Piriformis Muscle Pain

When you feel pain in the buttocks and in the lower back which is radiate down the leg to the foot, it is indicated to be Piriformis muscle pain.

What is Piriformis muscle pain?

Piriformis muscle pain arises in the buttocks or lower back which is radiate down the leg to the foot.
Piriformis muscle pain is generally due to compression or contraction of the piriformis muscle in certain places of the sciatic nerve;
The most common risk factor of Piriformis muscle pain is overuse or trauma from sports, but other conditions are produced by symptoms.

Anatomy of the Piriformis muscle?

• Piriformis is a muscle of the gluteal area which is situated deep to the gluteus maximus.
• This muscle is attached to one end with the sacrum and the other one is with the greater trochanter.
• This Piriformis muscle is responsible for stabilizing the hip joint and moving the thigh in different directions.
• This Piriformis muscle is a flat pyramid-shaped muscle that originates from the anterior surface of the sacrum, between the sacral foramina.
• Then it passes laterally to exit the pelvis bone via the greater sciatic foreman, often it is connected to the gluteal surface of the ilium, which is close to the posterior inferior iliac spine.
• This muscle is inserted into the apex of the greater trochanter with the posterosuperior to the insertion area of the conjoined tendon of the gemellus superior, obturator internus, and gemellus inferior muscle.

Causes of the piriformis muscle pain

• Overuse of the piriformis muscle, which is produced by extreme exercise.
• Running and other repetitive movements, in these activities, use this muscle.
• The patient is sitting for a long time in the same position.
• When the patient is lifting heavy things.
• When the patient is doing comprehensive stair climbing.
• When this occurs injuries the muscle is doing damage to the muscle and presses down on the sciatic nerve.

Most Typical piriformis muscle pain causes include:

• A vehicle accident
• A bad fall
• A direct hit during sports
• A penetration wound that reaches the muscle
• A sudden twist of the hip

Signs and symptoms of piriformis muscle pain

• The patient feels the pain mostly in the muscle.
• The patient is also feeling tingling and numbness in the lower leg due to sciatic nerve compression by tight piriformis muscle.
• The patient feels Lower Back Pain with the radiate pain which is back to the foot.
• The patient feels extreme pain when attempting certain activities running, climbing stairs, and walking.

This muscle pain is generally triggered by some positions:

• Running
• Sitting
• Applying pressure over the piriformis muscle
• Climbing stairs
• Sciatica is the primary symptom of piriformis muscle pain indicates the pain is referred to in the leg.
• The patient feels numbness and tingling in the buttocks and this sensation is extended down to the back of the leg.
• Also presents tenderness in the buttocks.
• The patient feels a problem in the sitting position and this pain becomes worse when the patient is sitting for a long time.

Diagnosis of piriformis muscle pain

• Healthcare specialists are diagnosed with piriformis muscle pain based on the patient’s history and physical exam.
• The cause of the muscle pain is diagnosed or ruled out by CT, MRI, electromyography, and injection tests.
• First, the doctor checks the medical history and symptoms and tries to find the cause of the pain.
• The doctor checks the swelling and posture by observation.
• In the examination, the patient checks the ROM ( range of motion ) of the affected lower limb.
• Some imaging examinations are also used to rule out the other causes of the pain.
• An MRI scan and a CT scan help the doctor for determining arthritis or a ruptured disk that is causing pain.

Treatment of piriformis muscle pain

RICE PRINCIPLE

In the initial phase of muscle, the pain doctor suggests to RICE principle to reduce the muscle pain.

• R [rest]: The patient is doing the rest when the muscle pain is occurring means not doing prolong sitting and not lifting the heavy thing.
• I [ice]: Applied to ice on the site of pain for the pain, the patient is also used to ice packs and frozen peas for pain relief and swelling.
• C [compression]: Applied compression bandage on the place of pain for the reduction of swelling.
• E [elevation]: Elevated to the lower limb to relieve the swelling.

Treatment of the piriformis muscle depends upon the chronicity of the disease.
The treatment includes physical therapy, stretching, and medical treatments like injection therapy, opiates, NSAIDs, and infrequently surgery.
Doctors and other health experts who are treated piriformis pain include orthopedists, physiotherapists, osteopathic physicians, sports medicine doctors, and occupational therapists.
There are many types of home treatments for piriformis muscle pain like stretching and strengthening exercises, a cold pack is used to help reduce the symptoms of piriformis pain and help muscles recover.

The treatment gives consists of rest and give to initial physical therapy, and performed individual flexion, rotation, and other basic activities which stretch the piriformis muscle.
A physiotherapist is provided with soft-tissue massage onto the gluteal with lumbosacral sites as well as cold packs and occasionally sometimes applied to electrical stimulation.
Occupational therapy is suggested to the patient to avoid prolonged sitting which increases the symptoms of muscle.
When this piriformis muscle pain is the cause of the sciatic nerve pressure so that requires surgical intervention for the release of the pressure of the sciatic nerve.
Some patients get to benefit from transrectal massage which is applied the therapeutic ultrasound treatment.

Pain Medications

• The doctor suggests taking a local injection of anesthetics drugs such as lidocaine, and bupivacaine.
• Take to Oral NSAIDs ( nonsteroidal anti-inflammatory drugs ) or over-the-counter such as ibuprofen.
• Some doctors treat piriformis muscle relaxants and drugs and also give corticosteroids.

