Piriformis syndrome: The runners blight and the pregnant woman's nightmare!

Piriformis Syndrome. 

If you are a runner and have been experiencing buttock, hip and leg pain or burning symptoms through the back of your leg, all of which are worse on or after running then you may be the unlucky sufferer of "Piriformis Syndrome" . 

Of course this condition is not limited to runners and can often be found during pregnancy, in people with generally weak gluts and in people who have had a slip or fall involving landing on their buttocks (this list is NOT exhaustive and in fact this condition can affect many people 'Ideopathically' or in other words, 'with no known cause'). 

 

Piriformis syndrome

Typical symptoms of Piriformis Syndrome can include:

The symptoms from Piriformis Syndrome are due to both muscle pain form the Piriformis itself and also compression of the sciatic nerve as it passes either underneath this muscle or (in around 15-20% of us) perforates the muscle and passes through it. 

Symptoms can include: 

  • Pain in the buttock

  • Pain down the back of the leg

  • Tingling or pain into the buttock and / or the back of your leg

  • Pain to the side of your hip 

 

What causes Piriformis syndrome? 

What causes Piriformis Syndrome is compression of the sciatic nerve by the Piriformis muscle as it passes through your buttock. This causes pain through the length of the nerve and this pain is known as "Sciatica".

When do people with Piriformis Syndrome get their symptoms? 

Symptoms are typically worse during running or walking, on sitting and placing direct pressure to the buttock area, going upstairs and sitting cross-legged. Symptoms can then be worse for the rest of the day (especially after exercise) or for 1-3 more days depending upon how inflamed the nerve and muscle have become. 

 

Who gets Piriformis syndrome? 

 Piriformis Syndrome is really a REACTION to other issues rather than a 'cause' in it's own right.

Runners are the typical group of people who get this problem, but RUNNING itself is not the cause. Other people who can get Piriformis Syndrome include walkers, people with weak gluts, pregnant women especially through the third tri-mester. 

In this clinic we find that the 3 main causes are: 

 

  • Sacroiliac dysfunction ("SIJ Dysfunction")

  • Pelvic instability (pregnancy) 

  • Weak Gluts / weak core

In identifying whether you have Piriformis Syndrome, the first step in making sure we put it right is to then identify which of the above is the cause of it in you.

 

How to treat Piriformis Syndrome and what to do if you have it 

The first thing is that we find that Piriformis syndrome can be over-diagnosed!

It does exist, but is not; in our experience the most common cause of sciatic pain (more commonly this comes from issues with the lumbar spine). 

But, if it is correctly diagnosed, then the CAUSE of it must also be identified. 

 

Sacroiliac Dysfunction: Treatment and management

Thorough assessment and a case history will identify whether Sacroiliac Joint (SIJ) dysfunction is the cause of your symptoms. 

SIJ dysfunction responds well to chiropractic adjusting (once the type of dysfunction / misalignment) has been identified, Piriformis release and a home based programme including:

 

  • Rest from aggravating activities (running! - We know.. you don't want to stop! But you may need to for a short time.) 
  • Ice (NOT HEAT)
  • A course of treatment involving SIJ adjusting, tissue release work and sometimes hip/lumbar mobilisations or adjusting. 
  • Glut and core strengthening 
  • Possibly nerve flossing

Typically this cause of Piriformis syndrome will then improve over 3-6 weeks of care. 

 

Pelvic instability - Pregnancy 

The result of the hormone "Relaxin" is that the ligaments in the body soften in preparation for child birth. 

The sacroiliac joints rely heavily on ligament support, so they can become unstable during pregnancy leading to overload of the muscles that try to support the SIJ. This can lead to overload / inflammation and chronic strain of the Piriformis muscle, leading to muscle spasm and sciatic nerve irritation. This can be compounded by the change in alignment of the pelvis as it tips forward to assist in child bearing, as this can also lead to further SIJ stress. 

Treatment and management for this kind of Piriformis syndrome includes:  

  • Rest from aggravating activities (if possible) 
  • Ice (NOT HEAT!) 
  • Sacroiliac support belt ("Trochanteric belt") 
  • Light mobilisations of the joints / release work
  • Glut strengthening and muscle stretching 

We do find that symptoms can be improved and that if looked after during the pregnancy and soon afterwards, the symptoms can be eased and then resolved. 

 

Weak Gluts and Piriformis Syndrome

Hi there all you runners!! Weak gluts can and do occur in runners due to hamstring dominance in running, but a weakness in the gluts can result in a loss of pelvic- hip stability during running which can cause problems with the SIJ / Overload to the Piriformis muscles and potential back pain too. 

We see all 3 of these issue (as well as knee pain) due to weak gluts in runners and this can be resolved by a treatment and strengthening programme. Involving: 

 

  • Rest from aggravating activities (running! - We know!  You don't want to stop! But you may need to for a short time.) 
  • Ice (NOT HEAT)
  • A course of treatment involving SIJ adjusting, tissue release work and sometimes hip/lumbar mobilisations or adjusting. 
  • HEAVIER FOCUS ON Glut and core strengthening, often beyond initial rehab exercises and onto strength/endurance exercises. 
  • Possibly nerve flossing

Typically this cause of Piriformis syndrome will then improve over 3-6 weeks of care. 

 

You should begin with an assessment at the clinic for Piriformis syndrome

If you are experiencing buttock or sciatic pain then your should begin your jourrney towards getting better with a visit to the clinic in order to have a full assessment in order to identify whether you do have Piriformis Syndrome (or something else) and if so which kind. 

In the meantime here is something for you to try: 

 

The best Piriformis exercises that strengthen that you can do easily at home - subscribe at the top of this page. Here's taster, a great stretch for the Piriformis! (Subscribe to receive another, plus the rest!).

 

Let us know how you get on! 

Sign up here for our video series to help YOU with Piriformis Syndrome starting NOW.

 

 

Contact us on info@precision-chiropractic.co.uk   

Tel: 02920 861800 

To find out how we can help you with your piriformis syndrome!

 

The team at Precision Chiropractic. 

Chiropractic care for sports injury, sciatic pain and leg pain in Caerphilly and Cardiff. 

 

 

 


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