Piriformis Syndrome and Sciatica are two conditions that often present with very similar symptoms consisting of pain in the buttocks and/or hip that radiates down the back of the thigh and possibly to the foot. Symptoms may include numbness and tingling in the leg or foot. Even though these conditions have very similar symptoms, they are distinguished by their underlying cause. As a result, the treatments may vary as well. This article will focus on piriformis syndrome and its treatment. Stay tuned for part II of this article that will concentrate on sciatica.

The piriformis is one of the small muscles in the buttocks that attaches the front part of the sacrum (the triangular shaped bone at the base of the spine) to the outer bone of the hip (the greater trochanter of the femur). The action of this muscle is to rotate the hip outward. It also assists in stabilizing the hip.

The sciatic nerve is the largest peripheral nerve in the body that extends from the low back down through the buttocks and down the back of the thigh. In approximately 10 percent of the population this nerve pierces through the belly of the piriformis muscle. In the rest of the population the sciatic nerve passes underneath the piriformis muscle. In either case, when the piriformis muscle becomes tight, spasmed, or inflamed, it puts pressure on the sciatic nerve. This irritation is called piriformis syndrome. It causes the very same symptoms associated with sciatica as mentioned above.

The piriformis muscle may become tight in athletes, particularly runners, who train too hard, too fast or too often without enough recovery built into the training regimen. The piriformis also may become tight in people who sit for long periods decreasing circulation of blood to this muscle. A third cause of piriformis syndrome can be from a misalignment or fixation of the joints in the hip or pelvis. Since the piriformis attaches to the sacrum and femur, a fixation or subluxation of the associated joints can lead to inflammation and spasm of surrounding muscles.

To diagnose piriformis syndrome we take a patient history and perform a thorough exam consisting of a chiropractic exam, orthopedic and neurological tests, and possibly x-rays of the lumbar spine. Our intention here is to rule out other pathologies that may have similar presentations.

Our treatment of piriformis syndrome may include the following procedures:

1. Adjustments of the spine, pelvis, hip to remove joint fixations so that the body is not compensating in ways that would fatigue stabilizing muscles.

2. Active Release Therapy (ART) - This is a soft tissue technique where we specifically treat the injured muscles and ligaments so as to remove adhesions, scarred muscle tissue, and nerve entrapments resulting from overuse and poor circulation.

3. Patient instruction for proper at home icing and heating protocols, as well as exercises. These will include stretching and strengthening exercises so that recovery is quicker and longer lasting.

Do you have pain, numbness, or tingling down the back of your thigh/leg? Do you find yourself squirming from discomfort while sitting? Or do you sit on top of opposite foot to relieve pressure in buttocks while sitting? These are some indications that you may be suffering from piriformis syndrome. Come visit us and let us help you out!