Also known as false sciatica, piriformis syndrome is a pathology that can cause pain and a tingling feeling from the buttock to the knee.
When a person suffers discomfort in the form of pain or a tingling feeling that starts in one of the buttocks and extends down to the knee, we are likely to think there may be a herniated lumbar disc or herniation affecting the sciatic nerve. However, there are other less common pathologies that can produce these sensations as well. One of them is what is known as piriformis syndrome. As its name suggests, it affects the muscle that bears the same name. But to understand this condition, it is important to know what the piriformis muscle is, its function, and where it is located.
This muscle is located in the pedicles of the third and fourth sacral vertebra, that is, in the deepest area of the buttocks. However, it extends to the greater trochanter of the femur and is also one of the six short external rotators of the hip. And there's more. Because of its position, the piriformis muscle is closely linked to the trunk of the sciatic nerve, and serves both as a hip flexor and for hip stabilization.
What is piriformis syndrome?
Also known as false sciatica, piriformis syndrome occurs when there is compression of the sciatic nerve as it passes between the piriformis muscle and the superior gemellus muscle. Basically, we are talking about a contracture of the piriformis muscle that causes pressure on the sciatic nerve, causing pain and tingling sensation that can radiate from the buttock to the knee.
Common symptoms
This pain in the buttock area, which can extend as far as halfway down the leg, and even to the back of the thigh, is one of the most frequent symptoms of piriformis syndrome. But there are others:
- Tingling sensation in the hamstrings (back of the thigh).
- Pain going when going up or down stairs or inclines.
- Pain when walking, or sitting for long periods, or when crossing one leg over the other.
- Reduced mobility of the hip joint.
Although, a priori, the symptoms of piriformis syndrome are reminiscent of those of sciatica or lumbar disc herniation, the truth is that there are small differences that can help distinguish one from the other. In the case of problems related to disc herniation or to the sciatic nerve itself, the pain is usually focused on the area of the lesion.
However, in the pathology related to the piriformis muscle, the pain can radiate to other areas such as the knee, the back of the leg and, sometimes, the lower back. Another important difference has to do with the fact that, in the case of piriformis syndrome, once the muscle is relaxed and the nerve is decompressed, the symptoms disappear.
Causes of piriformis syndrome
This pathology originates with pressure on part of the path of the sciatic nerve, but there is no single cause that triggers piriformis syndrome. Its symptoms, however, can help identify the reasons that make it more likely to develop.
For example, some of the most common causes of piriformis syndrome are:
- Contracture of the piriformis muscle. This is the most frequent cause because it involves the compression of the sciatic nerve and, consequently, the beginning of pain.
- Increased physical activity: overtraining or not letting the muscles rest sufficiently between sessions can also be the source of muscle contractures and, as a result, lead to developing piriformis syndrome. The same thing applies to muscular decompensation.
- Sitting for long periods of time: a sedentary lifestyle is another enemy of muscle health, and can cause problems in the piriformis muscle. Keeping your legs crossed, or holding some other bad position for a long time does not help either.
- Other causes: sometimes a fall, getting hit by something, a hip operation, or even surgery in the abdominal area can also be behind a diagnosis of piriformis syndrome.
Piriformis syndrome treatment
Physical therapy is one of the most effective treatments for piriformis syndrome. This is because the nature of this pathology is that it most often originates in a contracture of the piriformis muscle itself. Specialized physical therapy to relieve pressure may prove more effective for muscle relaxation than using painkillers.
In general, manual physical therapy, with both invasive and non-invasive techniques, is useful for helping patients with piriformis syndrome get back their quality of life in the shortest possible time. Instrument-assisted therapies can also be used when the patient's situation requires it. Among these types of therapies, two of the most commonly used are dry needling – in which a needle similar to those used in acupuncture is used in order to reach where the professional's fingers cannot, and pulsed electromagnetic field therapy (PEMS) – a variant of the TENS technique (transcutaneous analgesic electrical neurostimulation) based on the percutaneous application of sterilized filaments that penetrate the muscle, although there are other instrument-assisted techniques as well.
In those cases in which physical therapy does not achieve the desired results, infiltrations are another alternative for treating piriformis syndrome. This is a procedure intended to relieve pain with injections of certain steroidal anti-inflammatory medications, either on their own or in combination with local anesthetics.
In addition to the treatments listed above, it is important to remember that avoiding prolonged sitting, excessive exercise, and poor posture, and, instead, practicing stretching, adapted mobility exercises, and following the advice of professionals, is the best way to recover from and put an end to piriformis syndrome.
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Categories: Back pain, Lumbar pain, Rehabilitation