Dr. Alex Jimenez, El Paso's Chiropractor
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Piriformis Treatment˚


The piriformis muscle (PM) is well-known in medicine as a significant muscle of the posterior hip. It is a muscle that has a role in controlling hip joint rotation and abduction, and it is also a muscle made famous due to its ‘inversion of action’ in rotation. The PM also garners attention due to its role in ‘piriformis syndrome’, a condition implicated as a potential source of pain and dysfunction.

Piriformis syndrome can be defined as a medical condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The Sciatic Nerve may be irritated by the interaction between the SN and the PM producing posterior hip pain down the posterior thigh, imitating ‘sciatica‘.

Complaints of buttock pain with referral of symptoms are not unique to the Piriformis Muscle. Symptoms are widespread with more clinically evident back pain syndromes. It has been indicated that piriformis syndrome’ is accountable for 5-6 percent of cases of sciatica. In the majority of instances, it happens in middle-aged individuals and is far more prevalent in women.

Anatomy

Piriformis muscleThe PM originates on the anterior surface of the sacrum and is anchored to it by three fleshy attachments between the first, second, third and fourth anterior sacral foramina. Occasionally its origin may be so broad that it joins the capsule of the sacroiliac joint above and with the sacrotuberous and/or sacrospinous ligament below.

PM is a thick and bulky muscle, and as it passes out of the pelvis through the greater sciatic foramen, it divides the foramen into the suprapiriform and infra-piriform foramina. As it courses antero-laterally through the greater sciatic foramen, it tapers out to form a tendon that is attached to the superior-medial surface of the greater trochanter, commonly blending with the common tendon of the obturator internus and gemelli muscles.

The nerves and blood vessels in the suprapiriform foramen are the superior gluteal nerve and vessels, and in the infra- piriforma fossa are the inferior gluteal nerves and vessels and the sciatic nerve (SN). Due to its large volume in the greater sciatic foramen, it has the potential to compress the numerous vessels and nerves that exit the pelvis.

PM is closely associated with the other short hip rotators that lie inferior such as the superior gemellus, obturator internus, inferior gemellus and obturator externus. The primary difference between the PM and other short rotators is the relationship to the SN. The PM passes posterior to the nerve whereas the other otators pass anterior.

Causes: Piriformis Syndrome (PS)

Piriformis_syndromePiriformis Syndrome may be caused by or related to three primary causative factors;

1. Tight and shortened muscle fibers precipitated by muscle overuse such as squat and lunge movements in external rotation, or direct trauma. This increases the girth of the PM during contraction, and may the source of the compression/entrapment.

2. Entrapment of the nerve.

3. Sacroiliac Joint Dysfunction (SI Joint Pain) causing PM spasm.

Symptoms

Typical symptoms of piriformis syndrome include:

  1. A tight or cramping sensation in the buttock and/or hamstring.
  2. Gluteal pain.
  3. Calf pain.
  4. Aggravation from sitting and squatting.
  5. Peripheral nerve symptoms i.e. pain and paraesthesia in the back, groin, buttocks, perineum, behind thigh.

Piriformis Treatment

3d figures chiropractic treatment el paso txWhen it is believed that piriformis syndrome exists and the clinician feels that a diagnosis has been made, the treatment will usually depend on the suspected cause. If the PM is tight and in spasm then initially conservative treatment will focus on stretching and massaging the tight muscle to remove the PM as being the source of the pain.

If this fails, then the following has been suggested:

  1. Local anaesthetic block – performed by anaesthesiologists who have expertise in pain management.
  2. Steroid injections into the PM.
  3. Botulinum injections into the PM.
  4. Nerve Surgery.

Therapist-directed interventions such as stretching the PM and direct trigger point massage has always been advocated.

Summary

The piriformis muscle is a really strong and powerful muscle that runs from the sacrum into the femur. It runs beneath gluteal muscles the nerve travels beneath them. If this muscle goes into spasm, then the nerve creates radiating pain, numbness, tingling, or burning out of the buttocks to the leg and foot. Other people develop the syndrome while dealing with chronic low back pain.

Activities and motions that cause the piriformis muscle to contract further compress the sciatic nerve, causing pain. This muscle contracts once we squat, or stand, walk , go up steps. It tends to tighten when we sit at any position for more than 20 to 30 minutes.

Individuals who have a history of chronic low back pain frequently assume that their radiating sciatic pain is traceable to their lower spine. Their history of disc herniations, or sprains, strains has taught them to assume that it will go away like normal, and that the pain is out of their spine. It is just when the pain doesn’t respond as usual that individuals seek therapy, thus delaying their recovery.

Sciatica Pain

Dr. Alexander Jimenez ♛
Chiropractor💡 Author • Researcher • Injury & Trauma Clinician • Wellness Educator • 915-850-0900 📞
We Welcome You 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries.

We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.

We’ve been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body’s own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.

As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.

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With a bit of work, we can achieve optimal health together, no matter the age or disability.

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