Piriformis syndrome: symptoms and management

Dear Osteopathy/sports massage patients and fitness clients.

Here is a condition I'm seeing more and more of in clinic. I thought I'd brief any of you experiencing buttock pain of what to look out for, and how to differentiate piriformis syndrome from low back pain, as the two do not usually exist together.

So what is piriformis syndrome? Piriformis disorder is a neuromuscular condition causing compression of the sciatic nerve by the piriformis muscle. Piriformis syndrome accounts for 6-10% of all sciatic causes.

Piriformis syndrome affects mostly the demographic of 30-40 year olds, and it affects females to males in a 6:1 ratio. The condition is most commonly found in desk workers, runners and joggers and can be caused by anatomical variations, trauma, a fall, surgery, road traffic accidents, or any type of impact, or repetitive movement such as jogging and running.

Piriformis syndrome is also common in those that spend a lot of time being sedentary as more pressure is applied on the muscle with prolonged sitting, likely to cause strain. Poor ergonomics, hard surfaces with no padding further increases the susceptibility of being diagnosed with piriformis syndrome.

87% of the sciatic nerves pass through anteriorly to the piriformis muscle in the glutes, 10% pass through the piriformis, and 2% in front and behind of it. Those sciatic nerves that pass through the piriformis are more likely to be irritated.

Your Osteopath will rule out haematoma, lumbar radiculopathy (nerve root compression in the lumbar spine discs) etc with relevant questioning and physical examination. Usually patients with piriformis syndrome have a full range of motion and no pain or discomfort in the low back and their foot and hip on the affected side may be externally rotated due to a tight piriformis muscle.

There are physical tests such as Hibbs test and Frieberg's that produce symptoms if a positive result is found. The patient may also present with an antalgic gait (wonky walk) and palpation of the piriformis muscle by your Osteopath may provoke tenderness here and/ a lot of pain

Management of the condition with Osteopathy includes improving ergonomics, hands on therapy (Osteopathy) soft and deep tissue work, trigger point therapy, osseous manipulation, advice to use hot and cold, stretches for the piriformis, looking at ankle, foot, knee and hip function and compensatory patterns.

Your Osteopath will also encourage you to move around more every 20-30mins, especially if you're sedentary for long periods. In severe cases a tens machine may also help.

Short term: Osteopathy, before taking anti-inflammatories, try hot and cold first (ask your Osteopath for more specific advice), and natural anti-inflammatories such as turmeric can also be helpful for symptomatic relief.

Long term: Osteopathy maintenance and strengthening techniques for the piriformis can together work well to prevent reoccurrences of piriformis syndrome.

If you're suffering from pain, please get in touch with your Osteopath/physical therapist before trying recommended management protocols and please remember, prevention is always better than cure!

With love


Registered Osteopath BSc. Fitness Coach Sports massage practitioner, Berrylands

My OsteoPATH to Wellness

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