PIRIFORMIS SYNDROME
1. What is it?
The piriformis muscle is situated deep in the gluteal area and goes from the front edge of the sacrum to the greater trochanter of the femur. This muscle acts to rotate the leg away from the body. Anatomically, the sciatic nerve runs under the piriformis muscle. If the piriformis muscle becomes spastic or tight, the sciatic nerve can be irritated, creating a piriformis syndrome.
2. What are the causes/predisposing factors of injury?
A twisting or pivoting injury on the affected leg can irritate the piriformis muscle. Also, sitting cross-legged, having a functionally short leg from either foot hyperpronation or a posteriorly rotated pelvis can cause a piriformis syndrome. The latter problem is due to the piriformis muscle being overstressed as it tries to stabilize a rotated and tilted sacrum.
3. What are the symptoms?
An intense deep ache may be felt in the buttock and even travel all the way down into the foot. Exquisite tenderness can be experienced when the piriformis muscle is palpated. Resisted external hip rotation (trying to push bent knees apart, feet together) will be weak and painful.
4. What can be done to prevent or treat this injury?
Foremost, make sure if you pronate too much, you have proper footwear and/or orthotics. Also, attend to any dysfunctional lumbar spine and pelvis biomechanics by a combination of spinal manipulation, stabilization and strengthening exercises.
Specific treatment consists of deep soft tissue treatment, manipulative therapy, therapeutic muscle stretches and strengthening of the hip muscles.