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Piriformis Syndrome

  1. What is it?
    • It is the compression of the sciatic nerve by the piriformis muscle.
  2. Cause
    • Nerve penetration of the piriformis muscle
    • Trauma
    • Overuse of the piriformis : tightness of the piriformis muscle
    • Trigger points
    • Postural problem : hyperlordosis, pes planus
  3. Symptoms
    • Pain in the buttocks
    • Tingling or numbness in the buttocks
    • Sensation of pins and needles pricking
    • Numbness or tingling down to the leg
  4. Objective information
    1. Observation
      1. excessive external rotation of the leg
    2. Palpation
      1. Trigger points : along the sacrum or medial to the greater trochanter
      2. Contracted muscles : Gluteals, piriformis
    3. Orthopedic test
    1. Differentiating Assessment
      1. Compression of the nerve at the lumbar spine
      2. Lumbar spine stenosis
      3. Facet joint irritation
  5. Treatment plan
    1. Massage Contraindication
      1. 10 days after a cortisone injection
      2. Avoid compression of the sciatic nerve when massaging the buttocks ( Be careful when using the elbow on the gluteal area)
    2. Hydrotherapy : deep moist heat or heat
    3. Fascial techniques : gluteal area
    4. Friction : distal tendon of piriformis
    5. Trigger points work : piriformis trigger points work
    6. Joint play : posterior glide on hip joint to increase internal rotation
    7. Stretching to Piriformis
      1. PNF
      2. Passive stretching
    8. Self care
      1. Remedial exercise
        1. Self stretch for piriformis
        2. Strengthening exercise for abductors
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