Physiotherapy for piriformis syndrome

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. People who have a sedentary job, in particular, are often in a bent hip position with their legs spread apart.

This means that the piriformis muscle is hardly used and, like all muscles that we do not exercise regularly, lose strength. At the same time, the counter-movement to its actual function through the sitting posture creates tension. This causes the muscle to cramp more and more. It 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 can be that it presses on the nerve and the nutritional situation of the tissue deteriorates. This can lead to an impairment of the nerve and its function and lead to radiating pain or sensitivity disturbances in the area of ​​the lower back, the thigh and the knee. These problems then lead to the so-called piriformis syndrome and can be treated with physiotherapy, among other things.

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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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The clinical picture

The piriformis syndrome occurs relatively often in our society due to a lack of exercise and a one-sided attitude. The nerve can also be irritated by falling on the buttocks or excessive training of the muscles.
The symptoms of the pain in piriformis syndrome are similar to those of a lumbar spine syndrome. Back pain, buttock pain, and thigh pain can occur. Loss of sensation or tingling may also occur.

The physiotherapy findings should be used to find out which structure is causing the pain. Overloading the muscle leads to inadequate nutrition of the surrounding tissue. This means that the structures are getting too little nutrient-rich and oxygen-rich blood. This is necessary for their function. Malfunctions occur when the supply to the structures deteriorates. A dysfunction of the muscle leads to restricted mobility and shortening. A functional restriction of the nerves leads to pain that is typical of the nerves, or to sensory disorders.

Please also read our main topic for more information: Piriformis Syndrome.

physiotherapy

At the beginning of the physiotherapy, it is important to collect a detailed report that precisely identifies the structures causing the symptoms. If piriformis syndrome turns out to be the cause, surrounding structures, such as the lumbar spine, should still be treated. With piriformis syndrome, the previous incorrect postures or relieving postures, or the shortening of the muscle, also restrict the mobility in the lumbar spine.
If there are any blockages in the lower back, they may need to be resolved before treating the actual piriformis syndrome.

The muscle itself can be treated with the help of physiotherapy, more precisely with trigger point treatment, massage techniques or stretching.

In addition, the piriformis syndrome can also be treated very well on your own with the help of a fascia roller. To do this, you should sit long on the roll and first roll out one half of the buttocks with the roll, then the other. To increase the pressure, the foot of the leg that is not currently being treated can be placed on the lower leg of the other leg. There is an increased pressure load on the side that is to be treated.

You can read more information about the duration of the therapy here: Duration of piriformis syndrome

Trigger point therapy

Trigger point therapy is a passive technique in physiotherapy that is used to treat piriformis syndrome.

The patient lies either in the prone or supine position (then with the leg drawn towards the body, for a stretching position for the piriformism muscle) and the therapist looks for pain points in the muscle tissue.
Targeted, sustained pressure can relax the muscles. Massage techniques can also be used in these starting positions.
Trigger point therapy can be quite painful, but it should be tolerable for the patient to the extent that he does not tense against the pain. This would impair the effect of the therapy.

After a short time, the pain at the trigger point subsides and the muscles relax. Fascia techniques in the lumbar spine and buttock area can complement the manual treatment of the tissue in piriformis syndrome.

Stretching exercises

The stretching of the muscle is also important in physiotherapy for piriformis syndrome. The patient can do this himself very well by placing his legs on his back and hitting the leg that he wants to stretch over the thigh. Now you grasp the raised leg with your hands and pull it towards you towards your chest. With your elbow you can now easily push the crossed leg outwards at the knee.
You can find the optimal position by making small variations in pulling on and pushing away. There should be a noticeable but tolerable pulling in the outer, lower buttocks and lateral thighs.
The stretching position should be held for 20 seconds and then slowly released.After a short break, the exercise is repeated three to four times. Both sides should always be stretched.

Be careful with physiotherapy and prostheses in the hip joint! There is a risk of dislocation, i.e. dislocation of the joint, by pulling on the leg. The exercise should not be performed under any circumstances, even if a piriformis syndrome is present!

If nothing stands in the way of the exercise, the therapist can also perform a passive stretch from this position. That is, the therapist gently pushes the patient's leg into the stretch. Sometimes this helps the patient particularly well because they can relax the muscles and not struggle against the stretching. When the muscle is stretched, the nerve is also stretched. Stretching improves the mobility of the individual structures with one another and dissolves 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.

Read our topic for more information: Stretching Exercises Piriformis Syndrome.

Active muscle training

Active training of the muscles should also be part of physiotherapy for piriformis syndrome. For this purpose, hip extension should be trained more and mobility in this direction of movement improved.

From the four-footed position, for example, the leg can be moved backwards or to the side without the pelvis turning to the side on which the leg is lifted. This is important in order to make the movement from the hips and not from the back. The best way to check yourself is in front of a mirror, or you can put a flat object on your lower back, it shouldn't fall down.

Bridging, i.e. lifting the buttocks up from the supine position, is also a very good exercise in physiotherapy to strengthen the gluteal muscles and thus also the piriformis muscles. Again, the movement should come from the buttocks and not from the lower back.
The devices can be used to stretch the leg (extension of the hip) on the cable, or, if available, an extra device for hip extension.

In everyday life with piriformis syndrome, in addition to physiotherapy, attention should be paid to incorporating movement and shortening the sitting phases. Exercise, even just walking, swimming or cycling is always good for the nutritional situation in the muscles. It is alternately tensed and relaxed. The blood circulation situation improves, the tissue is well supplied and adhesions can be loosened or prevented and waste materials can be removed.

Alternative therapy options

In addition to manual physiotherapy, the patient's own exercises and stretching or device-supported training, electrotherapy can also be used to treat piriformis syndrome. The targeted use of certain forms of current can improve the blood flow to the muscles and nerves.

Summary

Piriformis syndrome is a common cause of pain and sensitivity disorders in the buttocks and thighs.

In a specific diagnosis of physiotherapy, the cause of the symptoms should be found and an individual therapy concept based on manual therapeutic techniques, massage and trigger point treatment as well as fascia techniques locally and on the surrounding structures such as the lumbar spine.
The patient should be shown exercises for self-stretching and also do them at home. Exercise therapy can improve hip mobility. The weakened gluteal muscles should be trained by the patient during therapy and as a self-exercise program at home in order to achieve long-term improvement of the symptoms.

Read a lot more information on MedOn.de at: Physiotherapy for piriformis syndrome

Piriformis muscle

1. Pear-shaped muscle -
   Piriformis muscle
2. Iliac scoop -
   Ala ossis ilii
3. Posterior sacrum holes -
   Foramina sacralia posteriora
4. Sacrum -
   Sacrum
5. Great Rolling Hill -
   Greater trochanter
6. Small rolling hill -
   Lesser trochanter
7. Femoral shaft -
   Corpus femoris
8. Ischium -
   Os ischii (ischium)
9. Fifth lumbar vertebra -
   Vertebra lumbalis V

You can find an overview of all Dr-Gumpert images at: medical illustrations

Further information on physiotherapy for piriformis syndrome

Further information on this topic can be found on the following pages:

• Piriformis Syndrome
  • Piriformis Syndrome stretching exercises
  • Duration of piriformis syndrome
  • Piriformis Syndrome Cure
  • Piriformis Syndrome causes
  • Piriformis Syndrome Symptoms
  • Piriformis Syndrome Therapy
  • Piriformis Syndrome in Pregnancy

You can find an overview of all topics in orthopedics under Orthopedics A-Z.