Fitness Focus
Copy-and-Share by Brad A. Roy, Ph.D., FACSM, FACHE
Piriformis Syndrome
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F
irst described in 1928, piriformis (peer-ee-form-us) syndrome is
a painful neuromuscular disorder that occurs when the piriformis
muscle irritates and/or compresses the proximal sciatic nerve.
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Sometimes referred to as wallet syndrome, pseudosciatica, or hip socket
neuropathy, piriformis syndrome is six times more prevalent in females than
males. This may be caused by differences in the angle of the quadriceps
femoris muscle, differences in pelvic structure, or to hormonal changes,
especially during pregnancy, that affect the muscles around the pelvis.
The piriformis muscle is a flat pyramid-shaped muscle located
deep in the buttocks near the hip joint that connects the sacrum to the
top of the femur. Activation of the piriformis muscle lifts and rotates
the thigh away from the midline of the body, allowing us to walk by
shifting weight from one foot to the other and to maintain balance.
The muscle is activated during all movements that require lifting and
rotating the thighs V the vast majority of hip and leg motion.
Passing alongside, or in some individuals through the
piriformis muscle, the sciatic nerve descends down the back of
the thigh to the lower leg and eventually branches into smaller
nerves that terminate in the feet. Although relatively rare,
piriformis muscle spasm also can impinge the pudendal nerve
that controls our bowels and bladder, resulting in groin tingling,
numbness, and sometimes even incontinence.
CAUSES AND SYMPTOMS OF PIRIFORMIS SYNDROME
Compression or irritation of the sciatic nerve can occur when the
piriformis muscle becomes inflamed, has spasms, or becomes tight.
Typically, this results from overuse, prolonged sitting, and activities
such as rowing in the sitting position. In addition, weak hip
abductor muscles, such as the gluteals, combined with tight
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adductors, increase the risk if they do not engage regularly. Athletes
performing forward-moving activities such as running and cycling
are more susceptible to the disorder, especially if they do not engage
regularly in lateral stretching and strengthening exercises. Excessive
or prolonged sitting (e.g., the hips flexed while sitting at work) also
increases the likelihood of developing piriformis syndrome.
Piriformis syndrome is not diagnosed frequently because the
symptoms of the disorder mimic those of sciatica and a definitive
diagnostic test is lacking. Typical symptoms can include:
• Tenderness or pain behind the hip, in the buttocks
• Pain can radiate down the back of the leg into the hamstring
muscles and, at times, the calf muscles.
• Numbness and tingling in the lower extremity
• Tenderness when pressure is applied on the piriformis
muscle, such as with sitting
• Low-back tenderness and pain
TREATMENT
Conservative treatment includes nonsteroidal anti-inflammatory
medications for symptom relief, massage, pain-free stretching
exercises, and avoidance of contributing activities such as
running, cycling, and rowing. Avoidance of prolonged sitting is
highly recommended, and short movement breaks every 30
minutes also are recommended. Light stretching is recommended
three to four times per day up to, but not beyond, the point of pain.
As symptoms alleviate, strengthening exercises should be added
that involve the hip abductors, adductors, external rotator, and
extensor muscles. A physical therapist or personal trainer can
provide guidance with developing an appropriate strengthening and
stretching routine.
PREVENTION
Most causes of piriformis syndrome are preventable and
frequently are related to activities of daily living. Avoidance of
prolonged sitting and utilization of correct sitting posture are two
important prevention strategies and essential for other aspects of
overall health and wellness. Other preventive strategies include:
• Using a proper warm-up and cool-down period
• Maintaining correct posture with even weight distribution on
both feet
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• Wearing proper-fitting shoes that are not worn out
• Using correct lifting techniques
• Regular stretching
• Strengthening exercises that include activities such as:
) Resistance band abduction and adduction exercises
) Side-lying clam shells
) Stability ball wall squats
Although a painful and restricting condition, piriformis
syndrome largely is preventable. Avoidance of prolonged
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sitting and chronic repetitive activities, along with undertaking
proper warm-up, stretching, and strengthening exercises, will
minimize the risk of developing this debilitating condition.
Brad A. Roy, Ph.D., FACSM, FACHE, is an administrator/executive
director at Kalispell Regional Medical Center. He is responsible for The
Summit Medical Fitness Center, a 114,800 sq ft medical fitness center
located in Kalispell, Montana, and a number of other hospital
departments.
VOL. 18/ NO. 4