis muscle.

  • Types of Piriformis syndrome

1.Primary

Primary piriformis syndrome has an anatomical cause, with variations such as a split piriformis muscle, split sciatic nerve, or an anomalous sciatic nerve path

2. Secondary

Secondary piriformis syndrome occurs as a result of a precipitating cause, including macrotrauma, microtrauma, ischemic mass effect, and local ischemia.

Clinical diagnosis is made by various clinical tests like Pace test, FAIR test, the Frieberg sign, Beatty’s maneuver, Hughes test and Hip abduction test.


Symptoms

Pain in the gluteal region

Shooting, burning, or aching down the back of the leg.

Numbness in the buttocks

Tingling sensations along the distribution of the sciatic nerve.

Gluteal atrophy, as well as shortening of the limb on the affected side.

In chronic cases, muscle hypotrophy is present in the affected extremity.


Treatment


Conservative

Treatment includes short-term rest (not more than 48 hours),

muscle relaxants,

NSAIDs

Physical therapy

In some patients, injection of steroids around the piriformis muscle may help decrease the inflammation and pain.


Surgery is the last consideration in patients with piriformis syndrome. It should only be considered in patients who have failed conservative therapy, including physical therapy. The surgery may help decompress the nerve if there is any impingement.


Physical therapy interventions include

  • Ultrasound

  • hot packs or cold spray

  • lumbar spine treatments.

  • Correction of faulty movement patterns.

  • Stretching the piriformis muscle by applying manual pressure to the muscle’s inferior border. It is important not to press downward, rather directing pressure tangentially, toward the ipsilateral shoulder, thereby weakening the muscle’s grip on the sciatic nerve and relieve the pain of the syndrome. There are various ways of stretching the muscle, which your physical therapist will be acquainted with.

  • Myofascial release at the lumbosacral paraspinal muscles after stretching and

  • McKenzie exercises has proved to show great results

  • Hip muscle strengthening program especially of the weak gluteal musculature with movement re-education can help in pain relief.

  • Your therapist will also provide you with tips to avoid aggravating you complaints and teach and equip you with Home Exercise Programs (HEPs) that will serve you a long way.

We are equipped with Physical therapists who are experts in identifying the cause of your hip or gluteal pain, and in treating them successfully; as we at Valley Healing Hands provide the best physical therapy at Brownsville, Texas for Piriformis syndrome or gluteal pain due to muscle spasm.


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