If you’re dealing with Piriformis Syndrome (PS), you’re definitely not alone. This condition can really cause some nagging discomfort and mess with your daily life.
Lots of folks with PS feel pain in their butt (yeah, that’s right—in the sciatic notch area) and might also experience lower back pain, sometimes along with that infamous sciatic pain that shoots down your leg (Shapiro and Preston, 2009).
Those symptoms might get worse after sitting on hard surfaces for a while, making it tough to find a comfy position (Papadopoulos and Khan, 2004).
What Exactly is Piriformis Syndrome?
Piriformis syndrome can come in 2 flavors: primary and secondary. Primary PS usually shows up as butt pain and may or may not include that radiating nerve pain, often thanks to some funky anatomy of the muscle itself.
Secondary PS is more common and usually pops up after some kind of trauma, leading to blood flow issues and changes in muscle or nerve tension, not to mention those imbalances in your legs.
That’s why getting a thorough check of your lower limbs is super important—it’ll help figure out what’s going on.
Common Symptoms and Signs to Look Out For
Here are some things you might notice if you’re dealing with piriformis syndrome:
Foot Pronation: You might see that your foot on the affected side is rolling in more than the other.
Leg Length Differences: The leg on the side that hurts could feel longer than the other one.
Tight Hip Muscles: You could be feeling tightness in the hip muscles on the affected side (those external rotators and adductors).
Weakness in Hip Abductors: You may notice that the hip abductors on that same side are a bit weak.
It’s pretty interesting that research shows that hip adduction and internal rotation can crank up the pain in piriformis syndrome (Papadopoulos and Khan, 2004; Shapiro and Preston, 2009; Hopayian et al., 2010). You might also find an increased Q angle or knee valgus during exams.
When you’re looking at how you walk, keep an eye out for these common quirks:
Excessive Pronation: During the later stages of your step, if your foot is rolling in too much, it could lead to the internal rotation of your femur.
Pelvic Rotation: You might notice that when your non-affected leg swings forward, your pelvis rotates laterally, which can affect how force travels down your leg.
Increased Tension in Piriformis: This tension can squish the sciatic nerve, which might bring on various nerve-related symptoms in your legs. The good news is, most neurological tests for piriformis syndrome usually don’t show any major nerve damage. Typically, your deep tendon reflexes, sensation, and muscle strength are intact.
Symptoms That Stick Out with Piriformis Syndrome
If piriformis syndrome is part of your life, you might feel that discomfort getting worse after sitting for around 15 to 20 minutes near where the muscle attaches (Boyajian et al., 2008). Common symptoms can include:
- Pain and/or weird feelings radiating from the sacrum to your butt, down the back of your thigh, and even above the knee (Foster, 2002; DiGiovanna et al., 2005).
- Relief when you’re walking around.
- Increased pain during times when you’re just sitting still.
- Discomfort in your other side’s sacroiliac joint (SIJ).
- Pain when standing up from sitting or squatting.
- Changing positions might not fully ease that pain.
- Struggles with walking—maybe you’ll notice a painful gait or a bit of foot drop.
- Weakness in your legs on the same side.
- Numbness in the foot on that same side.
When the piriformis muscle is tense, it may cause the hip on that side to rotate outward. If you’re lying flat on your back and trying to relax, this can be a key sign—trying to position your foot in a neutral way might make the pain come back (Frieberg and Vinke, 2008).
Getting the Right Imaging
Understanding what's going on with your body is super important, and tools like MRI, CT scans, EMG, and ultrasound can help rule out other issues that might mimic piriformis syndrome. Although techniques like sciatic nerve stimulation through magnetic resonance neurography can be useful for detection, they don’t get used all that often.
Functional Assessment and Testing for Piriformis Syndrome
Along with getting your personal story assessed, a solid objective evaluation is key. You want to check out the lumbar spine, pelvis, muscle lengths and strengths, ranges of motion in the joints, and how your muscles are firing. If everything points toward a diagnosis of piriformis syndrome, some hands-on treatment techniques might just help ease that nerve compression.
The FAIR Test
One of the go-to diagnostic techniques is the "Flexion, Adduction, and Internal Rotation" (FAIR) test. This test packs a punch with high specificity (0.881) and sensitivity (0.832), especially when paired with functional electromyographic assessments (Fishman et al., 2002; Filler et al., 2005; Hopayian et al., 2010; Kean Chen and Nizar, 2012). A common finding in piriformis syndrome is tenderness around the piriformis muscle, which can lead to a positive Lasègue sign (Durrani and Winnie, 1991).
- The patient lies flat on their back.
- The therapist stands on the side that isn’t being treated.
- The therapist gently flexes the hip joint of the treatment side to 60 degrees while keeping the knee bent at 90 degrees.
- The therapist stabilizes the joints on the side being treated.
- The therapist puts some downward pressure on the knee of the treatment side while internally rotating and adducting that hip joint.
- If this reproduces butt pain, you’ve got a positive FAIR test.
Piriformis Length Tests
Test 1:
1. The patient lies back comfortably.
2. Check if one foot is rotating outward more than the other.
Test 2:
1. The patient lies face down.
2. The therapist bends the knee on the treatment side to 90 degrees and holds that foot.
3. The therapist stabilizes the patient’s pelvis on the treatment side.
4. The therapist gently internally rotates the hip joint on that side and compares it to the other side.
5. Any loss of range shows shortening of the piriformis muscle.
Test 3:
1. The patient lies on their back.
2. The patient bends both knees to 90 degrees and keeps them together.
3. The patient internally rotates the hip joint, letting both feet gradually fall outward.
4. Look for any differences in how far the feet can move compared to each other.
5. The side that stays more upright (having less internal rotation) indicates a shorter piriformis muscle.
Living with piriformis syndrome can be tough, but understanding what it is and how to cope can set you on the path to feeling better and getting back to your daily activities.
If you're feeling any of these symptoms, don’t hesitate to reach out to a healthcare professional who knows their stuff when it comes to diagnosing and treating this condition.
With the right assessment and piriformis stretch plan, you can find relief and start moving without pain again.
Remember, you’re not in this alone—there’s support and guidance out there to help you through!
References:
Sacroiliac Joint Dysfunction and Piriformis Syndrome: The Complete Guide for Physical Therapists, by Paula Clayton (Author)
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