The Piriformis muscle is located in the buttocks, beneath the Gluteus Maximus . It runs diagonally from the Sacrum (base of spine) to the top of the Femur (thigh bone) and rotates the hip outwards. It is used to stabilise the hip during walking, running, cycling and climbing so is a very important muscle to look after. Unfortunately, it is located next to the Sciatic nerve, which controls the legs and feet.
What is Piriformis Syndrome?
Piriformis Syndrome is the name given when tightness of the Piriformis muscle irritates the Sciatic nerve and causes pain or tingling in the buttocks, lower back and legs. This is usually an overuse injury and symptoms can feel worse after sitting for long periods as the muscle seizes up. Piriformis tightness and the associated pain can be managed with some simple techniques. If these DO NOT improve the situation, then medical advice should be sought.
Ice packs will reduce any inflammation in the area. Be careful to cover the pack before placing on the skin. Useful if injury is suspected as part of the R.I.C.E. protocol of acute injury management.
Sciatica can be defined as:
Heat packs will help to relax the muscle if no injury is suspected. Again, make sure the pack does not directly touch the skin.
“Sciatica is a term used to describe nerve pain in the leg that is caused by irritation and/or compression of the sciatic nerve. Sciatica originates in the lower back, radiates deep into the buttock, and travels down the leg.” (www.spine-health.com)
Now – this is where the 2 pathologies can become a little confused as it does state that compression of the sciatic nerve causes sciatica and piriformis syndrome is compression of the sciatic nerve – however with sciatica the compression of the nerve typically comes from the nerve root which is where it exits the spine – which is above the piriformis muscle.
Causes of sciatica can often be much different from piriformis syndrome. Commonly if you have suffered a spinal disc injury at L4/5 region – a bulge in the disc can press on the nerve root causing pain symptoms. Because the nerve root exits the back through facet joints – it means it can be compressed at this area by having an overly tight back and the nerve being trapped by a tight facet joint. Sciatica involving a disc injury can take extended periods to reduce, ranging from 3-6 months. If it is due to tightness in the back then this can resolve within 2-3 months.
Common ways to develop sciatica are injuries while lifting, working in prolonged flexed positions and poor posture or extended sitting times. As a safety note – if you have back and leg pain accompanied by bladder or bowel dysfunction or numbness in your genitals or a total loss of the ability move your foot – you must proceed to an A&E, some disc bulges can cause significant compression to nerves that help your body’s vital functions and can be irreversible if not managed in a timely fashion. These symptoms happen to very small percentage of people with disc issues but it is important to make you aware.
Symptoms of sciatica usually include back pain in the lumbar region – with piriformis syndrome you do not get any back pain as it is local compression of the nerve below the level of the spine/nerve root. The back pain will then typically extend down the back of the thigh and in worse cases can go all the way to the foot. Pins and needles/tingling and even numbness can felt in the lower limb. Simple functions of washing, dressing and bending from the lower back may be difficult, walking and movements of the lower limb will also be compromised. A tightness type pulling pain is described down the back of the leg with sciatic symptoms – as well as intense pain shooting down the leg in short bursts.
Here are a selection of simple exercises that you can try at home to start managing your symptoms of sciatica and piriformis syndrome. The first 3 would be best for sciatica when the back has some involvement.
- Knee Hugs – lie on your back and gentle hug either one of both of your knees towards your chest – go as far as your symptoms allow – the goal will be to gain full range of movement. This exercise helps you to maintain the lower backs range of movement in bending / flexion.
- Lumbar Twists – In a crook lying position, keep your knees together, take your knees to each side as far as they will go. This rotates the lower back, mobilising the facet joints of the back and also loosening the lower back muscles.
- Prone Extension – Lie on your front, place your forearms on the front and push up gently just lifting your chest off the floor. You may feel some gentle pressure in the back but should not feel sharp pain. If you do, do not push in to the intense pain. Gently hold the exercises for a few seconds and return to a flat position and repeat.
For the symptoms of piriformis and sciatica which occur in the buttock, thigh and leg – take a look at these exercises to get you started.
- Seated Sciatic Nerve Glider – in a chair, sit up with good posture in to extension. With the affected leg, pull your toes towards you and gently straighten the leg and then bend it again. This must be performed slowly and should look like you are performing a slow kick with your toes pointed up. Do not kick fast as this can aggravate the nerve and make things worse. Aim to perform this exercise until the leg becomes a bit achy then rest. This exercise can be performed throughout the day when needed.
- Piriformis Stretch – relaxing the piriformis can help to reduce pressure on the sciatic nerve which can add to your leg pain. Lie on your back and pull your knee in to your chest on the side that is affected and point it diagonally over your opposite shoulder and hold for 20-30 seconds. This will target the small glute muscle which can commonly be compressing the sciatic nerve. Repeat as many times as you need to.
- Mobility Ball / Foam Roller – targeting any of the sore areas with mobility or roller tools is recommended. A foam roller to the back can ease tension, a mobility tool in to the piriformis or sciatic nerve can help to alleviate pain levels. You will feel some discomfort in the tissue but after you finish it should feel like a relief from pain. These tools can help to relax the tight tissue such as the piriformis and also reduce nerve pain.
MoveWell clinic is hoping to open for manual therapy including sports massage in July, when their Governing Body sees it safe, and hopefully back in the purpose built cabin situated in Red Lane, Rosudgeon. But in the meantime if you need any assistance then please get in touch for online or a telephone service.