myosesh Musculoskeletal post Piriformis Syndrome

Piriformis Syndrome



People often come in the clinic saying lower back pain with some numbness in hip and legs.

You may feel shooting or burning pain in the hip and hamstrings if you have this condition as sciatic nerve originates from L4, L5, S1, S2 and S3 and passes below piriformis muscle. Therefore, when piriformis gets tighten, irritated or inflamed, it affects sciatic nerve.

Piriformis muscle

Origin: Anterior part ofsacrum between S1-S4

Insertion: Upper part of the greater trochanter

Action: External rotation of the hip and stabilize the hip joint

Innervation: Nerve to Piriformis S1-S2

Aetiology

  • Poor body mechanic such as toes facing outside and SIJ dysfunction
  • Prolonged sitting
  • Hypertonic piriformis muscle
  • Trauma to the hip such as injury, direct invasion
  • Bipartite piriformis muscle

Signs and symptoms

  • Pain in one hip and may go down to the back of the leg
  • Pain with movement such and prolonged sitting, walking, running and squat
  • Toes face outside
  • Pain when you get out of the bed
  • Numbness, sharp and burning pain
  • Pain at the night

Assessment

Differential diagnosis

  • Trigger point of gluts muscle
  • Herniated disc
  • Lumbosacral radiculopathy
  • Sciatica
  • Hamstrings injury
  • Spondylosis

Treatment

  • Hands on treatment
  • Dry needling
  • Stretching (videos on instagram)
  • Work on and activate muscle to fix the posture that causes piriformis issue

It is important to rule out other conditions such as disc injury or SIJ dysfunction.

If any movement like hip flexion and external rotation causes same pain, treat piriformis and get the patient to be in same position to see if it improves pain level or not.

Reference

  • Brandon L. Hicks ; Matthew varacallo Piriformis Syndrome 2019 Stats Pearls (internet)

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