Pain in the Butt: Piriformis Syndrome by Dr. Mercola
Pain in the Butt: Piriformis Syndrome
January 06, 2017|35,002views
Spread the Word to
Friends And Family
By Sharing this Article.
By Dr. Mercola
Pain in your buttocks and radiating sciatic pain is sometimes the
result of piriformis syndrome, or tightening and irritation of the
piriformis muscle.
This is a small, but highly important muscle that runs from your
sacrum, passes under the greater sciatic notch and attaches at the top
of the greater trochanter at the top of your femur (thigh) bone.
The function of the piriformis is to externally rotate your hip.
Piriformis syndrome may be overlooked in a clinical setting as it looks
very similar to other pelvic or lower back musculoskeletal conditions,
such as lumbar radiculopathy or primary sacral dysfunction.1
Many times piriformis syndrome responds to a holistic treatment
approach, allowing you to prevent further damage to the area without
pharmacological treatment. There are actually two types of piriformis
syndrome.2 In primary piriformis syndrome there is an anatomic cause for the dysfunction, such as a split piriformis muscle.
Secondary piriformis syndrome is more common and is triggered by a
precipitating cause, such as an injury or poor postural control. Among
those who suffer from piriformis syndrome, less than 15 percent
experience pain from primary piriformis syndrome.3
Function of Your Piriformis Muscles
Although small and seemingly insignificant, the piriformis muscle
performs important functions in your ability to walk. The muscle enables
your leg to externally rotate, or turn out from the hip so your knee is
pointing away from your body.
However, the most important function is to provide stability to your sacrum and sacroiliac (SI) joints as you walk and move.4
You have two piriformis muscles that extend from the corner of each
femur to the sacrum. They are joined together at the sacrum with a band
of connective tissue that cradles the sacral bone and adjusts the sacrum
as you move. This is the secret to how your body regulates and
stabilizes the SI joints as you walk.
Your SI joints must be loose enough to allow the pelvic bones to move
as you walk and run, but stable enough to support your spine. They are
important for balance and joint stability, and are involved in most
movements of your hips and buttocks, which is why dysfunction of the
piriformis muscle can be painful and disruptive.
In the majority of individuals, the sciatic
nerve will exit inferior to the surface of the piriformis muscle. In as
much as 22 percent of the population, the nerve pierces the piriformis
muscle, predisposing you to piriformis syndrome.5 As the muscle contracts and tightens it irritates the sciatic nerve.
Your sciatic nerve is a thick nerve that passes down the back of the
leg and eventually branches off into smaller nerves toward the lower leg
and foot. It is the longest nerve in the human body, supplying
sensation and strength to the lower leg.6
When the sciatic nerve is irritated, it triggers nerve pain from the upper thigh, through the calf and into the foot.
A delay in diagnosis may lead to more permanent conditions of the
sciatic nerve or chronic somatic dysfunction. Using compensatory body
mechanics, triggered by the pain and muscle weakness, may also lead to
muscle and ligament damage to other areas of your lower extremities or
lower back.7
Body Mechanics That Can Trigger Pain
The exact cause of piriformis syndrome cannot always be identified. Some of the more common reasons include:8
Muscle spasms after an irritation to the muscle or an irritation to a nearby structure, such as the SI joint or hip.
Muscle tightening or swelling of the piriformis muscle after an injury to the area, or muscle spasm.
Bleeding in the area of the piriformis muscle that triggers inflammation to the muscle.
Spasms, irritation and tightening may all be triggered by poor body mechanics, placing undue stress on your muscles and the surrounding structure.
Women experience piriformis syndrome more frequently than men as
their body mechanics are different, related to a wider quadriceps muscle
angle at the hip causing the angle of the joint to be wider.9
Positions that keep your leg externally rotated can increase the
tightness of the piriformis muscle and increase the likelihood you'll
suffer from pain and discomfort.
For example, sitting with one foot under your bottom, lying in bed
with your hips externally rotated (knees pointed outward) all night, or
sitting at your desk with your legs spread will keep your hips
externally rotated.
Standing in hyperlordosis will also place added stress on your lower back and the piriformis muscle.10
Hyperlordosis is an exaggerated curve to your lumbar spine. In other
words, your lower back curves inward more than it should, putting your
buttocks out, your abdomen out, placing stress on your lower back.11 Hyperlordosis
may be the result of tight muscles around the hip and spine. This
causes some muscles to be stretched and weak, and others to be tight and
contracted.12 Muscles that are more commonly affected are:
Tight erector spinae and quadratus lumborum, muscles that are trunk extensors used to stabilize the spine
Weaker rectus abdominus, internal and external oblique muscles, hip extensors, hamstrings and/or gluteus maximus
Tight hip flexor muscles
Vigorous physical activity, such as marathon running, can also
tighten the piriformis muscle, causing pain, as can prolonged sitting
and/or having one leg slightly longer than the other.
It Begins With a Pain in the Butt
Symptoms of piriformis syndrome are varied, depending upon the source
of the problem and the degree of inflammation and/or muscle tightness.
The symptoms will often start with pain, tingling or numbness in your
buttocks.13
The pain may be worse the longer you sit, or may be relieved by
sitting and get worse as you stand and stretch the piriformis muscle.
