Piriformis syndrome: such an ancient and recent history

The piriformis muscle is the only connector of the iliosacral joint. Externally, it has the shape of an elongated triangle, attached to the pelvic bones. It passes through the sciatic foramen along with large vessels and nerves. This muscle formation is responsible for the movement of the pelvis, rotates and abducts the hip, provides forward tilt and supports the femoral head. If this area is affected by the disease, this area experiences severe stress, all symptoms are united by doctors under one name - piriformis syndrome. We will consider the symptoms and treatment with gymnastics, as well as medications, below.

Causes of the disease

A large number of vessels and nerves pass near the muscle itself and its ligaments, so during inflammation, when the lumen of the hole narrows, severe pain often occurs, the cause of which is ischemia of the piriformis muscle.

Let's look at the most common causes of the disease:

• lack of essential microelements in bone tissue;
• physical fatigue;
• incorrect posture for a long time;
• trauma to this area;
• chronic osteochondrosis in the lumbar and sacrum areas;
• poorly made intramuscular injection;
• hypothermia of the body.

These are the reasons for the appearance of primary inflammation; a secondary disease is also identified when the process spreads to the piriformis muscle from adjacent areas.

The disease itself is quite rare; there are no categories of people particularly susceptible to it. However, for those who regularly overload themselves with training, it is important to know what symptoms indicate an emerging problem.

What causes piriformis syndrome?

• Weak gluteal muscles, resulting in increased stress on the piriformis muscle.
• Subluxation in the hip and sacroiliac joint, which places additional stress on the piriformis.
• Rolling the foot (ankle) inward when walking, again, overuses the piriformis muscle.
• Pinching of the nerve root at the level of the first sacral vertebra leads to pathological tension of the piriformis muscle.
• Trauma (severe bruise, wound), which can lead to muscle tearing (in this case, yoga exercises to stretch the muscle may be ineffective).

Signs of the disease

Piriformis syndrome absolutely always has pronounced symptoms. A hidden form of this problem was not observed, so the disease is quite easily diagnosed based on the patient’s complaints. Symptoms of inflammation:

1. Severe pain occurs in the pelvic region, which is more pronounced when standing and walking, as well as when moving the hip, sitting cross-legged. Sometimes the sensation subsides if you fixate in a position with your hips apart.
2. It usually feels like a dull aching pain, there is shooting and burning, and it reacts to heat and weather changes.
3. There is also a decrease in sensitivity of the lower extremities, immunity to stabbing pain or burns.
4. With advanced inflammation, problems with the bladder may begin;
5. The skin in the surrounding area turns pale, and lameness begins.

Signs of sciatic nerve compression:

• the pain is pressing, can spread to the toes, and is accompanied by numbness and chills;
• sensations intensify upon palpation of the lower leg;
• sensitivity is also reduced, and pain is provoked by weather, heat, and nervous conditions.

If at least one of these signs appears, you should consult a doctor who will conduct a diagnosis and select an appropriate course of treatment.

The first thing the doctor will do is check the patient for signs characteristic of the disease. To do this, they are usually asked to perform a series of actions and describe the accompanying sensations; a visual inspection and palpation of the disturbing area are also carried out. Diagnostics rejects the instrumental research method, so don’t be afraid of going to the doctor.

Back pain radiates to the buttock

Buttock pain is a fairly common problem. It can be caused by many reasons, but the most common of them are problems with the spine and pelvic bones.

Causes of pain

The most common cause of pain in the buttock (in 75% of cases) is various degenerative diseases of the spine. They cause either local pain in the buttock or pain radiating from the damaged intervertebral disc or joint to the buttock area. Spinal diseases can cause irritation of nerve fibers and disruption of normal muscle tone (spasm, overstretching).

A prime example here is piriformis syndrome.

It often occurs with
lumbosacral radiculitis.
The essence of the syndrome is compression of the sciatic nerve by the piriformis muscle located deep in the gluteal region. At first, the pain worries only in the lower back, and then goes down to the buttock area, along the back of the thigh.

Dysfunction of the sacroiliac joint (joint)

can also cause pain in the sacrum and buttock. Various asymmetries of the pelvis can lead to disturbances in the functioning of the joint. Such asymmetries threaten those of us who have scoliosis, flat feet, or, for example, problems with one or both hip joints. The joint can also be damaged by injury (for example, falling on your back or side). The pain worries mainly in the sacrum area, intensifies when standing up and walking after prolonged sitting.

Two more common causes of pain in the buttock are spondyloarthrosis

(arthrosis of the intervertebral joints) and
spondylosis
(deformation of the vertebral bodies and the appearance of bone growths - osteophytes) of the lumbar spine. These diseases lead to compression or irritation of the nerve endings around the intervertebral joints, which causes pain to radiate to the buttock, thigh (usually under the knee). Characterized by pain when moving after a long stay in an uncomfortable position, limited mobility of the spine. Often the pain radiates to other areas of the body.

Treatment

If the doctor has identified the problem described above, then treatment will usually consist of:

• taking medications;
• massage;
• physiotherapy;
• Exercise therapy, therapeutic exercises;
• use of correctors (insoles, special underwear, etc.).

