Physical Therapy for Piriformis Syndrome Infographic
Piriformis syndrome develops due to tightening of the piriformis muscle, which can irritate and compress the sciatic nerve and cause pain through the buttocks, low back, and back of the leg. Piriformis syndrome is more commonly diagnosed in middle-aged patients with a 6:1 ratio of women to men affected.
The piriformis muscle is a flat, band-like muscle located in the buttocks directly above the sciatic nerve that stabilizes the hip joint and enables lower extremity movement. The piriformis muscle connects the upper thigh bone to the lower spine on each side of the pelvis, sitting deep in the buttocks. The sciatic nerve travels under the piriformis from the low back to the legs. When the hip is extended, the piriformis acts primarily as an external rotator, but when the hip is in flexion, the piriformis acts like a hip adductor.
Symptoms of piriformis syndrome include pain, tingling, or numbness in the lower back or buttocks that radiates down the leg or sharp, severe, pinprick-like radiating pain. A patient with piriformis syndrome may have difficulty sitting or putting weight on the buttock on one side, sciatic-type pain when the hip is moved and rotated outward, and reduced range of motion in the hip. The patient may also experience muscle spasms in the piriformis muscle, which put pressure on the sciatic nerve.
Piriformis syndrome is common in those who sit for long periods of time (office workers and taxi drivers) and in athletes ( e.g. cyclists) due to repetitive strain and overuse of the piriformis, which causes the muscle to spasm. During periods of increased weightlifting or pre-season conditioning, athletes may experience piriformis hyper atrophy. Another common cause is tight adductor muscles on the inside of the thigh which means the abductors on the outside of the hip can’t work properly and this places more strain on the piriformis. Injury from a fall on your buttocks, scoliosis, or prior hip surgery can also lead to this condition. Chronic low back issues can also cause the piriformis muscle to tighten up as a protective mechanism.
Physical therapy can isolate the true origin of the piriformis syndrome pain, help relieve pain, and restore normal movement and range of motion in the affected area. Targeted stretching and exercise are the go-to treatments for piriformis syndrome, working to loosen the tight piriformis and improve the strength and mobility of the piriformis and surrounding hip muscles for better overall function. The therapist may use heat, ice, or ultrasound to manage pain and provide movement re-education to minimize stress on the piriformis and restore stability to the lower extremity. The physical therapist also utilizes manual therapy and myofascial release to increase blood flow to the area, reduce piriformis muscle spasms, and improve mobility and range of motion.
Research has shown that mobilization of the sciatic nerve through manual therapy and strengthening of the muscles adjacent to the piriformis contribute significantly to the improvement of piriformis syndrome symptoms. One study assessed the effect of strengthening the adductor and external rotator muscles of the hip, which resulted in eliminating pain and improving lower extremity function. Other studies have found that central stabilization of the core, strengthening of the hip, correction of pelvis and spine postures, and stretching are successful in alleviating pain and improving the mobility and range of motion of the hip and piriformis muscles.
