Physical experts suggest the piriformis muscle stretch to manage the pain of piriformis syndrome.

The condition presents with spasms in the piriformis muscle.

The condition produces discomfort in the buttocks.

Consequently, the syndrome causes pain, numbness, and tingling. You feel the symptoms throughout the back of the leg. In fact, the symptoms may involve the foot in severe cases. This happens when the inflammation of the piriformis irritates the neighboring sciatic nerve.

Accompanying sciatic nerve irritation is due to the muscle's proximity to the nerve.

Anatomy of the Piriformis Muscle

Piriformis is a small-sized muscle. It lies deep in the buttocks (behind the gluteus maximus).

The anatomical landmarks of the muscle are;

• Piriformis starts at the base of the spine. It extends down to the upper surface of each thigh bone (femur) on the respective side.
• The piriformis muscle acts to rotate the hip. The outward rotation of the leg and foot is also brought about by it.
• The muscle runs diagonally alongside the sciatic nerve. As a result, the muscle lies directly under the nerve.

Factors contributing to piriformis syndrome

Many causative factors explain the precise cause of piriformis syndrome (1). However, controversy remains about the subject. Some plausible ones include the following;

• Piriformis muscle spasms may occur due to tension in the piriformis muscle itself.
• Any adjacent structure may contribute to a painful spasm in the piriformis muscle. For example, irritation of the sacroiliac joint or hip.
• Trauma or injury may lead to tightness and spasms of the piriformis muscle.
• Swelling of the piriformis muscle may be due to an injury or direct trauma.
• Bruising and bleeding in the region of the piriformis muscle also result in symptoms of piriformis syndrome.

Any of the issues mentioned above might irritate the piriformis muscle. However, many times a combination of factors contributes to piriformis syndrome. This can lead to a painful spasm in the buttock of the affected side.

The underlying sciatic nerve may also get irritated. Consequently, it causes;

• Pain
• Tingling
• Numbness felt in the back of the thigh, leg, or foot.

Piriformis Syndrome: Signs & Symptoms

Patients often report experiencing acute discomfort in the buttock. Presenting complaints also include leg pain similar to sciatica.

The signs and symptoms may include pain that travels down the back of the leg, calf, and foot.

Typical symptoms of piriformis syndrome include the following:

• Pain in the buttock area that feels like a dull ache
• Sciatica-like pain in the back of thighs, calves, and feet
• Pain on activities like climbing stairs or incline
• Worsening symptoms with extended periods of sitting
• Restricted range of motion in the hip joint

Extended sitting, walking, or jogging worsens the symptoms of piriformis syndrome. In fact, a patient may feel good after lying down on the back. This is because of the compression applied to the deeply located piriformis muscle.

Diagnosis of the Piriformis Syndrome

There is not a straightforward diagnostic test for piriformis syndrome. Usually, a patient's signs and symptoms show the diagnosis. Moreover, the physical examination of the affected side confirms the condition.

Some necessary steps in diagnosing piriformis syndrome include the following;

• Reviewing the patient's medical history
• Doing a physical examination
• Conducting diagnostic tests

Some other conditions that need ruling out while diagnosing piriformis syndrome include;

• A lumbar disc herniation
• Sacroiliac joint dysfunction

1. Physical Examination

Your doctor will examine your hips and legs as part of the physical examination. This also helps check the effect of movement on the severity of pain.

In most cases, moving the hip will cause discomfort to return. The examination will also rule out other potential factors for sciatica pain. Test for local tenderness and the strength of the muscles is also examined.

2. Medical history of the patient

The medical history includes an in-depth review of the patient's symptoms.

Medical history includes questions about the symptoms' first appearance, severity, etc.

Also, your doctor reviews any illnesses, such as arthritis, that may run in the patient's family.

3. Diagnostic testing

Diagnostic imaging techniques are of not much use to detect any muscular issue.

However, X-rays, MRI scans, and nerve conduction tests help in other ways. These tests exclude the possibility of other underlying conditions that mimic piriformis syndrome.

Your doctor may also give you an anesthetic injection with or without steroids. Such a measure confirms any source of pain arising from the piriformis muscle.