Usually the doctor prescribes painkillers and anti-inflammatory drugs, since the disease is treated for a long period of time, the course is repeated several times a year, at the time of seasonal exacerbation.

Self-massage can be performed at home, the main condition is a flat, hard surface; you will need to lie on the floor. Another type of massage is rectal, performed by a doctor during procedures. The doctor also helps to stretch the muscles; an important point when doing stretching is to never make it painful, at most a pleasant tingling sensation. A physiotherapist uses electric currents to warm up the affected area. Sometimes vacuum massage or laser therapy is prescribed.

Etiology

Pathology provokes abnormal changes in the piriformis muscle. Provoking factors include:

• injury;
• spasm;
• fibrosis;
• inflammatory process;
• increase in size.

The human piriformis muscle can be damaged due to intramuscular injections, which can provoke the occurrence of an intramuscular abscess and the formation of an infiltrate. The main etiological factors of pathology include the following:

1. Injuries. The cause of problems is excessive stretching of muscle tissue, tearing of fibers, and the development of fibrosis. With fibrotic processes, shortening and thickening of the muscle is observed.
2. Post-traumatic hematoma.
3. Vertebrogenic pathologies. This category includes spondyloarthrosis and osteochondrosis. These also include intervertebral hernias in the lower back. In addition, spinal and vertebral tumors are provoking factors. Damage to the fibers of the sacrum and spinal nerves causes a reflex spasm.
4. Inflammation. These include inflammation and prostate adenoma, damage to the bladder. Spasm of the piriformis muscle is associated with endometriosis, sacroiliitis, and myositis.
5. Muscle overload. Their cause is the prolonged stay of the pelvic-iliac segment in a forced position. With radicular syndrome, a person tries to take an antalgic position. Some sports can cause the disease - in particular, running and weightlifting.
6. Malignant tumors in the sacrum and proximal femur. They provoke anatomical processes in structures. Neoplasia can provoke spasm and inflammation of the piriformis muscle.
7. Pelvic asymmetry. It is observed with shortened legs or scoliosis.
8. Removal of the thigh. In this case, the muscle is in a state of constant spasm, which leads to the appearance of phantom pain.

Exercises

A few simple exercises, when performed correctly, can significantly ease the course of the disease. All elements are done on the floor, there should be no restrictive clothing, and it is forbidden to cause pain; if they do appear, it is better to discuss this with a doctor. We list the gymnastic techniques that a doctor may recommend:

1. Lying on your back with your knees slightly bent, you need to smoothly spread and bring them together, feeling the tension in the muscles.
2. Sitting on the floor, cross your legs, sit for about five minutes, then switch your legs.
3. Sitting on a chair with your legs bent 90 degrees, stand up without spreading your knees, then relax your lower limbs.
4. Sitting cross-legged on a chair, slowly press your body against the limb on top about ten times, then repeat with the other leg.
5. Standing on all fours, smoothly straighten one leg back, extending your toes, alternating legs, repeat three times.
6. Lying on your back, lift your straight leg up and pull in the opposite direction, trying to touch the floor. A springy, pulling sensation should appear, then the legs change, so three repetitions.
7. While on your stomach, with your legs closed, try to push one knee with the other, while resisting for about 5 seconds, then switch your legs.
8. While on your back, with your arms outstretched to the sides, your legs raised and bent, you need to try to bring your legs to the left, then the right side as far as possible, without lifting your shoulder blades from the floor. Repeated five times.

You need to do the training several times a day, otherwise there will be no visible effect. If there is such an opportunity, it is better to exercise in the presence of a special trainer who will monitor the correctness and safety of execution and suggest correct breathing.

Pathogenesis

The narrow part of the piriformis muscle is fixed on the greater trochanter of the femur, and the wide part is attached to the sacrum. It is responsible for external rotation and helps to abduct the hip inward. This part of the muscle tissue passes through the sciatic foramen. Nerves and blood vessels are located in this area.

Due to the constant contraction of muscle tissue, the size of the infrapiriform opening decreases. As a result, blood vessels and nerves are compressed. First of all, the sciatic nerve is affected, which leads to severe pain.

In addition, compression of blood vessels disrupts blood circulation in the nerve trunk. This is considered an additional factor in the development of sciatica.

Causes of the disease.

When the first symptoms appear, we often wonder why this happened to us. Often we do not perform unusual actions, do not lift extremely heavy loads, and do not spend the whole day in a forced position.

In fact, each of us has an adaptive reserve of the body, thanks to which for a long time we do not notice excess tension in the muscles, which can work at the limit of their capabilities for years. But there comes a moment when the muscle tells us in the language of pain: “master, I can no longer work in this mode.” A muscle spasm accompanied by pain is a muscle’s cry for help.

The cause of pain may be one awkward movement, but the history of the problem goes back to the distant past, because previously we simply did not notice tension in the muscle and could not take preventive measures to prevent clinically significant pathology. Therefore, it is more advisable to first consider the prerequisites for the appearance of excessive tension in the piriformis muscle, and then the immediate causes of the appearance of piriformis muscle syndrome.

