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The Body Restoration Massage Group
Piriformis syndrome is the compression of the sciatic nerve by the piriformis muscle. To the general public conditions
that affect the sciatic nerve and refer pain down the back of the thigh are often referred to as Sciatica. This term
is not specific, because it may refer to inflammation or compression in the lumbar spine, gluteals or at another
point along the nerve.
Functions of Piriformis:
Restrain rapid internal rotation of the hip eg: running
Externally rotate the femur when the hip is extended or in neutral.
Horizontally abduct the thigh when the hip is flexed to 90 degrees.
Internally rotate the femur when the hip is fully flexed.
Anomalies in the course of the nerve, such as penetration of the piriformis muscle.
Direct or indirect trauma eg: fall on the buttocks or MVA.
Inflammation or degenerative changes of the piriformis muscle, its fascia of adjacent joints.
Overuse with repeating bending and lifting, forceful rotation with weight on one leg, squatting while
holding a weight.
Postural and positional concerns. Hyperpronation tends to increase internal rotation and adduction of the thigh
during walking; the piriformis is overworked as it tries to control the excessive rotation. Flexion contracture or
hyperlordosis can cause tension in hip stabilizing muscles. This usually occurs in the 3rd trimester of pregnancy due
to the shift in the centre of gravity. If muscles is placed in a shortened position for a prolonged period, the piriformis
becomes hypertonic and can compress the nerve. Eg: sitting with knees abducted (often with ankles together);
sitting on one foot; driving a car for prolonged periods with a foot on the accelerato.
Anything that leads to or aggravates trigger points, which will in turn cause shortening of
the muscle such as sitting on a wallet in a back pocket
Usually unilateral. Compression of the sciatic nerve results in pain and paresthesia in the posterior
thigh, calf and sole of the foot. Sometimes accompanied by numbness in the foot.
Compression of the gluteal nerve causes buttock pain, with possible gluteal atrophy.
Active trigger points in piriformis result in pain in the low back, buttocks, hip and posterior thigh.
If both nerve entrapment and active trigger points, the pain is increased by sitting with
prolonged hip flexion, adduction and medial rotation, by arising from a seated position
of by standing. Usually aggravated by activity
Pain often decreases with external rotation
No massage locally for 10 days after a cortisone injection
No frictions are performed if the client is on anti-inflammatories
Joint play, with hip and sacral mobilizations are avoided in the 3rd trimester, and
performed with caution with OA or with a degenerative condition affecting the hip or
Treat soft tissue and compensatory structures eg: such as hypertonicity and trigger
points, and from altered posture
Decrease compression on the sciatic nerve, and reduce fascial restrictions
Reduce pain, hypertonicity and trigger points
Maintain range of motion
Reduce edema if present
A 60 minute treatment allows a thorough treatment of the lower body
Initially, treatments are more frequent, ideally twice a week for a few weeks. Otherwise,
once a week for 4 – 6 weeks is recommended.
If pregnancy is the cause, the condition will often resolve postpartum
If the cause involves soft tissue, the prognosis is good, providing the client is complaint
with the self-care program.
Client can perform a self-stretch for the piriformis using a belt or rope
Strengthen weak muscles
Pillow between knees while sleeping on side to prevent excessive adduction of the hip
Frequent breaks to stretch or walk
Chiropractic adjustments may be necessary if there is sacroiliac joint dysfunction
*This is not intended for self-treatment. It is for information purposes only*