In this article, our main focus will be on the Physical therapeutic treatment of piriformis syndrome and on how to heal piriformis syndrome quickly.
Are you having pain in hip or gluteal region.
We are here to discuss about possible contributing causes, diagnosis & treatment plan for piriformis syndrome.
Icd 9-cm code
- 355.0 lesion of sciatic nerve
Icd 10-cm code
- G57.00 lesion of sciatic nerve, unspecified lower limb
It is also known as
- Deep gluteal syndrome
- Fat wallet syndrome
- Hip lateral rotator tendinitis
- Hip lateral rotator tendinosis
- Wallet sciatica
It is composed of spasm, with or without trigger points, in the piriformis muscle.
Spasm in this case, is most oftenly a result of protracted shortening, particularly with hip flexed, because this is when the muscle is most active as an external rotator (driving car for prolonged period).
Repetitive motion of piriformis muscle can cause pain & dysfunction of muscle.
In 90% of population, sciatic nerve passes underneath the piriformis muscle, decreasing the chances of hypertonicity & edema causing nervous inflammation.
But in 10% of population, sciatic nerve pierces the piriformis and hence, increases the chance of its impingement.
- Origin – internal surface of sacrum
- Insertion – at superior border of greater trochanter of femur
- Action – external rotator of thigh during hip extension and abduct the femur during hip flexion
- Nerve supply – L5, S1, & S2
- Artery – inferior gluteal, lateral sacral, & superior gluteal artery
Piriformis muscle helps to stabilize the pelvis with increased motion in sacroiliac joins or other forms of pelvic instability.
Pain in this muscle are usually associated with lumbar spine, sacroiliac & hip joint pathology.
There is one thing to keep in mind that clinician must correctly identify the underlying cause of patient’s dysfunction.
Clinician should try to look for the underlying “cause of the cause“.
What are the causes of piriformis syndrome?
Patient with prolonged sitting in their day to day work. (occupation, driving, flying, etc for long periods)
Activities in which there is extensive & repetitive lateral hip rotation.
Spinal stenosis can lead to bilateral tenderness.
Trauma to gluteal or buttock region
It can also be caused due to pregnancy
- Postural changes
- Increased weight
- Change in foot biomechanics during ambulation
There may be anatomical anomalies.
There may be Hypertrophy of piriformis muscle.
There can also be the muscle imbalance of strength & flexibility of hip internal rotators & external rotators.
How to diagnose piriformis syndrome
There are certain signs & symptoms or you can say clinical findings.
- There is pain & spasm in piriformis muscle.
- Patient can also feel pain in passive internal rotation ( particularly at the end range of motion as the spastic muscle is stretched).
- There will be a gradual buildup of edema in belly of muscle, which causes the irritation in sciatic nerve.
- Irritation of sciatic nerve leads to referral of pain along hamstring or posterior aspect of leg. [this pain will not travel further than knee].
- There will be a pain with forced hip external rotation.
- There is tingling/numbness in affected buttock & present with sitting on the toilet, bleachers or narrow bicycle seat.
after diagnosis, we will teach you on how to heal piriformis syndrome quickly.
Special test for piriformis syndrome
- Aim – identify piriformis syndrome
- Procedure – patient is supine and foot of test leg is passively placed lateral to opposite limb’s knee and then testing hip is adducted. After that observe position of testing knee relative to opposite knee.
- Findings – it is positive if the testing knee is unable to pass over resting knee and reproduction of pain in buttock or along the sciatic nerve distribution.
Treatment of piriformis syndrome
In this way, you can heal piriformis syndrome quickly.
Piriformis syndrome is a condition in which the piriformis muscle, which is located in the buttocks, irritates the sciatic nerve, causing pain, numbness, and tingling in the lower back and legs. Here are some steps you can take to help heal piriformis syndrome:
- Rest: Avoid activities that put strain on your piriformis muscle, such as running or sitting for long periods of time.
- Ice: we advise patients for Applying ice to the affected area that can help in reducing inflammation and relieve pain.
- Physical therapy: A physical therapist can help you identify the root cause of your pain and develop a rehabilitation program that can include exercises to stretch and strengthen your piriformis muscle and surrounding muscles.
- Medications: Over-the-counter pain medications, such as ibuprofen, can help relieve pain and reduce inflammation.
- Stretching: Regular stretching can help relieve tension in the piriformis muscle and reduce pain.
- Massage: Massaging the affected area can help improve circulation, reduce muscle tension, and relieve pain.
- Injections: In some cases, your doctor may recommend a cortisone injection to help reduce inflammation and relieve pain.
Remember, healing from piriformis syndrome takes time, and it’s important to work with your doctor or physical therapist to develop a comprehensive treatment plan that is right for you. It’s also important to avoid activities that may make your symptoms worse, such as running or sitting for long periods of time.
There are some oral medications which are advised in this condition like
- Analgesic, nonsteroidal anti-inflammatory drugs (NSAIDs)
- In case of injection, we use corticosteroid, botulinum toxin
physical therapy Intervention
physical therapy proves to be very effective in this syndrome and will teach you on how to heal piriformis syndrome quickly.
- We will modify the day to day life or activities of an individual in such a way that the stress on piriformis is minimal.
- For example – strenous exercises should be avoided and keep your main focus on relieving stress on piriformis.
- we usually advise patients to carry billfold or large objects in their side pockets.
It helps in relieving pain.
It helps to facilitate hip flexion and lateral rotation
use of modalities
we can use ultrasound, electric stimulation, cold laser, or cryotherapy.
Addressing lack of flexibility
- modified pose of yoga (pigeon)
- yoga “frog” pose
- supine FAIR stretch
- we should also be focusing on the shortening of muscle.
we should also be focusing on the mobilization
- we should be focusing on the active release technique for Piriformis, Gemellus superior, Gluteus Medius, psoas, iliolumbar and sacrospinous ligaments.
- we can also do nerve glides for all points of sciatic encroachment.
- we should be doing mobilization technique for the sacroiliac joint.
Piriformis Syndrome is a painful disorder caused by inflammation or spasms of the piriformis muscle in your buttocks region which can lead to hip pain, deep buttock pain, sciatica, numbness and tingling in the legs, and difficulty sitting for long periods of time among other symptoms. Fortunately, there are many treatments available for this condition ranging from rest and physical therapy to medications and surgery depending on how severe your symptoms are and how much pain you are experiencing. If you think you might have piriformis syndrome then speak to your doctor about what treatment options would be best for you so that you can get back on track with less pain!