Home > Blog > Physiotherapy > Piriformis Syndrome Physiotherapy
Piriformis Syndrome Physiotherapy
Sciatica happens when our sciatic nerve is compressed when our spinal disc is herniated (often inaccurately termed as "slipped disc" and refers specificly to a pain/discomfort that is experienced that travels from our buttocks to our leg (usually one sided occurrence).
Sciatica can be caused either by herniated/slipped disc, chronic
hamstring tendinits, adhesions/compression of tissues around the sciatic
nerve. In the case of piriformis syndrome, it may also cause sciatica despite it is NOT a herniated or slipped disc. In some individuals or athletes, the piriformis muscles may compress the sciatic nerve, especially in some individuals where the sciatic nerve GOES through the piriformis muscles.
And this causes pain that is similar to sciatica too, so sometimes when a patient has sciatica, it may not be a slipped disc, it can be piriformis syndrome.
Pains and discomforts associated with sciatica usually travels down our
- back of thigh
- sometimes to calf and top of feet
Patients who suffer from piriformis syndrome or sciatica often report tenderness, soreness, aching or deep pain in their buttocks (tend to be one side more than the other), and this is aggravated by:
- climbing stairs
Our piriformis muscles main function is to:
- move our thighs from neutral to outwards (move away from center)
- externally rotating our thighs (rolling our thigh outwards from center)
This pain, termed as sciatica, often travels down the back of thigh and into
the lower back. Patients who have this syndrome generally complains of a deep
pain or tenderness in the buttocks, which is aggravated by sitting, climbing
stairs or doing squats/squat-like exercises. Our piriformis muscles helps us in
abducting our thighs (bringing outwards) and externally rotating our thighs
(rolling upwards, as in sitting cross-legged).
To visualize the movement of your piriformis muscle, do this exercise (safely, of course):
- balance on your left foot
your right foot away from your left thigh
- then rotate your
right thigh such that your right toes points towards the ceiling
That's what your piriformis muscle does.
stretching our piriformis muscle
Stretching our piriformis muscle almost always duplicates the pain and discomfort of piriformis syndrome. To stretch your piriformis, there are two methods:
#1: The Complicated But Proper Full Stretch (Assume you have right sided piriformis syndrome)
- Lie on your back and bend your affected hip and knee.
- Use your
left hand to hold onto the back of your right knee
- Pull your right knee
towards your left shoulder.
- This will cause your right piriformis to adduct and flex.
- Don't let go yet,
next, use your right hand to grab your suspended right ankle and rotate the ankle
#2: Shorter But Quick Method:
- Stand on your left foot and place your right foot on a chair or low table (your right knee and hip needs to be about 90 degrees flexed each)
- Then use your
right hand to press your right knee towards the left side of the body whilst
keeping your ball of your right foot on the same spot on the chair
What causes the piriformis syndrome?
Our piriformis muscle is located deep below the buttock (gluteal) muscles, originating from the spine of the sacrum and extends and attaching to the
greater trochanter of the femur, which is the bony bulge on the outside and
top of your thigh.
In the 80-90% of the population, the sciatic nerve is located UNDER the piriformis muscles...but in about 10-20% of the population, the very same sciatic nerve GOES THROUGH the piriformis muscle. And that's where the problem comes.
Because...muscles work by contraction and relaxation, so when the sciatic nerve goes through the piriformis muscle, and if/when the piriformis muscles either has a problem that causes it to be shortened or tightened on a semi-permanent basis, what happens is that there will be prolonged compression onto the sciatic nerve.
This causes sciatica.
diagnosing piriformis syndrome
Generally, piriformis syndrome is diagnosed based on
- consultative clinical medical history taking and review
- identification of piriformis syndrome's symptoms
- mechanical manual examination
This may be complemented with X-ray scans, nerve conduction tests and even MRI to confirm this specific condition as well as to rule out other health issues at the same time
There are two well-described medical tests that have been
clinically validated for piriformis syndrome diagnosis, which are:
- The FAIR-test, an electrophysiological
test which specificly measures all delays in sciatic nerve conduction especially when the piriformis
muscles is stretched against the sciatic nerve
- Magnetic Resonance Neurography (MRN), which is an advanced
version of the MRI that can highlight inflammation and the nerves
physiotherapy for piriformis syndrome
Once accurately diagnosed, step-by-steps physiotherapy treatments for piriformis syndrome starts with:
- Progressive piriformis muscle stretching, starting with 5 seconds of sustained stretch and slowly working up to 60
seconds per set. This is to be done several times daily, ideally at intervals of 2-6 hours except when sleeping
- Combined with: Ultrasound
therapy, gentle deep tissue massage, dry needling, strengthening
- Patient may benefit from ongoing regular weekly deep tissue massage
accurate diagnosis and treatments, this syndrome is easily managed with our senior physiotherapists.
Back to Top
Phoenix Rehab physio Services
Phoenix Rehab Group works with specialist
physiotherapists and rehab therapists who are highly
trained, qualified, experienced and passionate to provide high level of
expert care to our patients.
PHYSIOTHERAPY & PHYSICAL THERAPY
HAND THERAPY & SPLINTING
Patients who sustained injuries to their elbows, forearms, hands, wrists
(sprains and fractures) and fingers, and requires Hand Therapy to increase the function of their hand
following injuries or post-operations as well as custom made hand splints.
Commonly treated hand pain injuries includes
CLINICAL PILATES & WELLNESS PILATES
Clinical Pilates is a form of physical exercise that focuses on posture,
core stability, balance, control, strength, flexibility, and breathing. It is a system of safe and effective exercises, which
meet specific individual needs, to treat a wide range of injuries
You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.
TRADITIONAL CHINESE MEDICINE (TCM)
All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).
See our entire team here with introductions and their specializations.
At the first session, our specialist physiotherapists will carry out a thorough
assessment, helping them to select the most appropriate treatment to
help you recover as well as provide treatment in the same session.
Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
do Tell Your Family, Friends And Colleagues About Us =)
We appreciate you as a patient and want you to know that the #1 (and only) way we grow as a clinic is through word of mouth referrals from valued patients like yourself.
We do not rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics.