Piriformis Syndrome and Chiropractic Care

Piriformis syndrome is a neuromuscular disorder that causes bothersome pain and numbness. Chiropractic care can be an ideal solution.

What is Piriformis Syndrome?

In piriformis syndrome, the sciatic nerve is irritated or compressed by the piriformis muscle. As a result, patients will experience tingling, numbness, and pain along the sciatic nerve, and from the buttocks down through the leg. Piriformis syndrome may be caused by overuse, strain, or even anatomical issues. When the muscle spasms, it can compress the sciatic nerve beneath the muscle. This disorder is a type of entrapment neuropathy (nerve entrapment). Piriformis syndrome can be caused by “inactive gluteal muscles”, which can develop from “overactive hip flexors”. One example of this might be from sitting at work all day, with the hips flexed, leading to short and tight hip flexors. Overuse may also be caused bystrenuous activities, such as biking, running, and rowing, which can strain the legs. Without strengthening exercises and lateral stretching, these forward movement repetitions can lead to “weak hip abductors and tight adductors”. Combining these issues with the weak gluteal muscles, the piriformis muscle can shorten and contract. Contraction leads to the “sciatic nerve impingement”. In addition, the pudendal nerve, which controls bladder and bowels, can also be affected, and incontinence may occur. Stiffness in the sacroiliac (SI) joints, overpronation of the foot (which turns the knee medially), and falling injuries can also be responsible for causing this disorder. Piriformis syndrome can be diagnosed medically with the FAIR-test (which electrophysiologically measures conductions in the sciatic nerve) or with MRI (which can highlight inflammation). This disorder is not the same as sciatica (“compression/irritation of spinal nerve roots, as by a herniated disc”), although sciatica can be caused by piriformis syndrome. Typically, piriformis syndrome will be diagnosed when “sciatica occurs without a clear spinal cause”. In other words, there will be symptoms of sciatica, but the origins are not from spinal roots or the compression of discs; it involves the piriformis muscle.¹

How Chiropractic Can Help

Chiropractors can palpate over the trigger points to see if there is tenderness. Additional testing can be done to see if there is Freiberg’s sign (“pain with forced internal rotation of an extended hip”) or Pace’s sign (“pain and weakness with resisted external rotation and abduction of the hip”). The “straight-leg-raise test” can also help to diagnose piriformis syndrome. Chiropractic care can focus on rehabilitation by improving flexibility. Chiropractors may employ various stretching techniques and isotonic resistance exercises (i.e., lunging, step-ups, stair climbing, and partial squats). Weight-bearing exercises are the most effective. Coordination and proprioception can also be helpful. An example of this would be to exercise on one leg, eyes closed, on a rocker board or trampoline. This can help athletes with their neurological control. Functional alignment is also important. Orthotics and heel lifts can be a helpful part of a rehabilitation program, especially for those with foot pronation and leg-length discrepancies.²