Piriformis Syndrome is a pain in the ass. It’s true. Literally.

The principle symptom of piriformis syndrome is described as ‘buttock pain with or without leg pain’. How vague is that? There is a lot of confusion surrounding it and still a lack of consensus on the precise definition of this syndrome.

Pain in the ass, vague, difficult to pin down, surrounded by confusion. Sound like anyone?

Truly, I say to you, that Piriformis Syndrome is the Donald Trump of medical conditions.

It’s not just that it’s a difficult to pin down pain in the ass, or even the confusion as to what it is and how it has come to this. Piriformis Syndrome has many other facets in common with the Donald.

Like Trump, it affects an awful lot of people. As a student physiotherapist, I was always amazed at the number of lumbar/buttock pain patients that were diagnosed with piriformis syndrome in a musculoskeletal setting. You could say that it is as common as a man who boasts about his pulling (or should I say, grabbing?) power.

There’s also the fact that it has commanded waaay too much attention for such a relatively small thing. Given all that I had heard in advance, I was very excited to see the Piriformis muscle for real on a cadaver when I was a student physiotherapist (I know – my wife calls me Dexter!). I reckoned it must be monstrous. The Piriformis muscle is in fact a relatively small, triangle shaped muscle that lies deep within the gluteal muscles and is situated close to the sciatic nerve. So, when we had difficulty establishing which string of muscle was the Piriformis … well, I felt as let down as many who have met the Donald for the first time.

What does the Piriformis do? (You may also ask this of the Donald)

The piriformis muscle has a number of roles but it is primarily a lateral rotator of the hip and is an important abductor in a sitting position. Secondary to this muscular function, it also holds the head of the femur into the socket.

piriformis physio

Why the confusion?

The anatomical arrangements in this area have been studied extensively and numerous studies have demonstrated that in an estimated 10-15% of the population, a separate division of the sciatic nerve passes through the muscle belly of piriformis before continuing its usual path (Moore & Dalley, 1999;  Brukner & Khan,  2006).

Some say that the sciatic nerve is influential in the syndrome’s presentation. Others don’t. Previous research has either included the involvement of the sciatic nerve and accompanying neuropathic pain symptoms in the definition of the syndrome; or ignored the involvement of the sciatic nerve and referred to piriformis syndrome as pain that is derived solely from the muscle itself.

So, like Senor Trump, it’s controversial and there is a lot of nerve involved, but it’s not for everyone.

Why has the piriformis muscle become such a problematic muscle in today’s society?

The piriformis muscle is prone to injury like any other muscles due to sustained poor posture, repetitive strain, direct trauma or over-loading of the associated tissue. As previously discussed in many of my blogs our over exposure to seated flexion in our daily lives and in the work place is a significant factor in the increased incidences and diagnosis of Piriformis Syndrome. Shaklock 2005 reaffirms this hypothesis as he state’s that both postural and Injury-induced changes to the piriformis muscle not only cause local pain but may also result in irritation or ‘entrapment’ of the sciatic nerve due to their close proximity resulting in the development of peripheral neural symptoms such as paresthesia, anesthesia or weakness which may occur anywhere along the length of the affected sciatic nerve.

In other words, like the ascension of Trump, it’s because too many people spent too long sitting on their ass and didn’t get up and do something before it was too late. Sound familiar?

Finally, Piriformis Syndrome doesn’t care who it goes after. Here the analogy falls down somewhat, as we all know that 45 is selective in who he goes for.

How to treat Piriformis Syndrome

How does one impeach Piriformis? The good news is that it can be treated using a combination of dry needling, stretches and pressure release techniques.

At Platinum Physiotherapy, we seek to restore the nerve’s mechanical tensioning/sliding faults through the use of neural mobilisation techniques (this is a gentle movement technique to move nerves). And secondly, we reduce the nerve irritation with stretches and manual soft tissue mobilisations/pressure release techniques such as dry needling and manual trigger point release.

With Trump, some argue that the media’s extensive use of dry needling is beginning to take hold, though he is countering that with his own pressure release technique (golf) and long stretches (at Mar a Lago).

Our approach generally is to apply a combination of approaches and techniques that we believe will ultimately work. With Trump, as it is in Physiotherapy, I believe a little bit of everything will finally bring about a successful outcome.

If I haven’t had an episode of Piriformis syndrome to date, is there any way of preventing it developing?

If you have been reading my blogs, you may have picked up on the theme that the key to injury prevention is simple and involves allowing the body to move through postures and movement patterns, thus encouraging combined movements to destress the already overloaded neuromuscular system. Don’t wait for injury to inhibit you and prevent you from getting on with life. Embrace movement and allow your body to do what it was designed to do.

You could say the answer lies in Donald Trump himself. After all, he keeps talking about his ‘movement’.

Isn’t it ironic? As Alanis Morissette might say.


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