The piriformis muscle is a small muscle located in the buttock.
There are mainly two types of pain that originate from the piriformis.
In 85% of people, the sciatic nerve passes below the muscle, and in about 10% some fibers pass
above and others below. But the problem is that in 5% of people, the sciatic nerve goes
through the piriformis muscle. In this 5% of people, when the piriformis is contracted,
or in spams, it squeezes the sciatic nerve and causes a referred pain down the thigh and leg.
The second type of piriformis problem is when it has myofascial trigger points.
This is common in people who sit too long or compress the nerve by something they
use in their pockets, like a wallet. The pain from trigger points may radiate to
the sacroiliac joint area and the lateral thigh. So, let’s talk about piriformis muscle pain today.
Before I continue, let me remind you that this video is not intended to
replace medical advice. It is for educational purposes only. You should contact your doctor
for a proper diagnosis and treatment plan for you. In case of emergency,
go to the nearest emergency department or call an ambulance
In 1938 two anatomists, Beaton and Anson described the variations of the sciatic
nerve in relation to the piriformis muscle. They looked at cadavers and found that the
majority had this distribution where all fibers of the nerve pass below the muscle,
but in 5% the fibers go through the nerve, and in 10% one portion of the nerve goes above
and the other below. When the sciatic nerve is compressed it may cause sensations of numbness,
tingling, and pins and needles in the thighs, legs, and feet,
and also a weakness of the muscles of the thigh, leg, and ankle.
But more common than compression of the sciatic nerve, the piriformis may
develop trigger points and these will cause radiating pain to the pelvis, sacrum, and hip.
The function of the piriformis muscle is to work with the other five short muscles
inside the buttock and pelvis, and together they do the external rotation of the thigh.
This is a very important function especially when we stand on one leg, like when we walk.
Many patients think they have an injury to the hamstrings or adductor muscles
because the pain from the piriformis is deep and resembles a groin strain.
Another sign is that they lose the flexibility to rotate the hip. Another common sign is pain and
tenderness in the area of the ischial tuberosity, which is aggravated in prolonged sitting.
Many athletic and sports activities that involve sudden twisting may aggravate trigger points
in the piriformis muscle. Driving a car or a truck for prolonged periods may also aggravate
piriformis trigger points because the hip is bent and to keep the foot on the gas pedal the driver
needs to maintain an external rotation of the hip. Some conditions that can perpetuate piriformis
trigger points include chronic infections like chronic pelvic inflammatory disease,
sacroiliitis, hip joint arthritis, and post-total hip arthroplasty.
How do we treat piriformis pain? First, it is important to eliminate
any factor that perpetuates the problem. Second, it is important to modify the
sitting and sleeping positions. When sitting or sleeping, the knees should be kept in
alignment with the hips and shoulders. When sitting they should try to move as
much as possible. This is very important for drivers and long-haul truck drivers.
Check my other video about sleep positions, I show how you can add pillows to the knees
to keep the hips in a neutral position. If activities that involve standing on
one leg provoke pain, the person needs to train how to stretch the muscle to avoid a relapse.
Stretching is best done with the person lying down on a flat and firm mat.
so now we're going to stretch specifically the piriformis muscle, so this leg is straight and
this knee on the top of the other one, and we're going to pull the knee to this side
and you're feeling stretching the piriformis this is this muscle here ,
and now you do for the other side, this one straight and this one here
and you pull and you feel stretching the piriformis is a tiny muscle here but it's
very important and sometimes it's tight and can cause pain that goes down your leg
so you repeat this many times for each side There is another way to stretch the piriformis
which is by sitting in a chair. This is figure 4. so this muscle to stretch this muscle I recommend
that you sit you cross the leg if you don't have any problem in the hip or knee you'll be able
to do this position and then you go forward. Lean Forward, keep going dow,n down, down, when you reach
the maximum position take a deep breath count your ten one two three four five six seven eight nine
ten, take another deep breath and go down one two, three four five six seven eight nine ten,
take another deep breath one two three four five six seven eight nine ten, come back slowly
But if the person also has low back pain, this exercise may aggravate their pain.
So, I recommend the position of lying down flat on the mat.
Self-massage with a tennis ball or a self-release tool is recommended.
But it is important not to apply pressure on the sciatic nerve itself. Another way
to self-massage is using a foam roller. Watch my other video to learn more about it.
And last, when sitting in a chair, try to do movements of internal and external rotation
with both hips. This alleviates the tension and avoids spam in the piriformis muscle.
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