Piriformis Muscle Stretch and Physical Therapy

Extending the piriformis muscle is the basic principle of therapy for piriformis syndrome. Your physical therapist engages the muscle in a controlled and gradual manner.

1. Stretches for people with Piriformis syndrome

Carefully mapped outstretches are crucial to pain management in piriformis syndrome. These moves progressively act on the piriformis muscle.

Stretches targeting the hamstrings and hip extensors also help reduce the painful sensations. These stretches also target the sciatic nerve. All these measures aim to recover the patient's range of motion.

a) Stretches for the piriformis

Stretching one's piriformis muscle may be done in various ways. Two easy methods are as follows:

• Place your feet flat on the ground. Bend both knees and lie on your back.

Bring the right knee to the chest. Take the knee with the left hand and bring it towards the left shoulder.

Maintain the stretch and repeat on the other side as well.

• While lying on your back, you should keep your feet flat on the floor while bending both knees.

Place the right ankle on the knee of the left leg so that the two joints align.

Holding this stretched position, pull the left knee toward the chest. Repeat it on the other side too.

In the beginning, hold each stretch for five seconds. Gradually increase the duration until you are holding each stretch for thirty seconds. Perform the piriformis stretch at least three times every day.

b) Stretches for the hamstrings

It would be best if you stretched the hamstrings. This is because flexible hamstrings reduce sciatic pain. Consequently, the piriformis also relaxes with these stretches.

The hamstrings are major muscles that run down the back of each leg. The hamstring stretches are doable in a variety of different methods. Some of these include the following;

Stretching your hamstrings while lying on your back.

Lying down hamstring stretches eases lower back discomfort and leg pain. Lying down cuts back the tension exerted on the hamstrings.

a) Stretching your hamstrings using a towel.

This method of hamstring stretch utilizes a towel in hand and a suitable spot. Here is how to do the hamstring stretch with a towel:

• Lie down on your back and wrap a towel over the back of one leg. Support the thigh with your hands at each of the towel's ends. If a towel is unavailable, you may only use your hands to hold the thigh. Maintain the opposite leg flat on the floor.
• Slowly straighten your knee backward using your hands until you feel a stretch. Try to bring your foot parallel to the ceiling. Always extend the knee as far as comfortable.
• Hold the position for 10 seconds first, gradually increasing the time to 30 seconds.
• Count 4 to 5 times with each leg until you have completed a full set of this stretch.

Aim to complete two sets every day.

b) Stretching your hamstrings against a wall.

The best way to perform this stretch is at the edge of a wall or next to a couch:

• Keep one leg on the floor and the other on a wall or the arm of a sofa.
• Gently press the knee so that the lifted leg is as straight as is bearable.
• Hold the position for 10 seconds first, gradually increasing the time to 30 seconds.
• Perform this stretch four to five times with each leg, one at a time, for four to five repetitions.

Aim to complete two sets every day.

Stretching the Hamstrings While Sitting

Stretching the hamstrings in a sitting posture exerts more stress than lying down. However, doing it sitting with a gentle approach than standing.

However, you must modify the stretch according to your comfort level.

It is critical to avoid rounding the lower back. For example, you may fold the hips forwards. This is the correct way of doing this stretch.

a) The seated stretch of the hamstring

Follow these steps to stretch your hamstrings while you are sitting down:

• Sitting on the edge of a chair, extend one leg in front of your body. While keeping the heel firmly planted on the floor.
• Sit up straight and move the pelvis forward while straightening your spine.
• Stay in this position for a total of thirty seconds.
• Perform this stretch for each leg.

Make it a point to do this exercise twice a day.

b) Stretching the hamstrings on the edge of a bed.

Sit on the side of a bed and do the following stretches:

• You should place one leg along the bed's edge while the other should be on the floor with the foot.
• Maintain a straight spine while bending forward from the hips.
• Attempt to maintain a straight, pain-free leg on the bed.
• For 30 seconds, hold this stretch three times on each leg.

c) Advanced hamstring stretches in the sitting position.

Use two chairs for this stretch and go through the instructions outlined below:

• The spine, shoulders, and back should be straight.
• Straighten one leg by raising one foot onto the seat of the opposite chair.
• The hamstrings and calf muscles of the leg get stretched when you do this.
• Take a deep breath in and out to stretch your spine. Bend the trunk forward over the stretched leg while inhaling. Stop immediately if this posture causes leg or back discomfort.
• Hold the stretch for five to fifteen seconds, depending on your pain threshold.
• When done, switch legs.

