Piriformis Syndrome Chiropractic Care and Other Alternative Forms of Treatment

What is Piriformis Syndrome?

Piriformis syndrome is a neuromuscular disorder that causes both bothersome pain and numbness in those patients who suffer from it. Chiropractic care could be an ideal solution for patients who are looking for a safer, more natural way of treating the disorder. 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.

Causes

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 may 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 by strenuous activities, such as biking, running, and rowing, which can strain the legs. Without strengthening exercises and lateral stretching, these forward movement repetitions which lead to “weak hip abductors and tight adductors”. Combining these issues with the weak gluteal muscles, the piriformis muscle could eventually shorten and contract. Contraction leads to the “sciatic nerve impingement”.

In addition, the pudendal nerve, which controls bladder and bowels, might 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.

Diagnosis

Piriformis syndrome could be diagnosed medically with the FAIR-test (which electro physiologically 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, which is found by “pain with forced internal rotation of an extended hip”, or Pace’s sign, discovered when there is “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 will often 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. Such a task takes a lot of balance and coordination and could take time and practice before the patient is able to do it consistently and steadily, even when performed by patients who do not have piriformis syndrome. This method of combining exercise and balance could also 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. A pair of cheap shoes that do not have the correct support for proper form when standing or walking is not good for any patient, and it could be the cause of or exacerbate existing conditions and worsen the patient’s state of pain.²

Other Alternative Forms of Treatment

Massage therapy is used as a complementary form of treatment that often goes along with chiropractic care. Some chiropractors even have massage therapists in their employ to provide treatment of both types within the same office. Other chiropractors might recommend a local massage therapist that they trust to complement their own treatment style. Massage could help heal piriformis syndrome using soft tissue treatment. The therapist might try to reduce tension in the gluteal muscles with superficial effleurage before using static compression techniques on myofascial trigger points. The tissue should start to relax in the areas where pressure is specifically applied. While the muscles in the affected areas could be tender, patients should tell their massage therapist if they begin to feel particularly aggravating symptoms so that the therapist will know to reduce pressure or move on to a different area.³

At home, patients can try using a tennis ball to release the tension in the muscles for milder cases of piriformis syndrome. In order to relieve the tension, the patient should find a comfortable, firm chair and then sit on the chair with the tennis ball positioned under a point of pain. The patient should put just enough of their weight on the ball that they begin to feel pain without putting their full weight on the ball, hold for twenty seconds, and then move the tennis ball to a different region. If this method does not yield any results after a few tries over the course of a few days, the patient might want to consult a chiropractor or massage therapist for alternative treatment.⁴