Glute Pain Part 3: Piriformis syndrome

July 17, 2018

The Problem!

Piriformis syndrome is a condition that emanates from the piriformis; a muscle that lies underneath the glutes. Piriformis syndrome is the piriformis pinching or clamping the sciatic nerve. This can often be mistaken for ‘true sciatica’ (that occurs in the spine) as the symptoms can be similar. Back pain, glute pain and neurological symptoms down the back of your leg. However, sciatica is a bilateral condition (both side of our body) and therefore can be written off if you only have pain in one leg. Piriformis Syndrome will cause pain when it gets stretched and clamps down on the nerve… Something that stretching won’t fix then? Surely not!?


About the Problem?!

The piriformis muscle comes from the sacrum (the bone between your butt cheeks) and inserts onto the top of your thigh bone (femur) and externally rotates the hip (foot turning out). The sciatic nerve passes through the piriformis muscle (figure 1) in up to 20% of us (compared to going underneath the muscle (figure 2)), as the muscle can grow in a split fashion, with one origin, one insertion but effectively have two muscle bellies. This in itself is not a problem, people have many ‘defects’ from birth and never notice them. However, when the piriformis gets stretched, it will compress the sciatic nerve that passes through it. This will happen when you internally rotate the hip, an act you cannot truly eradicated from your life as it happens from walking.


 Figure 1: Sciatic nerve passing through the tendon of piriformis




Further, it has been theorised that only the tendinous parts of the piriformis are responsible for piriformis syndrome. The tendon is believed to be firmer than the muscle belly and therefore have a harsh reaction when compressing the sciatic nerve. This is thought to cause irritation of the nerve trunk and cause the well know symptoms. Should the nerve pass through the muscle belly, no damage, under normal conditions should occur to the nerve, as the consistency of the muscle is too pliable for the compressive force to damage the nerve. However, without a scan or cutting you open to have a look, nobody can say where your sciatic nerve passes through. It is likely, that if you’re reading this then your nerve passes through the tendinous part of the piriformis. And so, you should read the next section!



Firgure 2: Sciatic nerve passing underneath the piriformis




How the problem manifests in you!

Piriformis syndrome is a complex injury, and because of its complexity is still being discussed in current research. The cause of it isn’t always clear and is usually an insidious onset rather than one day waking up with this glut