The piriformis muscle is located deep in the buttock beneath the large gluteal muscle. It has its origins below the inferior aspect of the sacroiliac joint on the side of the sacrum or tail bone. The muscle travels to its end on the femur or upper thigh bone. It helps with outward rotation of the hip joint. The sciatic nerve passes beneath the piriformis muscle and at that location it can cause irritation to the nerve contributing to leg pain. This phenomena is called the “Piriformis syndrome”. In a small segment of the population, the sciatic nerve actually passes through the muscle.
Lower Back and Leg Pain
There are many causes of lower back and leg pain. Pinched nerves from disc herniations, arthritis causing narrowing of the openings in the spine (stenosis) where the nerves come out, and other biomechanical dysfunctions of the joints in the lower spine. This article distinguishes one particular cause of lower back and leg pain. The piriformis syndrome is characterized by a feeling of a “toothache in the butt” sensation. This article reviews the symptoms, causes and treatment recommendations for this condition. This syndrome is sometimes referred to as “Pseudo sciatica”.
What is the Function of the Piriformis Muscle?
The piriformis is a very important muscle that stabilizes the hip joint and enables us to walk, lift and rotate the leg away from the body. It is a muscle that assists in maintaining body balance so we don’t fall over. The piriformis is constantly working during our activities of daily living that include rotating or lifting the legs. In other words, nearly everything we do from standing, walking, running or lifting can cause stress and injury to the piriformis.
What are the Symptoms?
Symptoms may begin as a dull ache in the lower back and buttock on the side of muscle involvement. It may develop into a sensation of numbness and tingling in the buttock and upper posterior thigh. If it worsens, it mimics true sciatica with pain going below the knee. Weakness can ensue with time and make it difficult to walk up and down steps.
How is Piriformis Syndrome Diagnosed?
An important way of determining the diagnosis is obtaining a good history. The patient’s cooperation in discussing the onset, duration of symptoms and limitations is helpful to the clinician in arriving at a diagnosis. Doctors perform physical examinations that are used for diagnosis of sacroiliac, hip joint, lumbar spine joints and disc injury to determine if the piriformis syndrome is present or if there are different causes for the lower back pain. Palpation over the piriformis muscle may duplicate or intensify the complaints. The symptoms of a disc herniation and piriformis syndrome are very similar at initial presentation. By performing various tests for the lower back and sciatic nerve, the doctor can exclude one cause of leg pain and look for another cause. MRI and CT scans are negative for the piriformis syndrome. These tests should not routinely be ordered for sciatic pain unless there isn’t any progress or if there is a worsening of symptoms such as reflex loss, motor weakness, increasing sensory loss, progressively increasing and incapacitating pain and bowel or bladder control problems.
What are Treatment Options for the Piriformis Syndrome?
- Avoiding activities that trigger or cause the discomfort
- Chiropractic treatment that may include mobilization of the sacroiliac joint or lower lumbar spine
- Physical modalities such as electrical muscle stimulation can be used. Myofascial trigger points result from injury, chronic strain (posture), anxiety and situational stress, or repetition of motion to a muscle or group of muscles.
- Orthotics may be helpful in improving foot posture and reducing stress to the piriformis muscle.
- Exercise – Low Back Stretching & Low Back Strengthening
Piriformis problems can reoccur and can be easily aggravated by a return to the activities that precipitated the onset. Return to those activities should be gradual and limited by any symptoms. Follow up care will be needed as the condition resolves and a return to activities begins.
The doctors at Coon Rapids Chiropractic Office have experience in the care and treatment of the Piriformis Syndrome.