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.
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
- 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
- Piriformis test (prone hip internal rotation After 5mins of this video): https://www.youtube.com/watch?v=e3r29g7k2Hk
- Piriformis test https://www.youtube.com/watch?v=zha5jIv4_44
- Resisted External rotation: lie down on the stomach, knees bent at 90 degrees and together. Then practitioner put hand between medial side of the ankle and get the patient to bring leg (ankle) medially with resistance of practitioner.
- Trigger point of gluts muscle
- Herniated disc
- Lumbosacral radiculopathy
- Hamstrings injury
- 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.
- Brandon L. Hicks ; Matthew varacallo Piriformis Syndrome 2019 Stats Pearls (internet)