Back Pain Conditions »

Piriformis Syndrome

By Steven Hefferon, CMT PTA

If you have read any of my work you know I like to tell stories, I think they help me connect with you as the reader and my hope it that you can relate to my situation even though it may not be exactly the same.

Well in 2002, my wife and I adopted a 10 day old baby girl and in most cases, you have about 6 to 9 months before the baby starts to get into mischief. It's at that point that you have to put up the baby gates to keep a save area for the baby to explore.

In my case it was not the baby that was the problem but a 2 year old Golden Retreater that just has and over active desire to nurture Baby Jessica and I guess I had just not watch enough episodes of the "Dog Whisper" to know how to control the behavior so we put up the baby gates early to keep the dog and baby separated.

What does this have to do with Piriformis Syndrome, every thing because our bodies are great at adapting to our environment and when our environment changes so do our bodies, I'm going to give you my story but I ask you as you read through this what is your story, how has your environment change?

What is Piriformis Syndrome?

Please understand that Sciatica is not a condition, it is a symptom if a condition and Piriformis Syndrome is only one of the 4 conditions that can cause sciatica the pain you fell going down your leg.

Piriformis Syndrome causes Sciatica by irritating the sciatic nerve as the nerve passes through the hip on the way down to the foot. It is true that the sciatic nerve can run in 4 different way past the Piriformis muscle and if you ask me its not that important as to your ability to get relief so please do not worry about it.

The two most likely causes of Piriformis Syndrome are when the Piriformis muscle is tight and inflamed and continuously irritates the sciatic nerve or the second reason is the position of the pelvis, when you pelvis is not in the proper position the path of the sciatic nerve is going to have abnormal contact with the Piriformis muscle and thus be irritated, thus causing pain.

I said there are two main causes but the true secret is knowing that there is always a combination of factors and for most people the frustration come when you think you are doing the right thing but in fact you are only doing half the things necessary in order to get relief. Failure to address both the tight Piriformis muscle and then the abnormal position of the pelvis is going to lead to frustration and prolonged suffering.

What Changed in you?

In order to get to the root of your Piriformis Syndrome you will need to think about how things have changed for your over the years or how has you life been for the last number of years or even decades, what repetitive movements have you been doing.

What I'm looking you to identify are you daily Habits, Patterns, Postures, Positioning and or the thing you do all day long, that over time will cause a tight Piriformis Muscle or your position of your Pelvis to get out it proper position.

What changed in me?

In my case we put up two baby gates, one going into the kitchen and at the bottom of the steps. In both cases it was easier for me to just lift my leg up and step over the gate vs open it up and walk through. Well I stepped over the gate with the same leg each and every time for months and months.

Well like I said, it took month and month for me to start to feel the pain in my butt and than it went into the back of my leg. What is worse it took me a long time for me to figure out why I was getting the sciatic pain, and unknowing I kept lifting my leg over the gate even when I was in pain in part because, I just did not put the two together or just because it made life easer.

Every time I lifted my leg up I was putting my body through a motion that caused the muscle in my hips and lower back to develop in a way that strengthened them and pulled my pelvis to on into an abnormal position. Again that abnormal position of the pelvis caused the path of the nerve to have abnormal contact with the nerve, thus the pain.

Where I really felt it was when I had to push the lawn mower every step was murder and what make it even worse was that I had to turn my feet out wards to push off with me big toe so I had more power and its external rotation that causes the Piriformis muscle to get even tighter.

What you need to look for?

Ok in the absence of trauma to the area, you need to be looking for receptive motions that put your foot into external rotation or your toes in an out ward position. One test you can do is to just get on the floor and lay on your back and relax you legs and see which way your feet rotate. You can just look down at your feet as you sit and read this and see which way your feet are rotated. My bet is that in both cases your toes are rotated out ward, and that means your Piriformis muscle is tight and that is bad.

The second factor is the position of your pelvis, now the abnormal position of the pelvis is much harder to identify on your self but there are some motions that you can identify with. Getting in and out of a car you will do that thousands of times in year and you will do it the same way every time. Standing and weight shifting on to one foot while waiting in line or holding a baby on your hips.

These all cause a shift in the use of your core muscle and over time you will develop what are called muscle imbalances and those muscle imbalances will develop in to what are called postural Dysfunctions and its those postural dysfunctions are cause your Piriformis Syndrome and thus you will feel sciatica or pain down your leg.

Can it be that simple?

Of course there can be differing circumstances and variations to everyone's body type and body development but at the core and I mean at the root of the problem the more imbalanced you are the more likely you are going to have pain and if you fail to identify these environment factors the harder it will be to get lasting relief.

Yes, your case is different form mine, it may have been around for years and you could have tried everything to get rid of it and today you find that you are still in pain.

That does not mean you can forget anything I just said, because I bet that none of your health care professionals have addressed your daily life as deeply as needs to be to get relief or more importantly they have not looked at your body as a whole and addressed your muscle imbalances or postural dysfunctions to develop a plan to get you the relief you want.

What to do?

The first thing you need to do is "think" I know it hard to do when you have pain and stress is building but you have to identify those activities that are putting your self at rick. Those activities that are repetitive and over developing some muscle groups and do not address others.

In some cases you will have to stop exercising or at least stop doing the same exercises everyday, one example is if you treadmill everyday try walking backwards on it, go slow and hold on but changing the activity will stop the over development and help minimize the imbalances.

The action plan you come up with will need to have a whole body assessment phase looking for muscle imbalance and postural dysfunctions as the base of your recovery you should not even start or even try to do a single stretch or exercise before you get assessed, that is why I not giving you a single activity to try. Sorry...

To list some other good treatments for Piriformis Syndrome, you can try Trigger Point therapy if you have Piriformis Syndrome, you have Trigger Points in your Piriformis and other muscles there is no way that you can not, they go hand in hand. Stress reduction, drinking more water, inversion therapy, some seating devices work great at minimizing the pressure on the nerve...

What it boils down to is education coupled with action towards the root causes, not just addressing the symptoms of your pain, there is a huge difference and the results will show in the level of frustration you have not to mention the quicker the relief you will get.

Here are some treatments you may want to consider:

Inversion Therapy
Muscle Balance Therapy™
Trigger Point Therapy
Proteolytic Enzyme Therapy
Healthy Heating Pad