Piriformis Syndrome

with Rehab

Piriformis syndrome is a condition the affects the nervous system in the area of the hip, and is characterized by pain and possibly a loss of feeling in the backside (posterior) thigh that may extend down the entire length of the leg. The symptoms are caused by an increase in pressure on the sciatic nerve by the piriformis muscle, which is on the back of the hip and is responsible for externally rotating the hip. The sciatic nerve and its branches connect to much of the leg. Normally the sciatic nerve runs between the piriformis muscle and other muscles. However, in certain individuals the nerve runs through the muscle, which causes an increase in pressure on the nerve and results in the symptoms of piriformis syndrome.

SYMPTOMS

  • Pain, tingling, numbness, or burning in the back of the thigh that may also extend down the entire leg.

  • Occasionally, tenderness in the buttock.

  • Loss of function of the leg.

  • Pain that worsens when using the piriformis muscle (running, jumping, or stairs).

  • Pain that increases with prolonged sitting.

  • Pain that is lessened by laying flat on the back.

CAUSES

  • Piriformis syndrome is the result of an increase in pressure placed on the sciatic nerve. Often times piriformis syndrome is an overuse injury.

  • Stress placed on the nerve from a sudden increase in the intensity, frequency, or duration of training.

  • Compensation of other extremity injuries.

RISK INCREASES WITH:

  • Sports that involve the piriformis muscle (running, walking or jumping).

  • You are born with (congenital) a defect in which the sciatic nerve passes through the muscle.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

If treated properly, then the symptoms of piriformis syndrome usually resolve in 2 to 6 weeks.

RELATED COMPLICATIONS

  • Persistent and possibly permanent pain and numbness in the lower extremity.

  • Weakness of the extremity that may progress to disability and inability to compete.

TREATMENT

The most effective treatment for piriformis syndrome is rest from any activities that aggravate the symptoms. Ice and pain medication may help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. A referral to a therapist may be given for further evaluation and treatment, such as ultrasound. Corticosteroid injections may be given to reduce inflammation that is causing pressure to be placed on the sciatic nerve. If non-surgical (conservative) treatment is unsuccessful, then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD:

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Piriformis Syndrome

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH - Hip Rotators

  • Lie on your back on a firm surface. Grasp your right / left knee with your right / left hand and your ankle with your opposite hand.

  • Keeping your hips and shoulders firmly planted, gently pull your right / left knee and rotate your lower leg toward your opposite shoulder until you feel a stretch in your buttocks.

  • Hold this stretch for __________ seconds.

Repeat this stretch __________ times. Complete this stretch __________ times per day.

STRETCH – Iliotibial Band

  • On the floor or bed, lie on your side so your right / left leg is on top. Bend your knee and grab your ankle.

  • Slowly bring your knee back so that your thigh is in line with your trunk. Keep your heel at your buttocks and gently arch your back so your head, shoulders and hips line up.

  • Slowly lower your leg so that your knee approaches the floor/bed until you feel a gentle stretch on the outside of your right / left thigh. If you do not feel a stretch and your knee will not fall farther, place the heel of your opposite foot on top of your knee and pull your thigh down farther.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete __________ times per day.

STRENGTHENING EXERCISES - Piriformis Syndrome

These are some of the caregiver again or until your symptoms are resolved. Remember:

  • Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your caregiver. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under their guidance.

STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise so that you exercise the correct muscles. Sloppy form means that you are not strengthening the correct muscles.

  • Lie on your side so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up 4-6 inches, leading with your heel. Be sure that your foot does not drift forward or that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting (you may not notice this until your leg begins to tire).

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Quadriped

  • On a firm, lightly padded surface, position yourself on your hands and knees. Your hands should be directly below your shoulders and your knees should be directly below your hips.

  • Keeping your right / left knee bent, lift your leg out to the side. Keep your legs level and in line with your shoulders.

  • Position yourself on your hands and knees.

  • Hold for __________ seconds.

  • Keeping your trunk steady and your hips level, slowly lower your leg to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Standing

  • Tie one end of a rubber exercise band/tubing to a secure surface (table, pole) and tie a loop at the other end.

  • Place the loop around your right / left ankle. Keeping your ankle with the band directly opposite of the secured end, step away until there is tension in the tube/band.

  • Hold onto a chair as needed for balance.

  • Keeping your back upright, your shoulders over your hips, and your toes pointing forward, lift your right / left leg out to your side. Be sure to lift your leg with your hip muscles. Do not "throw" your leg or tip your body to lift your leg.

  • Slowly and with control, return to the starting position.

Repeat exercise __________ times. Complete this exercise __________ times per day.