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Piriformis Syndrome

Piriformis Syndrome causes pain in the buttock which radiates down the leg and is due to the Sciatic nerve being impinged by the piriformis muscle.

Piriformis syndrome symptoms

Symptoms of Piriformis syndrome include tenderness or pain in the buttock muscle. The pain may radiate down the back of the leg into the hamstring muscles and sometimes even the calf muscles. It is common for pain to initially be confused with a hamstring strain or hamstring origin tendinopathy. However there will be no area in the hamstrings which is tender to touch. Reduced range of motion of the hip joint, especially into internal hip rotation is often seen.

What is Piriformis Syndrome?

  • The piriformis muscle is one of the small muscles deep in the buttocks that rotates the leg outwards.
  • It runs from the base of the spine (the sacrum) and attaches to the thigh bone (femur) roughly where the outside crease in your bum is.
  • The sciatic nerve runs very close to this muscle and in some people (around 10% of the population) it passes straight through the muscles’ fibres!
  • If the piriformis muscle becomes tight it can put pressure on the sciatic nerve and cause pain which can radiate down the leg, commonly known as sciatic pain (seesciatica).
  • It has been suggested that this condition would be better referred to as piriformis impingement due to the impingement of the sciatic nerve.
  • A common cause of Piriformis syndrome is having tight adductor muscles (inside your thigh). This means the abductors on the outside cannot work properly and so put more strain on the Piriformis.

Piriformis Syndrome Treatment

What can the athlete do?

  • Apply heat therapy to relax the muscle. This should only be done if you are sure there is no acute injury.
  • Piriformis stretching exercises and other stretches for the external rotators of the hip joint should be done.
  • Stretch the groin (adductor) muscles.
  • Piriformis syndrome exercises to strengthen the muscle and hip abductors.
  • See a sports injury professional who can advise on treatment, rehabilitation and prevention.

What can a sports injury professional do?

  • Apply specific sports massage techniques.
  • Stretch the Piriformis muscle using Muscle Energy Techniques.
  • Apply ultrasound.
  • Advise on strengthening and rehabilitation to avoid injury recurrence.

Piriformis Syndrome Strengthening Exercises

Strengthening the piriformis muscle itself and also the other hip abductor muscles can be helpful in preventing piriformis syndrome recurring.

Side lying clam exercise

  • Lay on your side with the hip to be worked on top.
  • Bend your knees and position them forwards so that your feet are in line with your spine.
  • Make sure your top hip is directly on top of the other and your back is straight.
  • Keeping the ankles together, raise the top knee away from the bottom one.
  • Remember, don’t move your back or tilit your pelvis, all the movement should be coming from the hip.
  • Slowly return it to the starting position.
  • Repeat 15 times initially and gradually build this up to 2 sets of 20.

Resistance band abduction

  • Stand with one end of the band tied around the ankle and the other end attached to a fixed object, close to the floor.
  • Move the leg out to the side, away from the body, keeping the knee straight.
  • Once you get as far as is comfortable, slowly return the leg back to the centre.
  • Repeat 15 times and gradually build this up to 2 sets of 20 reps.

Hip extension exercise

  • Position yourself on all fours.
  • Shift your weight slightly off the leg to be worked.
  • Keeping the knee bent, raise the knee off the floor so that the sole of the foot moves towards the ceiling.
  • Slowly lower the leg, almost back to the starting position and repeat.
  • Repeat 15 times initially and gradually build this up to 2 sets of 20.

Piriformis Syndrome Stretches

Stretching exercises are important in the rehabilitation of piriformis syndrome. The piriformis muscle itself should be stretched on a daily basis, as should the groin and other buttock muscles.

Outer hip stretch

  • To stretch the muscles that rotate the hip outwards.
  • Lie on your back and bend the knee of the leg to be stretched.
  • Use the opposite hand to pull the knee over to the side as shown opposite.
  • You should feel this in the hip and buttocks.
  • Hold stretch for 30 seconds, repeat 3-5 times and stretch 3 times a day.

Piriformis stretch

  • Lay on your back and bend both knees with the feet flat on the floor.
  • Place the outer foot of the leg you wish to stretch on the lower thigh/knee of the other leg.
  • Grip behind the thigh and pull this knee in towards your chest.
  • You should feel a stretch in the buttock.
  • Hold this position for 30 seconds, repeat 3-5 times and stretch 3 times a day.

Groin stretch

It is important to stretch the long aductor muscles which attach at the knee as well as the short adductor muscles which attach above the knee.

  • Long adductor muscles need to be stretched with a straight leg.
  • This can be done either sitting or standing.
  • Short adductor muscles are stretched with the knees bent.

Short groin muscle stretch

  • Sit on the floor and put the soles of your feet together.
  • Use your elbows to apply a gentle downward pressure to your knees to increase the stretch
  • You should feel a stretch in your groin.
  • Hold this position for 30 seconds, repeat 3-5 times and stretch 3 times a day.

Muscle energy technique

With a partner lie on your front and get the partner to rotate the bent leg outwards (towards the horizontal) as far as it will comfortably go.

Then the athlete applies gentle pressure at about 25% effort to try and return the leg to the vertical. The partner resists this movement.

Hold this pressure for about 10 seconds and then relax. The partner then moves the leg further to stretch the muscle and holds this position for 30 seconds.

Repeat this process until you get no further improvements in mobility. This is an excellent stretching method and has produced some exceptional and instantaneous results. This should only be done by trained therapists.

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