Electrotherapy for piriformis muscle pain

The electrotherapy treatment contains ultrasound therapy(US), short wave diathermy(SWD), transcutaneous electrical nerve stimulation (TENS), and Interferential therapy (IFT) machine. which are used for pain relief & swelling of the site of the pain.
Ultrasound: Ultrasound for the release of pain and swelling.
SWD ( short wave diathermy ): SWD is used to reduce pain and swelling or spasms.

Physiotherapy treatment for the piriformis muscle pain

In the physiotherapy treatment of piriformis muscle pain stretching exercises, and massage are used for pain relief.

Stretching for the piriformis muscle pain

• Supine piriformis stretch
• Cross-body piriformis stretch
• Knee-to-chest piriformis stretch
• 4-point piriformis stretch
• Standing piriformis stretch

Supine piriformis stretch :

The patient’s position is lying on the back with both legs flat for the stretching position.
Then bend the knee joint and pull the affected leg up toward the chest.
Then the patient is held behind the knee joint with the help of one hand and grabbing the ankle joint with the help of the other hand, and then leading with the ankle joint, pulling the knee joint towards the opposite knee till a stretch is felt.
Do not force on the ankle or knee joint beyond a comfortable position.
Maintain this stretching exercise for 15 to 30 seconds, and then slowly back to starting position.
Always do the 3 complete sets of stretches every day.

Cross-body piriformis stretch:

The patient’s position is lying on the back with both legs flat for the exercise.
The patient is placed on the foot of the affected leg on the ground outside the unaffected knee.
Use with the other hand, the patient pulls the knee of the bent leg straight across the body till the patient feels the stretch.
The patient does not force the knee to the ground.
Maintain this stretching exercise for 15 to 30 seconds, and then slowly back to the starting position.
Always do the 3 complete sets of stretches every day.

Knee-to-chest piriformis stretch:

The patient’s position is lying on the back with both legs flexed.
Then place the ankle joint of the affected leg on the thigh of the opposite leg near the knee joint, and then the patient is using both hands and gently pulling the unaffected foot off the floor till a stretch is felt in the affected side buttock.
Maintain this stretch exercise for 15 to 30 seconds, and slowly back into the foot to the floor.
Always do the 3 complete sets of stretches every day.

4-point piriformis stretch:

This stretching exercise starts with all 4 limbs.
The patient’s position is to tuck the injured leg in front of the body so the calf muscle is parallel to the shoulder joint.
After then straighten the knee joint of the other leg and lower the hip joint toward the ground till a deep stretch is felt in the affected hip joint.
Do not force the body to touch the ground.
Maintain this stretching exercise for 15 to 30 seconds, and then straighten the injured leg.
Always do the 3 complete sets of stretches every day.

Standing piriformis stretch :

The patient’s starting position is the standing position, and place the painful leg over to the knee joint of the other leg while in the standing position.
Then flex to the standing leg and try to make it to the number 4 with the hip joint lowered off to the floor at a 45-degree angle.
After that flex, the waist down and swing the arms down while maintaining the back straight.
The patient is to stay in this stretching position for 15 to 30 seconds.
Then switch to the legs and repeat this stretching exercise 3 times 1 time.

Massage for the piriformis muscle pain

• Foam roller massage
• Tennis ball massage
• Sitting on a ball

Foam roller massage :
The patient’s position is in a sitting position on a foam roller so that the ends are pointing away from these sides.
This exercise begins with the feet flat on the ground in front of the hands which is supporting the weight behind the body.
Then cross an ankle joint over the other knee joint.
Tilt to the side so that the bulk of the weight is on the hip joint of the crossed leg.
Rock back and forth on the roller and feel the pain subside.
The patient is to continue this massage for 15 to 30 seconds, and then repeat this massage on the opposite side.

Tennis ball massage
The patient’s position is sitting on the floor and putting the ball under the side of the left hip joint.
Support the weight behind with the hands, and cross the left ankle joint over the other knee joint.
Then roll around on the ball till find an area of pain.
After then continue rolling over this site for up to a minute till the discomfort subsides.
Repeat this massage on the opposite side.

Sitting on a ball
The patient’s position is sitting with the tennis ball and another similar-sized ball under the hip joint.
The patient is performing this massage either on the floor or in a sitting position.
The patient is to keep both legs straight or flex the leg on the side with the ball under the hip joint so that the sole is against the opposite thigh.
After then gently push down till they feel some pain, and then back to the starting position.
The patient is repeated on the same side till the feels less discomfort in the tender place.
Repeat this massage on the opposite side.

Risk factors of this piriformis muscle pain

Risk factors of the piriformis muscle include some points :

• If they occur inflammation like overuse and sprain of the muscle
• occurs trauma generally blunt trauma onto the buttocks.
• Hematoma occurs in the piriformis muscle.
• If they occur scar formation in the muscle.
• If they occur cysts and tumors in the surrounding part of the muscle.

Prevention of piriformis muscle pain

• Do the warm-up and stretch before the run and every exercise.
• Then slowly build up the intensity of exercise and sports activity.
• Avoid running up and down hills or over rough surfaces.
• Get up and move around not sitting or lying down too long without some activity.

FAQ

Author: Dr.Hasti Rupapara