What is Piriformis Syndrome?
If you are experiencing hip, buttock, hamstring or sciatic pain, you may be suffering from Piriformis Syndrome.
It’s a disorder that occurs when your sciatic nerve is compressed and irritated as it passes deep through your buttock, resulting in pain and/or numbness down the leg.
Sometimes the condition is called ‘pseudo sciatica’, as it is often confused with pain in the nerve resulting from a low back disc bulge.
Your diagnosis of piriformis syndrome should be made after a spinal nerve root compression (e.g. disc bulge) has been eliminated as a cause of your sciatica symptoms.
Where is your Piriformis Muscle?
What are the Symptoms of Piriformis Syndrome?
You may experience one or more of the following symptoms:
- Pain is usually felt in one buttock – but you may experience radiation of pain down the back of the leg (sciatica).
- Pain aggravated by prolonged sitting or activities that stress the piriformis muscle.
- To avoid pain and pressure on the area, you may sit lopsided with your sore buttock tilted up.
- Sometimes, you’ll walk with the foot turned out due to shortening of the piriformis muscle.
What Causes Piriformis Syndrome?
Piriformis syndrome is most commonly caused by overworking your piriformis muscle or decreased space in the buttock area, which compresses the muscle and nerve.
The main reasons that the piriformis muscle overworks are:
- Protection or dysfunction of the adjacent SIJ or hip joints
- A weakness of your deep hip stability muscles
- Overpronating feet
Decreased space to the buttock area is most commonly due to:
- Hypertrophy of other buttock muscles
- Inflammation from the sciatic nerve or piriformis muscle itself.
- After trauma to the buttock area.
How is Piriformis Syndrome Diagnosed?
In most cases, a clinical examination excludes a potential lumbosacral spinal pathology.
Your physiotherapist performs clinical tests that potentially irritate your piriformis or provoke sciatic nerve compressions. They will then interpret the findings. Some piriformis-related tests are the Freiberg, the Pace, the FAIR, the HCLK and Laseguese’s manoeuvres.
CT, MRI, ultrasound, and EMG are mostly useful in excluding conditions that could replicate piriformis syndrome. Electromyography (EMG) can show sciatic nerve compression but only in cases of chronic piriformis syndrome.
What’s the Treatment for Piriformis Syndrome?
After a thorough assessment of your back, pelvis and hips, your physiotherapist will determine the cause of your pain.
Once diagnosed, your treatment could involve any of the following:
- Pelvis and spine re-alignment techniques.
- Joint mobilisation to restore normal joint mobility, range of motion and function.
- Massage or electrotherapy to help decrease any pain or piriformis spasm. They also help to increase blood flow and soft tissue extensibility.
- Stretching program for muscle length and flexibility
- Acupuncture or Dry Needling to reduce muscle tightness around the buttock.
- Deep core stability and hip strengthening exercise to stabilise your hip, pelvis and spine.
- If indicated by your physiotherapist or podiatrist, foot orthotics or foot arch exercises help restore foot and lower extremity alignment.
What’s Your Prognosis for Piriformis Syndrome?
Piriformis syndrome responds favourably in the vast majority of cases. Short-term symptoms usually reverse within a few days. Long-standing symptoms may take a few weeks to address the biomechanical and muscle habits predisposing you to the injury.
Only rarely will surgery be required.
For more advice about Piriformis Syndrome, please seek the professional advice of your physiotherapist.
Common SIJ & Buttock Pain Sources
The following conditions may cause buttock pain or SIJ issues.
- Piriformis Syndrome
- Poor Hip Core Control
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
Lateral Hip Pain
Article by John Miller
SIJ & Buttock Pain Treatment Guidelines?
