Piriformis Syndrome – September 2021

I have had many calls in this August 2021 lockdown with people having severe low back and leg pain. On average six a day to date.  As we have been hamstrung by the Ministry of Health (excuse the pun) and advised to send people to the nearest DHB/ Hospital as opposed to seeing them in person to care for them.  This a little ironic for given they are most concerned the hospital system will become over loaded and crash of too many people end up there….

I thought I would share some home help for people whom are experiencing this and may find this advice helpful.  As you are all aware when we are under house arrest we sit a lot more, a lot, lot more. For those of you whom are still lucky enough to be employed and working from home you will be glued to these screens. This article will help you to mobilise and stretch the muscles of your pelvis that can sometimes be responsible for sciatica.

Essentially two muscles that cross and thus stabilize the sacroiliac joint are the gluteus maximus (or buttock muscle) and the piriformis.

The Piriformis  muscle  originates from the anterior (or front) part of the sacrum and inserts into the greater trochanter (the large “bump” on the outside of the upper thigh) of the femur. Its action is mainly to externally rotate (or “turn out”) the femur and hip.

 

 

The sciatic nerve is a bundle of nerves composed of nerves from the lower spine (~levels L4-S3) and usually runs its course under the piriformis. In some people the sciatic nerve actually goes through the piriformis muscle.

Piriformis syndrome occurs when the piriformis is overly contracted, shortened, or tight and puts pressure on the sciatic nerve. The result of this is usually a real  “pain in the butt” and possibly down the back of the thigh, and sometimes pain that radiates into the low back.  People are telling me they find this so severe no medication can relieve.

I have often found that when the piriformis over works because the gluteus maximus is under performing, under functioning or not switching on. They are designed to help each other out, and when the gluteus maximus isn’t switching on the piriformis can reflexively over-contract or shorten to give the most support possible. The result is then excessive pressure or irritation to the sciatic nerve.

What I would do in the practice, what you can do at home ?

In the practice we would clear subluxations in your pelvis and low back along with the upper cervicals’ along with releasing the psoas and piriformis through soft tissue techniques.  We would also make sure your symptoms are not coming from a disc bulge or disc herniation which can also cause these symptoms and is a little more serious.

Additionally we look to see if you have ligament instability, or any lower limb dysfunction.  Occasionally it can be from a vitamin e deficiency.

Sometimes an inhibited piriformis on the opposite side or inhibited internal hip rotators contributing to or causing the problem. Because of the inter-connectedness of our bodies and the way the nervous system affects everything I  examine  all parts of the body to address the cause.

For the purposes of what is most likely happening to the calls I am  receiving during this lockdown, is people are not firing enough, sitting on their butts, subluxating their necks, low backs and or pelvis from a lack of activity and a lack of their regular chiropractic care.  Following long periods of inactivity, people are exerting themselves through say moving bags of cement around the yard, or house work in a crouched position upon which time the Piriformis over tightens.  Not even heavy pain killers and anti-inflammatory meds are relieving the pain.

 

What can I do at home to help?

 

Sleeping Position

To avoid irritating the hip muscles, including the piriformis, or getting those radiating spasms, place a supportive pillow or a folded blanket below your lumbar spine to ensure your spine is parallel to the floor.

 

 

Stretching

1. Simple Seated Stretch

  1. Start by sitting in a chair and cross your sore leg over the knee of your other leg.
  2. While keeping your spine straight, bend your chest forward. If you don’t feel pain, bend forward a little more.
  3. Hold this position for about 30 seconds.
  4. Repeat this stretch with your other leg.

2. Standing Piriformis Stretch

If you have trouble balancing with this stretch, stand with your back against a wall and your feet about 24 inches from the wall for extra support.

  1. While standing, place the leg that’s causing you pain over the knee of your other leg. It should create the shape of the number 4.
  2. Lower your hips at a 45-degree angle until they reach the ground. Bend the leg you’re standing on as needed.
  3. As you bend forward at the waist, reach your arms down to the ground while keeping your spine straight.
  4. Hold for 30-60 seconds.
  5. Switch legs when done.

