Syndrome is a muscular problem that can cause sciatica or leg pain.
It is often mis-diagnosed because it can mimic other problems, such as
disc herniations, which also present with leg pain. The good news is once
properly diagnosed itís usually quite easy to remedy.
The piriformis muscle is a tiny muscle located deep
in the buttock, underneath all the Gluteal muscles. It originates on the lateral aspect of the sacrum and inserts
into the head of the femur. It aids
in external rotation of the hip. Somewhat
insignificant on itís own, but problems arise because of the piriformis
muscleís relationship to the sciatic nerve. The sciatic nerve is the largest
nerve in the body. At itís largest point itís about the width of oneís
little finger. It originates in the low back from numerous roots and then runs
down the leg to supply all nervous system functions to the leg.
On itís way down the leg, it passes the piriformis muscle. Some
anatomic variations do exist: In some people the nerve passes over the
piriformis muscle, is some it splits and passes around the piriformis and in
others it passes through the piriformis. Problems
arise when the piriformis muscle becomes tight because it will often compress
the sciatic nerve giving pain into the distribution of the nerve.
Signs and Symptoms
- Deep aching in the buttock and thigh on the involved side.
Usually not beyond the knee.
- The pain is often aggravated by sitting, squatting or walking.
- Affected legs often externally rotated (toes point out) when
relaxed, such as when lying face down on the bed with your feet over the end
of the mattress.
- Right leg often affected after driving a long distance if the foot
has been in external rotation while depressing the gas pedal.
- Often causes low back pain.
- Some reports suggest a 6:1 female to male predominance.
Whatís Going On
If the leg has been externally rotated for an
extended period of time (such as when driving) the piriformis muscle can
shorten. When you try to straighten
out the involved leg the muscle compresses the sciatic nerve. If compressed long
enough the nerve will cause aching in the leg and even pain in the low back. The
leg doesnít necessarily have to have been externally rotated for a long time
Ė piriformis syndrome may be a result of faulty foot or spinal mechanics, gait
disturbances, poor posture or sitting habits of any other factor that could
cause that muscle to function abnormally.
What To Do About It
Your first approach
should be through stretching. Because
this muscle usually isnít stretched it may just be tight from running, etc.
To stretch your RIGHT piriformis, start off by lying on your back.
Bend your knees and cross your right leg over your left so your right
ankle rests on your left knee in a figure four position.
Now, bring your left leg towards your chest by bending at the hip. Reach
through and grab your left thigh to help pull things towards your chest. If you
havenít stretched your piriformis in the past, stretching may be all you need
to do. If stretching alone
doesnít help them youíll need to have someone check your pelvic and foot
mechanics. Pelvic mechanics can
play a role in piriformis syndrome, because the piriformis muscle originates on
the sacrum it can be directly influenced by poor pelvic mechanics. The good news is that itís usually easily fixed.
If your feet are contributing to the situation, you may need to get
different running shoes or maybe orthotics.
Also, youíll want your doctor to review your work and non-work postures
and positions to see if anything that youíre doing regularly may be
contributing to the tightness of the muscle.
- Stretch the Piriformis muscle.
- Address faulty pelvic or foot
- Address postural or work related
to activity gradually.
up slowly to pre-injury level.