Introduction
The piriformis muscle (the pear-shaped muscle) belongs to our gluteal muscles. It ensures that our hips stretch backwards, turn outwards and spread the leg outwards. These are all movements that we rarely make in everyday life.
Especially people who have a sedentary job often find themselves in a bent hip position with spread legs. This means that the piriformis muscle is hardly ever used and, like all muscles that we do not train regularly, loses strength. At the same time, the counter-movement to its actual function due to the seated posture puts it under tension.
This causes the muscle to cramp more and more. This can lead to painful tension in the gluteal muscles. Furthermore, our sciatic nerve runs through the muscle.
If the piriformis muscle is now cramped, it may press on the nerve and the nutritional situation of the tissue may deteriorate. This can lead to an impairment of the nerve and its function and can cause radiating pain or sensitivity disorders in the area of the lower back, thigh and knee. These problems then lead to the so-called Piriformis syndrome and can be treated with physiotherapy, among other things.
The clinical picture
Piriformis syndrome occurs relatively frequently in our society due to lack of exercise and one-sided posture. The nerve can also be irritated by falling on the buttocks, or by training the muscle too much. The pain in Piriformis syndrome is similar to that of a lumbar spine syndrome in terms of its symptoms.
It can lead to back pain, pain in the buttocks and thigh pain. A loss of sensation or tingling may also occur. It should be found out in the findings of physiotherapy which structure causes the pain.
Overloading the muscle leads to poor nutrition of the surrounding tissue. This means that the structures do not receive enough blood rich in nutrients and oxygen. This is necessary for their function.
Functional disturbances occur when the supply to the structures deteriorates. A dysfunction of the muscle leads to movement restrictions and shortening. A functional restriction of the nerves leads to nerve-typical pain, or sensitivity disorders.
At the beginning of physiotherapy, it is important to obtain a detailed report that identifies exactly the structures that cause the symptoms. If a piriformis syndrome turns out to be the cause, surrounding structures such as the lumbar spine should be treated if necessary. In many cases of piriformis syndrome, the previous incorrect posture and relieving postures, or the shortening of the muscle also leads to restrictions in mobility in the lumbar spine.
If there are blockages in the area of the lower back, these may have to be removed first before the actual piriformis syndrome can be treated. The treatment of the muscle itself can be done with the help of physiotherapy, more precisely with trigger point treatment, massage techniques or stretching. In addition, Piriformis Syndrome can also be treated very well with the help of a fascia roll on your own.
To do this, one should sit on the roll in a long seat and roll out first one half of the buttocks, then the other half with the roll. To increase the pressure, the foot of the leg that is not being treated can be placed on the lower leg of the other leg. This increases the pressure on the side that is to be treated.
You can read more information about the duration of the therapy here: Duration of Piriformis SyndromeThe trigger point therapy is a passive technique in physiotherapy, which is used to treat Piriformis Syndrome. The patient lies either in a prone or supine position (then with the leg drawn towards the body, for a stretching position for the piriformis muscle) and the therapist searches for pain points in the muscle tissue. Through targeted, sustained pressure, a relaxation of the muscles can be achieved.
Massage techniques can also be applied in these starting positions. The trigger point therapy can be quite painful, but it should be bearable for the patient to such an extent that he does not tense up against the pain. This would impair the effect of the therapy.
After a short time, the pain of the trigger point subsides and the muscles relax.Fascial techniques in the lumbar and gluteal areas can supplement manual treatment of the tissue in Piriformis Syndrome. Stretching of the muscle is also important in physiotherapy for piriformis syndrome. This can be done very well by the patient himself, by putting his legs in a supine position and by striking the leg he wants to stretch over the raised thigh.
Now you grasp the leg with your hands and pull it towards your chest. With your elbow you can now press the leg that is turned over very well at the knee slightly outwards. By small variations in pulling and pushing away, you can find the optimal position.
There should be a clear but bearable pulling in the outer, lower buttock area and lateral thigh. The stretching position should be held for 20 seconds and then slowly released. After a short break, repeat the exercise three to four times.
Both sides should always be stretched. Attention during physiotherapy and hip joint prostheses! Here there is a risk of dislocation of the joint due to the pull on the leg.
The exercise should then, even in the presence of a piriformis syndrome, under no circumstances be performed! If nothing stands in the way of the exercise, the therapist can also perform a passive stretching from this position. This means that the therapist gently presses the patient’s leg into the stretch.
Sometimes this helps the patient especially well, because they can relax the muscles and not fight against the stretch. When the muscle is stretched, the nerve is also stretched. Stretching improves the mobility of the individual structures among themselves and loosens adhesions.
The structures can function better again. In physiotherapy, for the treatment of Piriformis Syndrome, there are also special stretching techniques for the neural structures that should be developed as part of the therapy. An active training of the musculature should also be part of the physiotherapy for the Piriformis Syndrome.
For this purpose the hip extension should be trained more intensively and the mobility in this direction of movement should be improved. From the position of the quadruped, for example, the leg can be moved backwards or sideways without the pelvis turning to the side where the leg is lifted. This is important to make the movement from the hip and not from the back.
It is best to control yourself in front of a mirror, or to place a flat object on your lower back, this must not fall down. Bridging, i.e. lifting the buttocks upwards from the supine position, is also a very good exercise in physiotherapy to strengthen the gluteal muscles and thus also the piriformis muscle. Here too, the movement should come from the buttocks and not from the lower back.
On machines, the leg can be stretched (extension of the hip) on a rope pull, or if available, an extra device for hip extension. In everyday life with Piriformis Syndrome, in addition to physiotherapy, care should be taken to incorporate movement and shorten the sitting phases. Exercise, even simple walking, swimming or cycling is always good for the nutritional situation in the muscles. It is alternately tensed and loosened. The blood circulation situation improves, the tissue is well supplied and adhesions can be loosened or prevented and waste products removed.