Personally, this is one of my favourite musculoskeletal condition. It is often overlooked by physicians or any other health care professionals. The pain around the gluteal region is also often misdiagnosed as lower back pain or SIJ dysfunction. Ironic but true, this is one of the easiest musculoskeletal condition to treat. Let me share some points on making a clinical impression for piriformis syndrome before I share my treatment options.
1. Pain in the butt
2. Pain in the butt after sitting for 30 minutes or shorter
3. Pain radiates from bottom to calf or thigh (Similar to Sciatica)
4. Pressing on the piriformis muscle increases pain
PS: The 4 points I mentioned above isn’t anything special; they are just common findings! I am pretty certain that it is Piriformis syndrome once my client has any of the 2 points.
Reflection
I think individuals that has Piriformis syndrome can develop scoliosis. I have seen 3 individuals that developed scoliosis as a result of Piriformis Syndrome from my pupillage days to now. I believe individuals with Piriformis syndrome has a 3/10 chance of developing scoliosis if the pain is not managed.
I, myself, have piriformis syndrome and I used to think that it was because I did not have much cushioning on my gluteals but this has proven to be wrong after seeing people of various size and shape with the same problem. This tiny small muscle (Piriformis) attaches itself on the sacrum and greater trochanter) and is situated very near the sciatic nerve. Even though small, it causes debilitating pain for many . Some find it difficult to walk or to move their hips but most will only complain about buttock pain when they sit for too long.
Management
1. Acupressure around the piriformis muscle and/or painful regions around posterior hip to calf.
2. Strong and deep massage as pain allows. I normally cause pain till about 5/10 on the VAS.
3. PNF stretch of piriformis muscle
4. Sciatic nerve mobilisation
5. HEP: Self-piriformis stretch and self-sciatic nerve mobilisation
Do any of the 2 options for 30 minutes and your client should be fine after 3 sessions. Once pain is settled, focus on G.Max and Med strengthening!
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