Many sufferers don't suffer discomfort while running but find climbing stairs, squatting and sitting painful.14 Application of pressure to the center of your buttocks often elicits pain or tenderness.
The pain of piriformis syndrome is centered in your buttocks, while a
proximal hamstring strain will trigger non-radiating pain at the bottom
of the buttocks where the hamstring connects to the pelvis.15
If you experience piriformis syndrome you may also have reduced range of motion in your hip joint, specifically external rotation.16
You may experience weakness in external rotation of your hip muscles as
well. You can test this by lying on a bed or table with your outside
leg externally rotated and your knee hanging off and below the surface
of the bed or table. Try to raise and lower your knee.
If you suffer from piriformis syndrome you may not be able to elevate
your knee while in this position. Since the sciatic nerve is
anatomically in close proximity to the piriformis muscle, inflammation
in the piriformis may irritate the sciatic nerve and trigger
neurological pain that radiates down your leg, sometimes as far as your
foot.
Sciatic pain symptoms feel better when walking or lying down, but worsen when sitting or standing.17
Sciatic pain is sharp and searing, rather than dull, and is described
as "pins and needles." You may also experience numbness and weakness in
this leg. This pain can be debilitating and make it difficult to stand
and walk.
Diagnosis of piriformis syndrome is based on a review of your medical
history, physical examination and an evaluation of your lifestyle
choices that may impact the development of muscle inflammation and
spasms, such as vigorous physical activity, sitting habits and prolonged
sitting.
Treatment Options
If you have piriformis syndrome, there are several options for treatment. Using a foam roller is an important part of self-treatment. Fitness trainer Jill Rodriguez demonstrates the correct technique in the video above.
Your physician may recommend using anti-inflammatory or pain
medication to help alleviate the immediate discomfort. However, natural
remedies can also help reduce inflammation,
and physical therapy, stretches and changing your body mechanics may
help reduce both inflammation and pain without pharmacological
intervention.18,19,20,21,22
Avoid Poor Body Position
It is important to avoid body positions
that trigger contraction and irritation of the piriformis muscle,
whether you have the condition or want to prevent it. By keeping your
knee pointing forward while sitting, lying down and walking, you'll
prevent your hip from externally rotating and therefore reduce the
contraction and inflammation of the muscle.
Use Ice and Heat to Reduce Inflammation
By reducing the inflammation to the piriformis muscle, you'll reduce
the irritation to the sciatic nerve and therefore nerve pain radiating
down your leg. Using ice reduces inflammation to the area and reduces
your pain, while heat increases blood supply which speeds healing. Try
alternating ice and heat to reduce pain and speed healing.
Chiropractic or Osteopathic Manipulation
Using specific stretches and manipulating your lower back, chiropractors or osteopathic physicians may be able to help reduce the pain while helping to stretch muscles that have become contracted, inflamed and have spasms.
Iontophoresis
This is a simple procedure using mild electrical current to speed
healing by improving circulation and providing electrical stimulation to
the muscles. Some practitioners may use iontophoresis to deliver
medication directly to the injured muscle, but many times just the
electrical stimulation is enough to improve your discomfort.
Massage
Physical therapists and massage therapists can work out tight muscle
areas in the piriformis and surrounding structures You can achieve
similar results at home using a foam roller. Just be mindful of your
technique to avoid worsening your condition. For more information, see "5 Foam Rolling Mistakes to Avoid."
Stretching
Stretching the muscles in your lower back help them move more smoothly and work in a coordinated fashion. Active isolated stretches (AIS) promote oxygenation and circulation to the area. Try this rope stretch from Runner's World:23
Lying on your back with legs extended, wrap the middle of a rope
around one foot, holding the ends in your hands. Lock your knee
straight and turn your toes inward. Lift your leg straight up using
your quadriceps and hip flexors until your leg is at a 90 degree angle
to the floor.
Keep slight tension on the rope in one hand while extending your
hand on the same side as the extended leg out to your side to stabilize
your body and prevent you from rolling. Keeping your leg straight,
bring it across your body and straight down to the surface until your
hip begins to roll up. Do not pull your leg into position or it may
irritate the area.
Bring your leg back to perpendicular to the floor and then back to
the first position. Repeat this eight to 10 times on both sides daily.
Maintain Good Posture
Whether sitting, standing or working out, keep your shoulders, back
and pelvis in good alignment. Avoid sitting for extended periods while
working. Get up at least every 10 to 15 minutes to walk around. Avoid
running on canted surfaces (those that place one leg lower than the
other) as it places more stress on one side of your body than the
other.
Yoga
Certain yoga poses and stretches help to improve your core muscle strength, improve your balance and stretch your lower back muscles.
Exercises
Gluteal bridges and mini-squats are exercises that help strengthen
your gluteal muscles and support your piriformis muscles. Start these
after you've been pain free for a month. Start slowly with one set of
10 and work up longer sets and repetitions daily.
Side lying clam exercises also help to strengthen your lower back.
Lie on one side, and repeat on the other side when finished. Bend both
knees and position them facing forward so your feet are in line with
your spine. Keep one hip directly over the other and your back
straight.
Keeping your ankles together, raise your top knee without moving
your back or tilting your pelvis. All movement comes from the hip.
Repeat 15 times building to 2 sets of 20.
Spread the Word to
Friends And Family
By Sharing this Article.
Email
No comments:
Post a Comment