The Solution to Piriformis Syndrome Is Simple Once You Know What's Causing It

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, the reader, and my hope is that you can relate to my situation, even though it may not be exactly the same as yours.

In 2002, my wife and I adopted a 10-day-old baby girl. In most cases, you have about six to nine months before the baby starts to get into mischief. It's at that point that you have to put up the baby gates to create a safe area for the baby to explore.

Actually, the problem was not the baby; it was two-year-old Golden Retreater that just has an over-active desire to nurture Baby Jessica. I guess I just had not watched enough episodes of "Dog Whisperer" to know how to control its 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? Everything, because our bodies are great at adapting to our environment, and when our environment changes, so do our bodies. I'm going to tell you my story, but as you read through this, think about how your own environment may also have changed.

What is Piriformis Syndrome?

Please understand that sciatica is not a condition; it is a symptom of a condition. In fact, Piriformis Syndrome is only one of the four conditions that can cause the sciatica pain you feel 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. While it is true that the sciatic nerve can run in four different ways past the piriformis muscle, it really is irrelevant to your ability to get relief, so why worry about it?

The two most likely causes of Piriformis Syndrome are a tight and inflamed piriformis muscle that continuously irritates the sciatic nerve, or a pelvis that is out of position. When the latter happens, the sciatic nerve is going to have abnormal contact with the piriformis muscle, which will irritate it and cause pain.

I know I just said that there are two main causes. But the truth is that there is always a combination of factors that cause sciatica pain, which is why people often get frustrated. They think they're doing the right thing, but they're actually only doing half the things necessary to get relief. Failure to address both the tight piriformis muscle and the abnormal position of the pelvis will inevitably lead to 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 you over the last few years, or even decades. For example, what repetitive movements are you now doing that you weren't doing before? I want you to take a close look at your daily habits, patterns, postures, and positioning - especially the thing or things you do all day long that over time will produce a tight piriformis or cause your pelvis to get out of proper position.

What changed in me?

As I mentioned earlier, what changed in my life was that n my wife and I put up baby gates - one at the entrance to the kitchen, the other at the bottom of the steps. In both cases, it was easier for me to lift my leg up and step over the gate rather than open it and walk through. Well, I stepped over the gate with the same leg each and every time for months and months.

After a few months, I started to feel pain in my butt. Then it went into the back of my leg. What's worse, it took me a long time to figure out why I was having sciatic pain. I just kept lifting my leg over the gate, even when I was in pain - partly because I just did not put two and two together, and partly because it made life easer.

Every time I lifted my leg, I was forcing my body to go 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 into an abnormal position. That abnormal position of the pelvis caused the path of the nerve to have abnormal contact with the sciatic nerve, hence the pain.

As bad as the pain was when I stepped over the baby gates, it was much worse when I had to push the lawn mower. Every step was murder. And because I had to turn my feet out wards to push off with my big toe so I had more power, the external rotation caused the piriformis muscle to get even tighter.

What do you need to look for?

In the absence of trauma to the affected area, you need to be looking for repetitive motions that put your foot into external rotation or force your toes into an outward position. One test you can do is to get on the floor, lie on your back, and relax your legs and see which way your feet rotate. My bet is that your toes are rotated outward, which means that your piriformis muscle is tight, which is bad.

The abnormal position of the pelvis is much harder to identify on yourself, but there are some motions we all tend to do that can cause this - for example, getting in and out of a car (you'll do this thousands of times a year, and you'll do it the same way every time). Another common motion is shifting your weight from one foot to the other while you're waiting in line or holding a baby on your hips.

These motions produce a shift in the way you use your core muscles. Over time, you will develop what are called "muscle imbalances," which will eventually lead to "postural dysfunctions." These postural dysfunctions are what cause your Piriformis Syndrome, and they are the reason behind the sciatica or pain running down your leg.

Can it be that simple?

Of course, your circumstances, body type, and body development may be different, but the general rule is that the more imbalanced your muscles are, the more likely you are going to have pain. And if you fail to identify these environmental factors behind these imbalances, the harder it will be for you 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 should you do?

The first thing you need to do is think. I know it's hard to do when you have pain and the stress is building, but you have to identify the activities that are putting you at risk - activities that are repetitive and overdevelop some muscle groups while ignoring others.

It may turn out that you will have to stop exercising, or at least stop doing the same exercises every day. For example, if you use the treadmill every day, try walking backwards on it. (If you do this, be sure to go slow and hold on.) Changing the activity even slightly may prevent overdevelopment and help minimize the imbalances.

The action plan you come up with will need to include a whole-body assessment phase that will look for muscle imbalances and postural dysfunctions. Understand that this is the basis for your recovery. You should not even try to do a single stretch or exercise before you get assessed. That's why I can't give you one magic activity that will solve all your problems. Sorry.

Once you've had the assessment done, you might want to try Trigger Point therapy, which is a method of applying pressure to key points in your piriformis and other muscles. Stress-reduction techniques may also help, as will drinking more water, and inversion therapy. Some seating devices are great for minimizing pressure on the nerve.

The formula is simple: education plus action. Now that I've given you a primer, you need to take action that focuses on the root causes, not merely doing things that address the symptoms. This will make all the difference, and you'll finally see results - less frustration and quicker, lasting relief.

 

 

 

 

 

 

 

• First Name:
  
• Email: