One of the many potential causes of pain and numbness is Piriformis syndrome. Simply put, this is when the piriformis muscle (located in the buttocks, underneath the gluteus maximus muscle) becomes irritated. The piriformis muscle runs all the way from the gluteal region of the spine through the pelvis, over to the top of the femur (thigh bone). This muscle is responsible for rotating the leg outward through rotation of the hip.
Common symptoms of Piriformis syndrome are deep aching in the buttocks, numbness or tingling down the back of the leg, or discomfort while walking up or down stairs.
As we have discussed in previous posts, we perform an exam that takes detailed history into account to determine an accurate diagnosis.
Completing factors and orthopedic tests allow us to make an informed determination of the issue. (Imaging such as X-rays will not be of much use—while it may provide information about the sacroiliac joint or the hip, it will not show much in regard to soft tissue.) Once we have determined that the patient does, in fact, have Piriformis syndrome we can then address some of the underlying causes.
The piriformis muscle may be sitting on top of the sciatic nerve, which is a large nerve traveling down the back of the leg. We have talked about sciatica in the past, which is irritation of the nerve, causing pain down the leg. Many times, the cause of the patient’s Piriformis syndrome is simply a muscle spasm that is aggravating the sciatic nerve. Another potential cause is the tightening of the muscle due to some sort of injury.
Rarely, Piriformis syndrome may be due to overuse or some underlying biomechanical issues. If there is limited hip joint movement, there will be compensation in the piriformis muscle. In addition, being seated for extended periods of time may often aggravate the issue.
As with any inflammatory response, we will address inflammation with ice, some type of anti-inflammatory, and rest. Of course, the patient should always avoid activities that will further aggravate the problem. We can then move to a therapy-based approach from a chiropractor, physical therapist, or even perhaps an athletic trainer. Stretching the muscle by performing some simple exercises will reduce any tension.
For patients that have been properly diagnosed with Piriformis syndrome, there are many simple stretch exercises available online. (I do not recommend looking up exercises before obtaining a proper diagnosis.) These exercises will hopefully remove any tension on the sciatic nerve. In addition, there has been new research indicating that stretching the hamstrings is beneficial as well.
Increasing range of motion in the piriformis muscle and hip joint is also an effective step during treatment. (In the past, we have spoken about our model that focuses on mobility and stability here at Tulsa Spine and Rehab.) Finally, we want to determine if there are any deficiencies in stability, e.g., in the gluteus medius or the hip stabilizers. Stability exercises will likely contribute to a strengthening of the musculature.
In some cases, the patient will not respond well to a therapy-based approach. Their pain management physician may decide to inject local steroids or pain relievers in that case. There is even research in which physicians are using Botox (botulinum toxin) to relax the muscle and reduce irritation.