 

 

3. Supine Piriformis Stretch

  1. Lie down and bend your knees upwards.
  2. Cross the affected leg over your other leg and bend it upwards toward your chest.
  3. Grab your knee with one hand and your ankle in your other hand. Pull the bent leg across your body until your glutes are pulled tight.
  4. Hold for 30 seconds to a minute and release.

4. Outer Hip Piriformis Stretch

  1. Lying on your back, bend your sore leg upward and place your foot close to the back of your other knee.
  2. Tuck your foot behind that knee and twist your leg to the opposite side. Your knee should be touching the ground (or as close as you can get).
  3. Place the hand on your opposite knee and raise your opposite arm in the air.
  4. Hold for 20 seconds.
  5. Switch to the other leg.

You’ll want to recover from this stretch! Lie on your back, bend both knees together and gently pull them with your hands toward your chest.

5. Groin/Long Adductor Stretch

  1. Sitting on the floor, stretch your legs straight out in front of you, spread as far apart as possible.
  2. Place your hands on the floor next to each other while angling your torso forward toward the ground.
  3. Lean forward and rest your elbows on the ground. If you encounter pain, stop right away!
  4. Remain in the position for 10-20 seconds.

6. Inner Thigh/Short Adductor Stretch

  1. While sitting on the ground, put the soles of your feet together in front of your pelvis.
  2. Hold your ankles with the opposite hands (left hand – right ankle and vice versa).
  3. Gently push downward with your knees with the effort to touch the ground with them. You need to stop right before any pain occurs, which means that if you feel pain, get back an inch or two and stay there.
  4. Hold for 30 seconds, release, and flutter your legs in that position (like a butterfly) for 30 seconds.

Want an even deeper stretch? Push your knees down with your elbows or bend your torso forward while keeping your back straight.

7. Side Lying Clam

  1. Lie down on the side of your body that isn’t in pain.
  2. Bend your legs back, holding one foot over the other and keeping your legs parallel to each other. You should be creating an “L” shape.
  3. Keeping your feet together, lift up the top knee while keeping the rest of your body in the original position.
  4. Slowly bring your knee to the initial position.
  5. Repeat 15 times.

8. Hip Extension

  1. Get down on the ground on all fours, making sure your hands are in line with your shoulders.
  2. Raise your affected leg upward with your knee bent toward the ceiling.
  3. Gradually lower your leg until it’s almost touching the ground.
  4. Repeat 15 times

9. Supine Piriformis Side Stretch

  1. Lie on the ground with your legs flat and back straight.
  2. Bend your sore leg upward, resting the foot on the outer side of the opposite leg beside the knee.
  3. Ease the knee of your affected leg across the middle of your body with your opposite hand until you feel a stretch, making sure to keep both your shoulders and hips on the ground.
  4. Hold for 30 seconds, return to the starting position and switch legs.
  5. Repeat the process 2-3 times.

10. Buttocks Stretch for the Piriformis Muscle

  1. Place your hands and knees on the ground, getting into position on all fours.
  2. Bring the foot of your affected leg underneath your stomach, twisting it toward the opposite side near the hip, while pointing with the knee toward the shoulder.
  3. Lower your head, until your forehead touches the ground, and lean your forearms on the ground for support.
  4. Slowly stretch the non-affected leg out behind you, while keeping your pelvis straight.
  5. Push your hips slightly toward the floor.
  6. Hold for 30 seconds and return to the initial position slowly. Repeat 2-3 times.

If you want a movie. This Physio does a great explanation.

https://www.youtube.com/watch?v=5ZXJEO6fc-4

 

 

Trigger point therapy

This can also be done with a cricket, hockey, golf or tennis ball. Roll for 30 – 60 seconds. This can be super painful.