While SIJ and buttock pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
PHASE I - SIJ Pain Relief & Joint Protection
While pain relievers or anti-inflammatory medications are often prescribed for acute SIJ dysfunction, they will not address the actual cause of SIJ pain. A healthcare practitioner who has a comprehensive understanding of the biomechanics and muscular control of your SIJ, pelvis and hip complex should thoroughly assess chronic cases of SIJ dysfunction. Managing your sacroiliac pain is the main reason that most people seek treatment for sacroiliac joint dysfunction. In truth, it was the final symptom that you developed and should be the first symptom to improve in most cases. If this is the case, the prevention of a recurrence becomes your priority.
You can often achieve natural short-term pain relief using ice or heat packs applied to your SIJ's.
You are managing your inflammation. Sacroiliac joint inflammation is best eased via ice therapy and techniques or exercises that unload the inflammed structures. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen. Some seronegative arthritis conditions can predispose you to sacroiliitis. Your doctor can arrange special blood tests to assist in diagnosis in these conditions. Prolonged morning stiffness is a common complaint. See Ankylosing Spondylitis.
SIJ Protection & Support
Sacroiliac joint instability occasionally requires additional passive support until your muscles successfully control the joint. Supportive taping is often beneficial during the initial pain reduction phase.
SIJ Stability Belt
You may manage longer-term instability with a sacroiliac joint stabilisation belt. However, an exercise protocol to specifically address your SIJ issue usually is more effective.
If you have any questions, please seek the advice of your SIJ physiotherapist.
PHASE II - Restoring Normal ROM and Strength. Early Hip Core Exercises.
As your SIJ pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal pelvic joint alignment and normalising the dynamic muscle control that affects the SI Joints.
Your physiotherapist may commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. They will also implement a similar activation and strength program that addresses your deep gluteal muscles. These muscles are sometimes referred to as your hip core muscles. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for your specific needs.
PHASE III - Restoring Full Function
Your physiotherapist will turn their attention to restoring your normal pelvic alignment and maintaining sacroiliac joint range of motion during more functionally stressful positions. They will also work on your muscle power, proprioception, balance and gait (walking pattern). Depending on your chosen sport or activities of daily living, your physiotherapist will aim to restore your SIJ function to allow you to return to your desired activities safely.
Everyone has different demands for their sacroiliac joints that determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon. Your physiotherapist will tailor your sacroiliac joint rehabilitation to help you achieve your own functional goals.
PHASE IV - Preventing a Recurrence
Sacroiliac joint dysfunction does tend to return if a thorough muscle control program is not undertaken. The main reason it is thought to be chronic and specific muscle weakness. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely or periodically.
In addition to your muscle control, your physiotherapist will assess your SIJ, spine, hip and lower limb biomechanics and correct any deficits that may predispose you to SIJ pain and dysfunction. Fine-tuning and maintenance of your sacroiliac joint stability and function are best achieved by addressing deficiencies and learning self-management techniques. Your SIJ physiotherapist will guide you.
More information: SIJ Pain & Dysfunction
Common Causes of Hip & Groin Pain
Hip Joint Pain
- Hip Arthritis - Hip Osteoarthritis
- Hip Labral Tear
- Hip Pointer
- Femoroacetabular Impingement - FAI
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
Lateral Hip Pain
Adductor-Related Groin Pain
Pubic-Related Groin Pain
Inguinal-Related Groin Pain
- Inguinal hernia
- Sportsman's hernia
Iliopsoas-Related Groin Pain
- Hip Flexor Strain
Other Muscle-Related Pain
- Piriformis Syndrome
- Muscle Pain -Muscle Strain
- Poor Hip Core
- DOMS -Delayed Onset Muscle Soreness
- Core Stability Deficiency
Common Sources of Spinal Pain & Injury
- Neck Pain - Cervical Spine
- Upper Back Pain - Thoracic Spine
- Lower Back Pain - Lumbar Spine
- Sacroiliac Pain - SIJ
- Scheuermann’s Disease
- Spinal Stenosis
- Rib Stress Fracture
Nerve-related / Referred Pain
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques, education and advice. Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly skilled in prescribing the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential pilates, yoga and exercise physiology components to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports & Exercise Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstations set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please get in touch with your PhysioWorks team.