Piriformis syndrome is a condition that develops due to irritation or compression of the Sciatic Nerve while passing through piriformis muscle. The piriformis muscle is located deep inside of the gluteus muscle connecting the hip bone and sacrum. The piriformis muscle usually gets tight with trigger points (irritated muscle knot) and it can interfere with the conduction of sciatic nerve resulting in weakness, pain and strange sensation in lower leg, ankle and foot.
The sciatic nerve directly innervates hamstring muscles and indirectly innervates the entire lower leg and foot muscles via its two branches, Tibial nerve and Common fibular nerve.
Tibial nerve – the muscles of the posterior leg (calf muscles), and some of the intrinsic muscles of the foot.
Common fibular nerve – the muscles of the anterior leg, lateral leg, and the remaining intrinsic foot muscles.
What is the symptom of piriformis syndrome?
- Pain in the buttock or hip area is the most common symptom.
- Radiating pain or numbness from the buttock area down into the lower leg
- Tenderness in the buttock area when pressure is applied.
- Achillis and calf muscle pain or stiffness
- Lower leg weakness and imbalance
When suspect Piriformis syndrome?
- The entire foot, ankle and toe weakness (Not a single muscle weakness)
Check toe dorsi flexion, plantar flexion, ankle inversion, eversion, dorsi flexion, plantar flexion. If all directions are showing weakness, go and check piriformis muscle.
- Pain in the calf muscle or achilles is not relieved with local treatment
When local muscle or tendon treatment is not successful, we need to suspect the higher structure such as the innervating nerves or the muscles that can entrap the nerve.
How to confirm/ diagnose Piriformis syndrome?
- Direct Palpation on piriformis muscle (It is common seeing twitching response from the muscle having trigger point)
- After trigger point release in piriformis, retest muscle strength in the ankle, foot and toes (If the strength gets stronger, the source of weakness is piriformis muscle)
How to treat the piriformis syndrome?
- Trigger point therapy in the piriformis muscle
Perform Trigger point release manually. Using fingers or elbow spotting on the point and hold with proper amount of pressure until feeling it softens up.
- Piriformis stretching program
Figure 4 stretch in supine and seated position, Pigeon stretch
Piriformis stretching with form roller
- Gluteus strengthening program
Week gluteus muscle can cause piriformis muscle over-activation and tightness.
Thus, strong Gluteus muscle can prevent the deep muscle tightness.
Also, repeating strengthening and stretching improves muscle condition.
Exercise protocol: dynamic stretching for warm up – strengthening – stretching with form roller – regular stretching