Commonly a result of overstretching, trauma, or prolonged bad posture, piriformis syndrome can be the proverbial pain in the buttocks. These symptoms of the piriformis muscle dysfunction may be caused by other clinical entities that include gluteus medius dysfunction, herniated or bulging disks, "sciatica" and other musculoskeletal problems in this area i.e. sacroiliac joint dysfunction, knees, ankles and heels.

With piriformis syndrome,  the piriformis muscle contracts and sandwiches/compresses the sciatic nerve, producing numbness and pain going down the thigh and calf.. If the compression is on the inferior gluteal nerve (a branch of the sciatic nerve), the pain will be in the buttock (local symptoms).

Anatomically, the piriformis muscle lies deep to the gluteal muscles. It originates from the sacral spine and attaches to the greater trochanter of the femur, which is the big, bony "bump" on the outside top of the thigh. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle. It is thought that acute or chronic injury causes swelling of the muscle and irritates the sciatic nerve, resulting in sciatica. Patients with an aberrant course of the nerve through the muscle are particularly predisposed to this condition.

It is very common to lean away from the side of the contracture in order to reduce the compression of the sciatic nerve. The great majority of these conditions that present have already been through a gamut of procedures, medications or injections with little or no improvement.

Types of correction

Muscular massage helps to reduce the spacticity and fibrotic muscle, usually quite effectively on its own.  In some cases, mobilization of the sacroiliac and lumbar spinal joints helps to restore biomechanical integrity and improve overall motion. Posture training is another pillar of rehabilitation.

As is the case in most muscle disorders, the indication of the appropriate stretching exercises for the muscles involved will assist in a speedy recovery. A course of daily stretching exercises is recommended (part of the protocol) to patients to assist in recovery of the muscles and tendons. Targeting the piriformis is done with a single knee to the chest with painful side cross-over.

It is convenient to apply heat for 15 to 20 minutes before the massage and stretching exercises are done in order to increase the elasticity of the muscle, and ice for five minutes afterward in order to reduce the inflammation produced by the stretching exercises.

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