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Discomfort from too much sitting? Inactive glutes? Buttock and leg pain? Though small in size, the piriformis could have a big impact on keeping the human movement system moving smoothly. Addressing an overactive piriformis may be part of the solution.
The piriformis is a tiny muscle that originates on the anterior surface of the sacrum, travels through the greater sciatic foramen, and attaches to the greater trochanter of the femur . It accelerates hip external rotation, abduction, and extension.
Piriformis syndrome has traditionally been described as a referred neural pain in the posterior hip and leg caused by hypertrophy or spasm of the piriformis. The pain is caused by pressure applied to the sciatic nerve by the piriformis due to the passage of the nerve through or under the muscle . Pain associated with this problem often mimics the signs and symptoms of lumbar nerve root compression or sciatica in the buttock and posterior leg. The client will often report sciatica-type symptoms and experience tenderness in the piriformis fossa. Pain when sitting is common, as is pain with hip flexion, adduction, and internal rotation.
While the signs and symptoms of the syndrome may be similar to other lumbo-pelvic pathology, the cause of piriformis syndrome remains relatively undefined as to reasons for development of spasm or hypertrophy of the muscle. It is interesting to note that a description of the syndrome is found in most medical texts, yet the criteria for diagnosing piriformis syndrome and pathophysiology still remains a controversial issue . However, the reason why the piriformis is hypertrophied or in spasm is often described as “undefined and confusing.” If the practitioner considers the principles of the kinetic chain and dysfunction of its linked components, it is not difficult to hypothesize why the piriformis may become involved in an impingement of the sciatic nerve. If the client has chronic tightness of the hip flexor, the gluteus maximus will become reciprocally inhibited . This is significant because of the functional responsibility of the glute to decelerate medial femoral rotation during heel strike or functional movements. Since the piriformis is a primary external rotator of the femur, it becomes synergistically dominant in controlling the femur. This type of dominant function has the potential for causing the spasm, hypertrophy, or tightness described in most texts. The external hip rotators have also been noted as being the least stretched muscles of the lower body .
If a client complains of pain associated with that described above, the health and fitness professional should first instruct the client to visit their medical professional. If a client has been released from therapy or their doctor and the pain persists, an effective strategy for correcting this type of dysfunction would be to first release the hip flexor through appropriate integrated flexibility techniques, then implement reeducation of the gluteus maximus through isolated strength training, and, finally, recondition the lumbo-pelvic hip complex through integrated functional movements in the appropriate range of motion, plane of motion, and speed, specific to the needs of the client.