Knowing the function of a muscle allows you to identify potential conditions that may lead to overuse of the muscle, called risk factors. The piriformis muscle is involved in external rotation of the leg, that is, the outward rotation of the forefoot when the leg is straightened.

If you bend your leg at the hip joint 90 degrees, this muscle will be involved in hip abduction, that is, moving the knee outward. The piriformis muscle is one of the main stabilizers of the hip joint, preventing excessive movement when moving on slippery and inclined surfaces and rough terrain.

Main risk factors for developing piriformis syndrome

1. Flat feet. With longitudinal flatfoot, the medial (inner) arch of the foot becomes flattened, which leads to pronation (internal rotation) of the forefoot. We remember that the piriformis muscle turns the leg outward, that is, with flat feet it is forced to take on a large load, counteracting the forces tending to turn the foot and the entire lower limb inward. Since flat feet are extremely rarely symmetrical, the piriformis muscle on the side of the more flattened foot is more susceptible to spasm.
2. Shortening the leg. Functional or anatomical shortening of the lower limb leads to an asymmetrical position of the pelvis and the appearance of a functional block in the sacroiliac joint. To compensate for impaired body statics and stabilize the pelvis, the piriformis muscle on the side of the shortened limb is forced to be in a state of greater tension, which serves as a prerequisite for the occurrence of piriformis muscle syndrome.
3. Scoliotic deformity of the spine. The formation of scoliotic arches of the spine inevitably affects the position of the pelvis and sacrum, which is accompanied by asymmetric tension in the muscles of the trunk and lower extremities and is a prerequisite for the occurrence of muscular-tonic syndromes of various localizations.
4. Coxarthrosis. Osteoarthritis of the hip joint leads to a reflex spasm of the muscles involved in the movement of the femur relative to the pelvis. Since the piriformis muscle is a stabilizer of the hip joint, it inevitably contracts and can lead to the development of piriformis syndrome.
5. Pathology of the pelvic organs. Any volumetric processes in the pelvic area (tumors, aneurysms, abscesses) can lead to the formation of a reflex spasm of the piriformis muscle. This must be remembered in the presence of concomitant complaints and symptoms from the pelvic organs, as well as in case of atypical manifestations of piriformis syndrome.

Immediate causes of piriformis muscle spasm (you may recognize yourself in one of the situations presented)

• an attempt to prevent a fall (slipped on a slippery surface, miraculously maintained balance, did not fall, but a few hours later pain appeared in the sacrum);
• staying in a forced position for a long time, standing with legs wide apart, performing physical activity (unloading goods to stabilize the pelvis with legs wide apart, moving the load from top to bottom, at first I felt tension in the lower back and pelvis, then pain appeared in the buttock);
• monotonous performance of repeated unusual actions to which the person was not adapted (planted/digged potatoes at the dacha, decided to finish everything in one day, and the next morning felt severe pain in the buttock);
• strong intense muscle contraction at a high pace under changed conditions (I used to run on a track in the gym, everything was fine, but I decided to run through the forest and the next day pain appeared in the thigh and buttock);
• long stay in the position of bending the legs in the hip joints with the knees apart (there were no problems with the pelvis throughout the pregnancy, but after a long labor I could barely get up from the couch, walked and dragged my leg, there was pain in the buttock and radiated to the leg);
• direct injury to the gluteal region (after the accident, fortunately, I did not receive any serious injuries; the impact was from the driver’s side; I did not feel it immediately, but after a couple of days I began to experience pain in the gluteal region);
• long-term fixed position of the leg (I decided to go with my family to Sochi by car in order to save time, I decided to drive without stopping, I sat behind the wheel for 18 hours, I get out of the car, and it’s like my leg is not mine, it’s numb and hurts).

Preventing piriformis muscle spasm

There are no specific methods for preventing pathology. It is recommended to avoid excessive stress on the muscles and injuries.

It is important to contact a specialist in a timely manner. This will help in the initial stages to diagnose and treat pathologies that can provoke piriformis syndrome.

In addition, following these rules will help prevent the development of the disease:

• avoid hypothermia;
• do not engage in heavy physical labor;
• Do not stay in a position for a long time that reduces pain.

Piriformis syndrome is a fairly serious pathology that causes severe pain. It is caused by a whole complex of factors - increased physical activity, injuries, hypothermia.

Secondary pathology

Secondary syndrome is associated with the influence of external factors. These include the following:

1. Traumatic injury to the buttocks. It can cause inflammatory damage to soft tissues, muscle spasms, and a combination of both. As a result, compression of the nerve occurs.
2. Direct damage to the piriformis muscle, postoperative injuries, increased stress on the lower back. Under the influence of these factors, muscle spasms appear.
3. Shortening of muscles. The syndrome is caused by changes in the biomechanics of the leg and lumbosacral region. This often causes compression and irritation of the sciatic nerve.

Secondary pathology is associated with microtraumas. They appear due to overuse of the piriformis muscle. These include long distance movement or direct impact.