Piriformis Syndrome 

The piriformis muscle is situated in the buttock and connects your sacrum (the triangular bone at the base of your spine) to your hip bone. It is one of a group of muscles which act to rotate the leg outwards. This muscle can often become tight following unaccustomed exercise or because it has had to work extra hard to perhaps compensate for other weak muscles in the buttock.

The sciatic nerve is one of the main nerves in the leg and it exits the lower spine at the levels of L4-S3. The sciatic nerve runs underneath the piriformis muscle (in a minority of people can actually run through some of the muscle fibres) and tightness of this muscle can cause a ‘pinching’ or ‘trapping ‘ of this nerve.

The symptoms are similar to that of sciatica but generally pain is felt from the buttock and radiates down the back of the leg. Pain in the lower back is not usually present unless there is a problem in that area as well. As with sciatica other altered sensations may be present such as pins and needles or numbness along the distribution of the nerve. Weakness in the leg is uncommon.

Because the sciatic nerve is involved in many lower back problems a careful and through assessment will be carried out to ensure a correct diagnosis.

Treatment for piriformis syndrome is two-fold. Initially, the symptoms need to be resolved and typically this involves the use of soft tissue mobilisation techniques to ‘release’ and stretch the tight muscle. Secondly, the reason for the muscle becoming tight in the first place needs to be established in order to prevent recurrence of the problem. Commonly, it has been found that the piriformis muscle compensates for a lack of strength in other muscles which ought to be providing the stability around the lower back and pelvic area. Correct stability retraining will help to prevent a recurrence and many patients find thePilates approach extremely beneficial.