This is the first entry in our monthly physiotherapy blog. Our goal is to provide useful information to all of our interested clients and colleagues on subjects that can benefit almost everyone.
The Problem
Piriformis syndrome (PS) or ÂWallet Neuritis is a peripheral nerve entrapment of the sciatic nerve as it exits the sciatic notch and courses under the piriformis muscle. Most people with PS report symptoms of hip pain, buttock pain, intolerance to sitting, and sciatica. Sciatica refers to an aching, burning, or sharp pain that radiates down the leg and can result in motor weakness, numbness, or both.
In a small percentage of the population, the sciatic nerve actually pierces the piriformis muscle, splits the piriformis muscle, or both. If symptoms manifest here, this is known as a Primary Cause of PS; however, this is only believed to occur 15% of the time.
In the other 85% of cases, a Secondary Cause is identified. These include:
- trauma to the piriformis muscle i.e. falling onto the buttock
- arthritis of the sacroiliac joint
- overuse causing a myofascial trigger point to develop
- postural faults such as a leg length discrepancy, or standing with the leg laterally rotated
- having a mechanical problem in the sacrum or low back
- gait abnormalities i.e. excessive pronation may also contribute to this condition
PS may of course mimic other conditions. A complete history, physical and neurologic assessment should be performed by your doctor or physiotherapist to ensure an accurate diagnosis. Other musculoskeletal conditions resembling PS include: lumbosacral radiculopathies, degenerative disc disease, a herniated disc, compression fractures, spinal stenosis, lumbosacral strain, ankylosing spondylitis, hamstring syndrome, or trochanteric bursitis.
The Who
PS is believed to occur in approximately 10% of people with low back pain and sciatic nerve problems. PS is more common in women than men, possibly due to the biomechanics associated with the wider pelvis of women.
The Solution
The physiotherapy management for PS consists of soft tissue release techniques for the piriformis muscle, mobilization or manipulations of the low back and sacroiliac joint. Modalities such as ice, heat, ultrasound, transcutaneous electrical nerve stimulation or interferential current may also be utilized to help manage any pain or muscle spasm associated with PS. Some therapist will also be able to offer dry needling techniques such as intramuscular stimulation (IMS) and acupuncture.
Sleeping with a pillow between your legs is often recommended as it may help to take the stretch off the piriformis muscle and prevent irritation. A home exercise program of stretches for the piriformis muscle, core/stability exercises for the back and gluteal muscle strengthening may also be prescribed by your therapist.
For more information on any of these treatment technique or modalities, please contact the Vancouver Physiotherapy and Sports Clinic and speak to one of our physiotherapists. And donÂt forget to like us on our Facebook page. You can also check us out on Twitter at @physiovancouver.