Osteopathic Intervention

The most important thing in a piriformis syndrome is to lower the tone of the piriformis muscle. The exact cause for the shortening should be found out. The osteopath looks at the position of the pelvis in relation to the sacrum.

If the pelvic vane is positioned forward in comparison to the sacrum, the piriformis muscle is overstretched and the osteopath, by mobilization or manipulation, moves the pelvic vane backward so that the piriformis muscle is no longer in the stretched position. In principle, there is nothing the osteopath can do against a muscle that is too long except to correct the malposition, which automatically shortens the muscle again. A shortening of the M. Piriformis can be caused either by a global problem or by a pelvic shovel that is positioned backwards.

First, the osteopath applies direct techniques, i.e. triggering or massage on the Piriformis muscle. He also shows the patient an independent stretching exercise: sitting in a long position, place one leg on the other side and apply additional pressure with the opposite arm to increase the stretching. To loosen adhesions, the osteopath can also use the “Blackroll” aid.

Some exercises can be found in the article Fascial Training. If the complaints decrease after the exercises, the only symptom is hypertonus of the Piriformis muscle, which is caused by overstraining during training or a temporary “closing” of the muscle during acute stress. If the complaints do not subside, the pelvic shovel can be brought into the correct position by special mobilization or manipulation.

The pelvic position should be checked after each mobilisation and if this has not been successful, the manipulation can be carried out. Also after the manipulation a direct treatment can be done to improve the circulation in the muscle. If the symptoms still do not improve, there could be a blockage in the area of the lumbar spine, especially in the area L5-S2, because that is where the innervation of Piriformis muscle originates.

Please refer to the articles on physiotherapy mobilization exercises lumbar spine and physiotherapy mobilization hip There could be adhesions in the intestinal area, which could pull on the pelvis and thus lead to a malposition. Due to the increased tone in the area of the intestine, the pelvis is pulled relatively forward, so that a stretching in the Piriformis muscle occurs. If the adhesions in the area of the intestine are loosened, the pelvis continues to move back into the correct position.This is usually done through a connective tissue massage.

If not, the above mentioned techniques can be used. The muscle then shortens again and the physiological function is restored. On the contrary, an excessive tone of the pelvic floor can pull the pelvis relatively backwards, which can lead to hypertonus of the M. Piriformis.

The pelvic floor can be treated by direct techniques or by mobilization of the hip. In addition, the patient is instructed to regulate the tonus himself by breathing and pelvic movement. In general, an increased tone in the pelvic floor is not good, as it can lead to aggravated pregnancies, residual urine, problems when going to the toilet and much more.

If the tonus of the pelvic floor decreases, the pelvis straightens up again or it can be supported by the above-mentioned mobilization. The direct techniques on M. Piriformis can further decrease the tonus. Because of the similar innervation of the intestine and pelvic floor and muscle, the lumbar spine should also be examined for blockage if a disorder is suspected in these areas.

Due to the blockage, the supply of these areas may be limited, so that adhesions or hypertonus may occur. The supply can be restored by mobilizing or manipulating the lower lumbar spine. This holistic view of osteopathy serves to better understand the processes in the body. During one session, the lower extremity can also be examined for possible movement restrictions and blockages, since a muscle imbalance may have occurred and this can be stopped by correcting the affected structures.