Piriformis syndrome

Hypertonicity or spasm of the piriformis muscle may cause irritation of the sciatic nerve, sometimes to the point of causing neuritis. Although the sciatic nerve most typically passes inferior to the piriformis, normal variants exist with its passage through or posterior to the piriformis muscle. The sciatic involvement often causes confusion between piriformis syndrome and a disc herniation. 

Piriformis syndrome is manifested as pain in the buttocks or hip with radiation into the calf or foot. It can be severe enough to result in the patient becoming bedridden. More rarely, there is low back pain as well, especially around the sacroiliac joint. Examination demonstrates decreased internal rotation and adduction of the hip with pain accompanying these motions. 

Muscle strengih in external rotation and abduction is generally normal but may exhibit some decrease. The muscle and Its attachments are tender to palpation. There are three counterstrain lender points associated wiih piriformis syndrome mid-pole sacrum, piriformis muscle, and the posteromedial trochanteric point. 

Left piriformis syndrome was diagnosed and was treated with osteopathic manipulation. The sacral shear was treated with a muscle energy technique and the tender points were treated with counterstrain. She was given a piriformis stretch to perform at home three time daily. She experienced immediate improvement after the treatment. 

This case is typical of piriformis syndrome. An overstretch of the muscle had caused it to con-... 

If a patient does not respond after several treatments, it is important to search for some activity the patient is doing that is either aggravating the piriformis muscle or causing a sacral dysfunction Oiat puts abnormal tension on the muscle. Rarely, the obturator muscle is involved and mimics piriformis syndrome. This may need to be ruled out in obstinate cases. 

This point needs to be looked for whenever there is a piriformis syndrome or with a tender point in the belly of the piriformis muscle. 

Figure 111. Site of piriformis syndrome. (From Moore, D. C. Regional Block A Handbook for Use in the Clinical Practice of Medicine and Surgery, 4th ed. Springfield, Charles C Thomas, 1971.)...

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