The piriformis muscle is one of those muscles that most people don’t know much about, but greatly effects our everyday lives as well as our athletic careers. The piriformis muscle is thought to help externally rotate the hip or in other words turn the foot outwards. It plays a role in locomotion and there is some evidence it helps with extension of the hip. How many times per game are you rotating your foot or extending your hip. If you are like most athletes the answer is probably a lot.
While the piriformis muscle is small it can be a big source of hip, low back, and leg pain. There are a couple of reasons why this might happen. The first one is that the piriformis muscle may split in half with the sciatic nerve running through the muscle. When the muscle contracts it is compressing down on that nerve and causing irritation. This is an anatomical variant. The second way that the piriformis muscle might cause someone pain is just by being very tight or inflamed. The piriformis muscle generally runs on top of the sciatic nerve and when hypertonic (overly tight) or inflamed it may cause mild compression of the sciatic nerve again leading to irritation of the nerve.
The sciatic nerve for obvious reasons plays a large part in the pain that people in Fox Chapel may experience when it is coming from the piriformis muscle. Whether the muscle lays on top of the nerve or the nerve bisects the muscle, compression of the muscle often causes some pressure to be placed on the sciatic nerve. This can then lead to irritation and inflammation surrounding the nerve. The nerve then transmits pain signals because of this.
HOW IS IT DIAGNOSED?
Look the best way to determine if piriformis muscle is the source of your pain is by going to a musculoskeletal specialist and have them perform some tests. There is a decent amount of controversy on whether the piriformis is truly a source of back and leg pain. The evidence appears to indicate that the piriformis can be a source of pain, however other causes are more likely. The best way for a clinician to test for the piriformis being a source of pain is probably the FAIR orthopedic test. In this test the clinician at Tauberg Chiropractic & Rehabilitation has the patient lay on their side takes the patients leg and drops the knee inward causing the hip to adduct and internally rotate. This stretches the piriformis muscle and if it is the source of the patient’s pain is likely to reproduce symptoms.
One way to check at home if the piriformis might be the cause of your pain is to lay on your back take the leg which is experiencing the symptoms and cross it over the other leg above the knee. It will look like you are making a figure 4 with your legs. Then bend the straight leg at the knee and place the bottom of your foot on the ground. You will now be bending at the hips on both sides if you are doing this correctly. If you experience increased symptoms this may indicate the piriformis is bothering you. Regardless it is still best to get a medical consultation.
HOW CAN CHIROPRACTIC IN FOX CHAPEL HELP?
There are a few things that a chiropractor can do to help with this sports injury. Manipulation to the hip and low back, IASTM, myofascial release, and exercise therapy are all effective treatments for piriformis syndrome. The best thing to do usually is to combine all of them together in one treatment plan to help a patient with this condition. A musculoskeletal expert such as the one at Tauberg Chiropractic & Rehabilitation in Fox Chapel can better determine exactly which of these techniques should be used and which ones should be avoided.
WHAT CAN YOU DO IN THE MEAN TIME?
Stretch: I have found that the best way to stretch the piriformis muscle, which you probably should be doing after an intense lower body work out regardless of if you have pain or not, is to assume the same position you would for the at home test. Lay on your back, take the leg which is experiencing the symptoms and cross it over the other leg above the knee. It will look like you are making a figure 4 with your legs. Then bend the straight leg at the knee and place the bottom of your foot on the ground. Then hug the bent leg. This should give you a pretty good stretch in the buttock area.
Avoid further strengthening of the area: Since hypertonicity (tightness) of the piriformis muscle is likely the cause of piriformis syndrome it is not ideal to strengthen the muscles in this area. Instead of strengthening the piriformis, or the muscle surrounding it, it may be a good idea to strengthen muscles that work in opposition to the piriformis. Those muscle are generally the extensors of the hip such as the iliopsoas or the rectus femoris. The easiest way to strengthen those muscles are probably by doing resisted (weighted) leg lifts.
Kevork Hopayian, F. S. (2010). The clinical features of the piriformis syndrome: a systematic review. European SPine Journal, 2095-2109.
Lori A. Boyajian-O’Neill, D., Rance L. McClain, D., Michele K. Coleman, D., & Pamela P. Thomas, P. (2008). Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach. The Journal of American Osteopathic Association, 657-664.