The Piriformis Muscle and Its Discontents
There’s a good chance that you probably have never heard of the piriformis muscle. It seems like a fairly innocuous muscle resting there on your pelvis to help you spread and rotate you leg, just one humble member of a straightforward group of muscles. If, however, you are having problems with your piriformis muscle, it can be a literal pain in the butt.
What and where is the piriformis muscle?
The piriformis is one of the gluteal muscles. Its name, piriformis, comes from the Latin for “pear” and is meant to denote its shape, although it takes a bit of poetic imagination to see it as pair shaped.
The piriformis is the smallish muscle that connects the base of the spine to the femur. In order to get to the femur it leaves horizontally through the greater sciatic opening. The piriformis’s tendons tend to become entangled with its neighboring muscles—both the superior and inferior gemelli, and the obturator internus.
These interconnections are part of makes the piriformis muscle important for us.
The purpose of this muscle is not only to help us slightly rotate the leg but also to help us in walking.
So why is this muscle so important?
Piriformis syndrome is a nerve and muscle condition that happens when the piriformis pushes up against the sciatic nerve. This can cause the usual pains that pregnant women often become familiar with as their pregnancy moves into the latter stages. You might experience pain in the buttocks or legs, or a numbing or tingling sensation along the leg or on the buttocks.
Your doctor may have difficulty identifying the cause of your discomfort because a good set of exams to verify the condition have not yet been worked out. There are some tests, however, that physicians have developed to exclude other causes for the condition. These tests identify, for example, if a herniated disk is the cause. Therefore, figuring out if the piriformis syndrome is the cause of the patient’s pain becomes a process of elimination. In fact, the medical community is moving towards formally accepting physicians should use piriformis syndrome as the default diagnosis when they can identify no other cause for sciatic pain.
The two most common causes for piriformis syndrome are either individual oddities of sufferer’s anatomical structures or overexertion/injury.
There are three recommended treatments for piriformis syndrome: physical therapy, anti-inflammatory medication, and deep massage. Treatments tend to focus on relieving pain rather than correcting the underlying issue. This is due to the difficulty of diagnosis and the fact that the medical community has not yet developed a standard corrective procedure.
Typically, your doctor will recommend a low intensity non-drug treatment involving rest and light physical therapy. The sufferer will typically do a course of muscle loosening warm-ups every day and avoid physical activities that might strain the piriformis muscle. Some physicians will recommend a combination of slightly more involved physical therapy in combination with massage and an exercise process focusing on increasing the strength of the muscles groups surrounding the piriformis muscle in order to reduce the piriformis’ workload. Often physicians will refer the sufferer to a back specialist for course of more targeted therapeutic treatments.
If such initial treatments don’t succeed in reducing pain and increasing mobility, various pain relieving strategies are the next step. Your physician may recommend some anti-inflammatory drugs, corticosteroids, or botulinum toxin either individually or in some combination. Usually your physician will inject these right into the site of pain. If injection becomes the recommended course, usually the goal will be to inactivate the piriformis muscle by paralyzing it for up to half a year.
In severe cases, physicians will sometimes operate to remove the source of the pain.