Deep Gluteal Pain Syndrome

Piriformis 244x300 Deep Gluteal Pain Syndrome

Traditionally, the term “Piriformis Syndrome” is used to reference a problem with the Piriformis muscle (in the buttock area). This muscle can commonly affect the sciatic nerve, being an often overlooked cause of sciatica.  Commonly it presents with pain in the buttock and lower back, and potentially involving neural (nerve pain) symptoms down the back of the leg.  Generally it is thought that muscle tightness and/or weakness will underpin symptoms, leading to direct compression or irritation of the sciatic nerve.

 

The Piriformis Muscle

The Piriformis is a small muscle located under the Gluteal muscles, deep within the buttock. The Piriformis originates from the inside of the sacrum and attaches to the femur (thigh bone), at the greater trochanter. The function of this muscle actually varies depending on thigh position. The Piriformis externally rotates the leg when in a “neutral” position. However, Piriformis will actually internally rotate (turn the thigh outwards) and abduct the leg (lift the leg out to the side) if the hip is bent higher than 90 degrees. Looking closely at the adjacent image, one can imagine the various movements it can perform.

Therefore, Piriformis can perform two different movements dependent on thigh position. It also plays a role in pelvis stability during walking, with the right Piriformis stabilising the hip while the left leg steps.

Deep Gluteal Pain Syndrome

Deep Gluteal Pain Syndrome is a more recently coined phrase, resulting from the belief that Piriformis Syndrome is too narrow and specific a diagnosis for individuals presenting with these particular signs and symptoms. This diagnosis is used as an umbrella term to encompass any cause of pain deep within the buttock region, or at the back of the hip joint. Structures besides Piriformis which may cause a painful response include fibrous bands containing blood vessels, the gluteal muscles, the hamstring muscles, the Gemelli-Obturator Internus complex, vascular (circulation) abnormalities, and space occupying lesions (tumours). Nonetheless, it is thought that Piriformis muscle is still primarily responsible for almost 70% of all deep gluteal pain syndromes.

So, in a nutshell, all Piriformis Syndromes are Deep Gluteal Syndromes, but not all Deep Gluteal Syndromes involve the Piriformis muscle!

What Are The Risk Factors For Sciatica?

  • Age – as we age, natural degeneration of bones and discs in the spine can increase the likelihood of irritation of nerve tissue. Sciatica tends to be most common in those aged 50-60.
  • Height – this may be a risk factor, especially in men aged over 50.
  • Occupation – physically working in awkward or static positions (carpentry, machine operators) has been shown to increase ones risk to sciatica more than simply being in static positions for prolonged periods (eg. sitting at a desk).
  • Driving – The his has been shown to be a major risk factor, believed to be due t the combination of compression, immobility, & vibration.
  • Smoking? – there is minimal evidence to suggest that smoking can predispose to sciatica.

Deep Gluteal Pain Syndrome; Signs and Symptoms
Several typical factors are reported by those experiencing Deep Gluteal Pain Syndrome;

  • Pain over the lower back, gluteal (buttock) area, often involving pain down the back of the leg. As the sciatic nerve is commonly involved, there may also be Pins and Needles or Numbness.
  • Pain after sitting for a period of time or when first standing up, as bearing our body weight on any of these irritated/inflamed structures within the buttock will simply serve to exacerbate symptoms.
  • Symptoms may be worse after a period of activity – leading to overuse of these already tightened and hypersensitive tissues – such as walking but normally not until several hours post-activity.

How Can Physiotherapy Help?

At K. M Woods Physiotherapy Ltd., an in depth and accurate assessment will be undertaken to ensure correct identification of the source and causes of the pain. Specific, individualised treatment can therefore subsequently be provided, comprising primarily of hands-on treatment and exercise.

Treatments may include

  • Hands-on soft tissue or myofascial release to reduce pain and muscle tension
  • Acupuncture – both for pain relief and improve muscle tissue conditioning
  • Exercise therapy – typically including stretching, strengthening and soft tissue self-release techniques, this can both reduce symptoms and minimise the likelihood of re-injury in future.
  • Biomechanical re-education is often a paramount component of treatment, if an issue with biomechanics is felt to be a contributing factor to symptoms.
  • Education regarding training regimes, load management, pain management, postural positioning etc.

What Can I Do To Help This Condition Myself?

Prior to, or while attending physiotherapy, the patient can also help the recovery process by following several steps to address both cause and symptoms if experiencing Deep Gluteal Pain Syndrome…

  • Stretching of the hip muscles can be effective means of releasing localised tension potentially reducing pain levels
  • Self-release of these localised soft tissues can also be undertaken independently using a massage ball or foam roller, aimed at reducing pain, improving blood flow, and decreasing tension (see blog on Foam Rolling)

 

Wish to enquire if we can he with you hip/back pain? Or simply looking for advice with regard to training volumes as you look to rehabilitate an injury? Call 0141 3530906 today – our specially trained Glasgow physio team can help!