What is piriformis syndrome?
Wikipedia’s definition is:
Piriformis syndrome is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing pain, tingling and numbness in the buttocks and along the path of the sciatic nerve descending the lower thigh and into the leg.
In my experience as a Sports Massage therapist, this occurs more frequently than the other main cause of sciatic pain; a slipped (or herniated) disc. With Piriformis syndrome, the modalities (when it is worse or better) are different to a slipped disc. The patient is better when active, worse when sat down. The pain is often worse when driving and the condition is common in those who drive long distances. The reverse is more likely to be true with a slipped disc- the symptoms improve when at rest, and are worse for moving around.
Other indications for a tight piriformis are that the patient stands with the feet in an everted position- so that they are splayed outwards. This can be clearly seen with the patient on the couch by the way the foot naturally tends to turn outwards.
What can we do to help?
Luckily, sports massage and trigger point treatment of piriformis are highly effective methods to ease sciatic pain, restoring the hips to more balanced functioning. Usually, a patient feels immediate benefit from one treatment so long as they can tolerate some solid and sustained elbow pressure in the buttock!
Following a course of treatments allows for addressing other problems in the hips that will often accompany a tight piriformis. This includes over-active hip flexor muscles, tension in the lower back, and under active glutes and core. Ah yes, the infamous core, that everyone is aware of these days! It’s probably the subject of another blog article, but it’s worth saying here that improving core muscle tone is one half of the equation; the other being putting that into practice through awareness of those muscles.
I advise people to practice, as an exercise, switching between 100% core activation (that’s glutes, lower abdominals and pelvic floor) and 0% to get a feel of the upper and lower limits, then try to aim for 30% as a general state for standing, sitting, running, and all the rest.
Lastly, the magic of tennis ball release is an excellent way to keep piriformis troubles at bay. This is how it’s done: