Mobile Massage Sydney Remedial Massage Sydney Active Release Techniques Sydney Piriformis Syndrome
The piriformis muscle is known to have a major affect on the sciatic nerve. Often when disc involvement has been ruled out of causing sciatica the piriformis muscle is looked at as being the potential culprit in compressing the sciatic nerve. If release of this muscle relieves or fixes the symptoms then it is highly likely that the person was suffering form piriformis syndrome. The Sciatic nerve is usually compressed between the piriformis muscles and the sacrospinous ligament.
The superior gluteal nerve can also become impinged causing weakness in the gluteus medius, Minimus and TFL as it is a motor nerve.
If symptoms don’t travel any further than the knee then it could also be the femoral cutaneous nerve impinged at piriformis.
Who it affects?
Usually the peroneal and tibial parts of the Sciatic nerve travel together under the piriformis. In 15% of people the nerve splits and either penetrates the piriformis or wraps around it. In around 1% of people both divisions of the sciatic nerve pass through the piriformis muscle.
· Tightness in piriformis cause by overuse such as running, walking, poor standing posture (leaning to one side), standing on one leg, crossing the leg (male style).
· Tightness from under use of muscle.
· Lots of sitting and compressing the sciatic nerve against the piriformis muscle. This can build up adhesions between the nerve and the muscle.
· A fall onto the buttock that may damage piriformis and sciatic nerve.
· Sports such as soccer, rugby, AFL, cricket (bowling), martial arts and other sports that involve going onto one leg or lots of kicking.
- Pain in the low back, glutes or down the leg.
- Occupation? Sitting for long periods can compress the nerves in the buttock.
- Does the client sit on a wallet?
- History of back pain? Any disc injuries? This could rule out piriformis syndrome.
No real visible signs with piriformis syndrome. If it is the inferior gluteal nerve then there may be some muscle wasting at the gluteus medius, Minimus or TFL.
Pressure on the piriformis muscle should replicate the symptoms i.e.: shooting pain down the leg.
Note that the Gluteus Minimus trigger point replicates the sciatic nerve pattern to some extent. Note that you would not be pressing on the piriformis you would be pressing more lateral onto Gluteus Minimus.
Gluteus Minimus Trigger Points
Resistive and Range of motion tests –
With AROM and PROM there may be limited ROM in internal rotation of the hip if piriformis is restricted.
MRT for external rotation may increase symptoms as the piriformis with contract and shorten onto the nerve.
Special Tests –
Piriformis test: also known as the FAIR test (Flexion Adduction and Internal Rotation). Client is side lying with their leg flexed at knee and knee coming slightly off table. The practitioner takes leg into at least 60° of flexion. If there is Sciatic pain produced then it is likely this is caused by piriformis. The leg can be extended (straightened) to increase symptoms.
Pace Abduction test: the client is seated on the edge of the treatment table with the hips partially abducted apart. The practitioner places hands on the lateral sides of the knees and tries to put knees together. The client has to try to keep the legs from coming together. If the shooting nerve pain is reproduced then it is likely to be piriformis syndrome.
If the subjective and objective measures test positive for piriformis syndrome then it is likely that this is what they are suffering from.
If you treat a client and they recover from their symptoms then it is likely that piriformis was the problem. If there is no response from treatment then further investigation may be required. There may be a disc injury.
Usually 3-5 treatments will be required depending on severity.
Soft tissue massage will be required to release the piriformis muscle. Glutes and surrounding structures will also need to be released to take pressure off the area. The hamstrings and calves can also be released to take pressure off the sciatic nerve.
Piriformis stretching given to the client to be performed regularly will help to alleviate the problem and prevent it from coming back.
Worse case scenario is surgery if the nerve is penetrating the muscle and causing symptoms.
Disc injury, SIJ dysfunction, and Gluteus Minimus trigger point.