Piriformis Syndrome

PIRIFORMIS SYNDROME (MYOFASCIAL PAIN DYSFUNCTION OF PIRIFORMIS MUSCLE)

Pelvic surface of the 2nd to 4^th sacral segments; Superior margin of greater sciatic notch and sacrotuberous ligament.

Greater trochanter of the femur.

Ventral rami of S1 and S2.

In weight-bearing activities, it is needed to control vigorous and/or rapid medial rotation of the thigh (during early stance phase of walking or running).
Stabilises the hip

Characterised by bizarre symptoms that seem unrelated; pain and paresthesia may be reported in the lower back, groin, perineum, buttock, hip, posterior thigh and leg, foot, and during defecation, the rectum.
Symptoms are aggravated by sitting, a prolonged combination of hip flexion, adduction and medial rotation or by activity.
Patient may complain of swelling in the painful limb and of sexual dysfunction, dyspareunia in females, and impotence in males.
Three specific conditions may contribute to piriformis syndrome:
1. Myofascial pain referred from TrP’s in the piriformis muscle. The taut bands and shortened muscle fibers associated with TrP’s represent a mechanism that would place the muscle in sustained tension with bulging of its diameter.
2. Nerve and vascular entrapment by the piriformis muscle at the greater sciatic foramen. There is a potential for entrapment of vessels passing through the greater sciatic foramen by the piriformis muscle. Sciatic foramen, the accompanying nerves and vessels must be compressed whenever the muscle is shortened or

Dysfunction of the SI joint. Displacement of the SI joint may interact with myofascial TrP’s of the piriformis muscle to establish a self-sustaining relation. Sustained tension in the muscle caused by the TrP’s could maintain displacement of the joint and dysfunction induced by the joint displacement perpetuates the piriformis TrP’s.

Any unaccustomed overload of the muscle, such as;
Spreading knees maximally to lower one end of a large container between knees on to the floor.
Catching oneself from a
Twisting sideways while bending and lifting a heavy
Forceful rotation with the body weight on one
Can become overloaded when undergoing a strong lengthening contraction to restrain vigorous and/or rapid medial rotation of the weight-bearing limb occurring during running.
Flexing the thighs at the hips with the knees spread apart for obstetrical or urological procedures or for coitus.
Direct trauma by striking the buttock over the piriformis muscle with a hard
First time motor vehicle

Driving a car with the foot in place on the accelerator for long periods or sitting on one foot.
Chronic
Arthritis of the hip joint and conditions requiring total hip
Morton foot
Hyper-pronation of the
Lower limb length

Body asymmetry – Whenever a lower leg length inequality or a small hemipelvis produces a compensatory functional scoliosis, the inequality should be corrected, a heel lift and ischial lift should be used.
Postural and activity stress – When sleeping on the side, the patient should place a pillow between their knees with the support extending to the ankles to avoid prolonged adduction at the hip with the thigh Patient should avoid prolonged immobilisation of the involved lower limb when driving a car for a long distance. Stop and walk briefly every 20-30 minutes. Avoid sitting on one foot. Change position when sitting at home or at work frequently.
Mechanical stress – Patient should be warned against either making a strong lateral rotary effort or restraining a strong medial rotary momentum when weight bearing on the involved side such as during; tennis, soccer, volleyball or competitive SI joint displacement should be treated. Correct Morton’s foot structure
Self-therapy – Complete a home program of prolonged piriformis Tennis ball may be used for self-application of ischemic compression to the piriformis muscle. Performing a “loosening’ technique in which the patient performs rhythmic full rotations of the hips, letting the trunk and arms loosely flow.