Treatment for Piriformis Syndrome through Physical Therapy

In addition to doing standard stretches, you may need appropriate physical therapy. A physical therapist customizes such exercises according to the needs of each patient. The target of these exercises is to ease the piriformis spasm.

a) Exercising a wide range of motions

Skilled individuals who address piriformis syndrome include;

• Your health practitioner
• A physical therapist
• A physiatrist
• A chiropractor

These healthcare experts map out a personalized stretching program to reduce piriformis spasms. Consequently, these exercises and stretches target and improve the range of motion.

b) Deep Massage

Deep massage treatment speeds up the healing process in case of piriformis spasms. DMT is also known as manual release.

The increased blood flow to the affected muscles reduces the severity of spasms. It would be best if you always looked for a competent massage therapist.

The treatment plans for piriformis syndrome umbrella a range of therapies. Some examples include the following;

Specific Treatment Options for Piriformis Syndrome

A medical practitioner may suggest many therapies for piriformis syndrome. It depends on the intensity of the patient's condition.

You may require a combination of more than one of the non-invasive therapies. These are listed below:

1. Ice Baths and Massage using Ice Packs

You may use ice packs and massages as soon as the first pain symptoms arise.

Taking an ice bath or using an ice compress caters to cold therapy.

For an ice compress, lie on your stomach on a comfortable surface. You may apply an ice pack directly to the affected region.

Apply ice compress for at least twenty minutes. If required, repeat the process every two to four hours.

Combining the cold compress with a bit of massage is also beneficial. Lay down on your stomach and massage the sore region with a big-sized ice cube.

It would be best if you prevented an ice burn on your skin. Keep ice packs on your body for eight to ten minutes.

2. Treatment with Heat

Alternating between hot and cold might be beneficial for specific individuals.

If you use a heating pad, you should lie on your stomach. Apply the pad directly to the sore region for up to twenty minutes.

Be careful not to doze off while lying on a heating pad since too much contact might result in skin burns.

3. Medications to Treat the Pain of Sciatica

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective remedies to reduce inflammation in the body. For example, ibuprofen or naproxen. These medicines help relieve the pain of spasm-induced piriformis.

4. Steroids for the Piriformis Muscle

Injections are a potential therapy option for patients suffering from severe pain. The pain may be due to piriformis syndrome or sciatica.

5. Injections for the Piriformis

It is possible to ease the severe pain of piriformis syndrome with injections. These injections are given into the muscle.

A local anesthetic and a corticosteroid are given to the muscle. These medications reduce spasms and discomfort.

In most cases, an injection aims to reduce severe pain. This also makes it possible for the patient to undergo physical treatment.

6. Botox injection

The injection of Botox is an option for resistant cases of piriformis syndrome.

The injection is given after all other treatment options fail.

Botox is the trade name given to the preparation of botulinum toxin. The toxin acts as a muscle relaxant. Botox is used in aesthetic skin procedures to ease fine lines and wrinkles.

The same muscle-relaxing action of botox eases any spasm in the piriformis muscle. Botox relaxes the piriformis. It reduces pressure on the underlying sciatic nerve when injected.

Botox injections also act as preemptive measures. This is because relaxed muscles prepare patients to undergo physical therapy and stretching exercises.

7. Electrotherapy for Piriformis Syndrome

TENS utilizes an electric current of very low amplitude to stimulate a muscle. TENS also enhances blood circulation.

A nourished and relaxed muscle is better able to cope with pain. This is, in fact, the primary target of TENS therapy.

TENS therapy is helpful for piriformis syndrome as well. Electrical stimulation with the TENS unit stimulates the piriformis muscle.

TENS therapy is usually well tolerated by the majority. However, some patients may need an interferential current stimulator (IFC).

IFC is an alternative to TENS therapy. It helps cut back on muscle spasms in the piriformis and block pain.

Severe cases may require surgical interventions. For example, cutting the piriformis muscle. However, the procedure is rarely needed. It is usually undertaken for patients that fail to respond to other treatment modules.