Piriformis syndrome

Piriformis syndrome: What’s that?

The sciatic nerve is the longest and thickest nerve in the human body. It runs along both sides of the lumbar spine behind the hip joint via the posterior and thigh and further as a split nerve into the foot.

Parts of this nerve can be compressed, e.g. due to tension or hardening of the so-called pear muscle (pirus = Latin for pear → piriformis muscle) (piriformis syndrome).

The piriformis muscle runs deep into the posterior muscle, directly in the vicinity of the sciatic nerve (nervus ischiadicus).

It is conspicuous that mostly women aged 40 to 60 are affected by this.

Causes of a piriformis syndrome

As already mentioned, tension/hardening of the piriformis muscle is normally causal.

This tension can, for example, be triggered by single-sided burdening in case of hip/leg malalignment, e.g. pelvic obliquity. These malalignments can also result in a blockage of the sacroiliac joint (SIJ), from which furthermore muscle tensioning may arise.

Frequent and long sitting or climbing stairs are further causes for incurring a piriformis syndrome. The continuous burdens may strain the muscle and finally cause the associated complaints.

Excessive muscle activity and insufficient stretching prior to and following sports activities may also trigger a piriformis syndrome.

In seldom cases, a direct injury (traumata) of the pear muscle may be causal.

Symptoms of a piriformis syndrome

As nerves generally cannot endure any pressure, the pain is incurred more as a symptom, which is frequently localised in the posterior region single-sided.

The compression of the sciatic nerve may result in the symptoms of a slipped disc, i.e.

• pain radiating to other areas of the leg and pelvis
• a feeling of numbness along the further course of the sciatic nerve
• discomfort (tingling)

Diagnosis of a piriformis syndrome

An experienced physician will use differential diagnosis (e.g. imaging procedures such as CT or MRI) to distinguish the piriformis syndrome and a slipped disc. This is necessary as the symptoms of both ailments can be similar.

During the physical examination, the examiner observes any painful hip movement. Using various function tests (such as the FAIR test), the examiner can target activation of the piriformis muscle by movement of the hip.

Furthermore, the examiner can palpitate the typical “trigger point (hardening in the tissue).” If pain in the posterior region is then incurred, this can be viewed as an indicator of a piriformis syndrome

Therapy of a piriformis syndrome

It is important to hinder further irritation of the nerve and to loosen the tension/hardening of the piriformis muscle. This can, for example, take place via physiotherapy or stretching exercise.

Accompanying shock wave therapy can also help to loosen muscle tension.

In order to achieve pain reduction, the treating physician can inject medication into the piriformis muscle.

Activities which cause the symptoms, including sitting for longer periods or climbing stairs, should be avoided during the acute phase.

Certain sleeping positions (e.g. an angled knee) may also cause tension of the piriformis muscle. Generally, varied sleeping positions cause improved muscle circulation.

In several cases, the symptoms then disappear of their own accord.

If the symptoms are not alleviated, operative therapy can be considered in isolated cases. Here, the focus is on freeing the sciatic nerve from its compression.

How can a piriformis syndrome be prevented?

Prevention can be made by avoiding the triggering risk factors:

• Single-sided burdening of the pelvic muscle
• Malpositioning of the leg axis and spine
• Sitting for too long
• Unfavourable sleeping position

Furthermore, it is important to stretch your muscles adequately prior to and following sports activity.

How can the BORT CoxaPro hip brace relieve the complaints of a piriformis syndrome?

The support material of the BORT CoxaPro hip brace consists of elastic compressing material, which stimulates circulation due to its compression effect and can contribute to pain relief.

The optionally available piriformis pad (art. no. 991 126) ensures targeted trigger point massage (targeted activation/stimulation) of the tensioned piriformis muscle. As a result, its tension can be loosened. The pressure on the sciatic nerve is reduced, thus contributing to the relief of the symptoms. The structure and function of this pad were developed based on manual trigger point therapy often applied for physiotherapy. Here, muscular tension is loosened using targeted pressure combined with circular movement.