Piriformis Syndrome Explained: Causes, Symptoms, Treatment and Prevention Strategies in Sedentary Lifestyles

Piriformis syndrome is a condition that involves the irritation or compression of the piriformis muscle and its adjacent sciatic nerve. The piriformis muscle is a deep hip muscle responsible for stabilizing the hip joint and assisting in external rotation of the thigh. When this muscle becomes tight, inflamed, or experiences spasms, it can put pressure on the sciatic nerve, which runs beneath or sometimes through the piriformis muscle. 

 

Causes of Piriformis Syndrome

• Muscle Imbalances
• Overuse or Repetitive Strain - prolonged sitting
• Poor Posture
• Trauma or Injury
• Hip Joint Dysfunction
• Sedentary lifestyles
• Sports such as running or cycling
• Muscle Tightness
• sacroiliac joint dysfunction

Symptoms of Piriformis Syndrome

• Buttock Pain - Deep, aching pains which can be localized or radiate down the back of the thigh or extend into the calf or foot.
• Sciatica like Symptoms - pain, tingling, numbness, or weakness in the gluteal, thigh, and leg.
• Increased Pain with Sitting - especially on hard surfaces
• Pain with Certain Movements - such as climbing stairs, walking uphill, or getting in and out of a car might elicit discomfort.
• Altered Gait Patterns - such as walking with the foot turned outward or with a limp.
• Tender Piriformis Muscle -  muscle may have tenderness or tightness
• Sensory Changes - experience altered sensations, such as tingling or a "pins and needles" sensation, along the path of the sciatic nerve.
• Associated Muscle Weakness

 

Test for piriformis syndrome vs sciatica:

It's essential to differentiate between piriformis syndrome and sciatica, as their causes and treatment approaches can vary. As physiotherapists, we utilize a combination of clinical tests and thorough assessments to make accurate distinctions.

Tests for Piriformis Syndrome

Piriformis Muscle Stretch Test:

In this test, the patient lies on their back and the affected leg is flexed, adducted (moved inward), and externally rotated. This can reproduce pain if the piriformis muscle is involved.

Piriformis Muscle Palpation:

Gently palpating the piriformis muscle while the patient reports pain can help identify localized tenderness or muscle tightness.

Freiberg's Test:

The patient lies on their back with the hip and knee flexed. The therapist applies resistance as the patient tries to externally rotate the hip against resistance. Pain or discomfort suggests piriformis involvement.

 

Tests for Sciatica

Straight Leg Raise Test (SLR):

The patient lies on their back and the therapist raises the patient's extended leg. Pain radiating down the leg suggests irritation of the sciatic nerve.

Crossed Straight Leg Raise Test:

Similar to SLR, but performed on the unaffected leg. If it reproduces sciatic pain on the affected side, it suggests nerve root involvement.

Slump Test:

The patient sits and slumps forward while extending one knee. This test assesses nerve tension and can reproduce sciatic symptoms if there is nerve irritation.

Sitting Straight Leg Raise Test:

The patient sits and raises the extended leg. Pain radiating down the leg indicates sciatic nerve involvement.

Neurological Examination:

Assessing reflexes, muscle strength, and sensory changes in the affected leg can help identify nerve-related deficits associated with sciatica.

How to sleep with piriformis syndrome?

For individuals experiencing piriformis syndrome, finding a comfortable sleeping position can significantly impact pain levels and overall restfulness. As physiotherapists, the aim is to provide practical advice to help manage condition during sleep:

Back Sleeping:

Sleeping on your back is often recommended for piriformis syndrome. Place a pillow under your knees to maintain a slight bend in your hips. This reduces pressure on the piriformis muscle and minimizes strain on the sciatic nerve.

Side Sleeping:

If you prefer side sleeping, lie on your non-affected side with your knees slightly bent. Place a pillow between your knees to keep your hips aligned and prevent your top leg from pulling down on the piriformis muscle.

Fetal Position:

Curling into a fetal position can be beneficial. Lie on your non-affected side, bring your knees up toward your chest, and tuck your chin slightly. This position can help reduce pressure on the lower back and buttocks.

Avoid Crossing Legs:

While sleeping, avoid crossing your legs, as this can exacerbate piriformis muscle tightness and nerve compression.

Proper Pillow Support:

Use a supportive pillow that keeps your head and neck aligned with your spine. The right pillow can help maintain neutral spinal alignment, reducing strain on the lower back and pelvis.

Pillow Placement for Leg Support:

For extra relief, place a small pillow or cushion under your affected leg while sleeping on your back or side. This can help ease strain on the piriformis muscle.

Pre-sleep Stretching:

Gentle stretching before bedtime can help relax the piriformis muscle. Consider trying piriformis stretches or other lower back stretches.

 

Piriformis Syndrome Exercises

Piriformis Stretches

Piriformis Stretch - Seated Cross-Legged Stretch:
Sit on the floor, cross one leg over the other, and gently press the raised knee toward your chest. Maintain an upright posture and feel the stretch in the buttock area.

Piriformis Stretch - Supine Figure Four Stretch:
Lie on your back, cross one ankle over the opposite knee, and gently pull the lower leg toward your chest. You should feel a stretch in the hip and buttock region.

 

Hip and Gluteal Stretches

Hip Flexor Stretch:

Kneel on one knee with the other foot forward. Gently push your hips forward while maintaining an upright posture. This stretch targets the front of the hip.

Standing Gluteal Stretch:

Cross one ankle over the opposite knee and sit back as if you're sitting on a chair. Keep your back straight and feel the stretch in the buttock area.

 

Strengthening Exercises

Bridging Exercise:

Lie on your back with knees bent and feet flat on the floor. Lift your hips off the ground, squeezing your glutes and core muscles. Lower down and repeat.

Clamshell Exercise:

Lie on your side with your knees bent. Keep your feet together and lift the top knee while keeping your feet touching. This targets the hip abductor muscles.

Piriformis Ball Squeeze:

Lie on your back with a small exercise ball or cushion between your knees. Squeeze the ball while engaging your glutes and hold for a few seconds.

Plank:

Support your body on your forearms and toes, maintaining a straight line from head to heels. Engage your core muscles while holding this position.

Dead Bug Exercise:

Lie on your back with arms extended toward the ceiling and knees bent at 90 degrees. Lower one arm and the opposite leg toward the ground while maintaining a stable core.

 

Exercises to Avoid in Piriformis Syndrome