I thought I would write a bit about Piriformis Syndrome (PS) since I have had a few clients recently with this condition and I know from the literature that it is relatively under diagnosed. I see so many people in Southampton with symptoms of ‘sciatica’ or gluteal pain that it inspired me to write this blog on how Sport Massage and Deep Tissue Massage can be of real benefit.
Piriformis Syndrome occurs when the sciatic nerve is compressed or irritated by the piriformis muscle in the hip. Piriformis is a small muscle that connects the lower spine to the upper surface of each thigh-bone and its action is to assist in rotating the hip and turning the leg outward.
PS can present as pain in the buttocks or lower back, pain, numbness or tingling in the back of the thigh and down the path of the sciatic nerve into the lower leg. It is often brought on by long periods of walking or sitting. The reason it is overlooked in some clinical settings is be because it can either present like lower back strain and is therefore not treated adequately, or it presents as ‘sciatica’ which is the name given to any pain caused by irritation of the sciatic nerve but is not a diagnosis in itself. As well as PS, sciatica can be caused by a herniated disc, spinal stenosis (narrowing of the spinal canal) or infection or trauma to the spine. Due to these more sinister conditions, the relatively benign PS is often overlooked. As a Massage Therapist, when people complain of ‘sciatica’ detection for piriformis syndrome is part of the consultation to treatment as Sports Massage is effective at stretching and relaxing the muscle and connecting muscles and tissues and relieving the strain and the discomfort.
Causes of PS include overuse and strain. A common reason for overuse is the fact that a lot of us sit down at a desk for much of the day. This trains our hip flexor (thigh) muscles to be short and tight and deprives our gluteal (buttock) muscles of being used. As our gluteal muscles become weak, other surrounding muscles such as piriformis and hamstrings have to perform extra roles that they have not evolved to do. Piriformis then gets tight and may swell causing irritation to the near by sciatic nerve. Overuse and strain can also result from activities performed in the sitting position eg rowing and bicycling that involve strenuous use of the thighs, which can become short and tight. The gluteal muscles become disproportionately weak which leaves piriformis susceptible to overuse and strain. Another potential cause is over-pronation of the foot. In the situation the knee is tempted to role towards the midline and piriformis contracts to prevent over-rotation of knees.
After assessment and if appropriate soft tissue therapy can commence. The aim of deep massage is to encourage repair of piriformis, to reduce spasm and therefore its grip on the sciatic nerve.
Other muscles of the buttock and thigh can also be released using a technique called Myofascial Release. A regular stretch routine (including piriformis) will be recommended as well as strengthening exercises for the gluteal and hamstring muscles.
Other treatments may include anti-inflammatory medications used as pain relief or an injection of steroid or anaesthetic which numbs the pain and therefore enables the client to stretch piriformis.
How to prevent PS?
Avoid prolonged sitting, include bouts of standing if working at a desk, warm up before exercise. Regular stretch and strengthening with the help of an experienced Sports Massage Therapist like the ones at YOU Massage Therapy Southampton