Piriformis syndrome is a relatively uncommon neuromuscular (involving the nerves and the muscles they innervate) disorder. The disorder occurs when the piriformis muscle (in the lower section of the gluteal region), which serves to rotate the femur laterally and stabilize the hip joint, compresses the sciatic nerve. The sciatic nerve is a long nerve that runs down the leg, and is the longest nerve in the human body.
The piriformis muscle is very important not just for the functions mentioned above, but also in that the muscle allows us to walk, shift our weight from one foot to another, and maintain our balance when walking and standing. Therefore, the piriformis muscle is involved in most of the motions related to the hips and legs. It is thus a very important muscle, and when it sustains an injury, it causes major issues related to mobility.
Symptoms of Piriformis Syndrome
Piriformis syndrome typically begins with pain and tingling, and numbness in the buttocks. The pain can progress and extend down the length of the sciatic nerve, causing sciatica. This pain is the result of the piriformis muscle compressing the sciatic nerve, such as when occurs when sitting or running. The pain can be further triggered when climbing stairs, or sitting for long periods of time without moving. There is no definitive test to run to determine if a patient is suffering from piriformis syndrome. However, in many patients, there is a history of trauma to the area, as well as repetitive, traumatic activity, such as occurs in long-distance running. Therefore, diagnosis of piriformis syndrome is made by a patient’s reports and by a physical examination that tests a variety of movements that are the function of the piriformis muscle. Other issues need to be ruled out that may cause sciatic nerve compression, including a herniated disc. These tests can include radiologic tests, such as MRIs.
The typical rest, ice, heat, repeat method may help relieve the symptoms of piriformis syndrome. Exercises and stretches may also prove beneficial in treating the patient. Anti-inflammatory medications, muscle relaxants, and corticosteroid injections may also be helpful in treating the pain, though they should be an avenue of last resort. Other forms of therapy, including iontophoresis, which utilizes a gentle electric current, may be helpful. Botox, which paralyzes a given muscle, may also be a component of a beneficial treatment plan. Surgery is a viable, but should be a last resort, option.
Considering piriformis syndrome is typically caused by sports or repetitive movements that stress the piriformis muscle, such as running, prevention, and limiting exposure by not engaging in these activities may be recommended while healing occurs, or possibly on an indefinite basis. Other forms of exercises may be suggested, such as swimming in place of running, or a cardio machine instead of a treadmill, both replacement exercises maintain an emphasis on “low-impact” fitness training. If sitting for prolonged periods is both cause and culprit, it may prove helpful to take walking break intervals throughout the day, to prevent nerve compression. Good posture is also necessary. Warming up before any activity is important, and intensity should be increased gradually to prevent the onset of injury. If pain occurs during activity, that activity should be stopped until the pain subsides and before further injury is sustained.
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