Traditionally, the generic term “Piriformis Syndrome” has been used to reference a problem with the deep hip rotator muscle in the buttock area, which can give rise to symptoms of pain, discomfort, and tightness about the lower back, buttock, and thigh areas. The Piriformis muscle can affect the sciatic nerve which runs through the muscle belly, Piriformis being an often overlooked cause of sciatica. Generally it is thought that muscle tightness and/or compensatory tightness for adjacent weakness will underpin symptoms, leading to direct compression or irritation of the sciatic nerve.
The Piriformis Muscle
Piriformis performs two different movements about the hip, depending on thigh position. It also plays a role in stabilising the pelvis 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 varied signs and symptoms. This diagnosis is used as an umbrella term to encompass any cause of pain about the lower back area, pain deep within the buttock region, or pain 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, circulation abnormalities, and in very rare cases the presence of tumors. Nonetheless, it is thought that Piriformis muscle is still primarily responsible for almost 70% of all deep gluteal (buttock) pain syndromes.
Essentially, 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 flexed 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, builders working in a kneeling position for prolonged periods).
- Driving – The his has been shown to be a major risk factor, believed to be due to the combination of compression (as we bear our weight on the Piriformis muscle when seated), immobility, & vibration.
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 thigh. As the sciatic nerve is commonly involved, there may also be pins and needles, tingling, or numbness anywhere down the leg, into the shin or foot.
- 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.
- Specific rehabilitation, to ensure the physical issues which predisposed to sciatica are addressed, & hence symptoms do not return.
- Biomechanical re-education is often a paramount component of treatment, if an issue with movement or walking patterns 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)
- Specific strengthening of the localised weak/poorly conditioned muscles in usually helpful, as this reduces the need for the Piriformis muscle to compensate and hence become overactive. A thorough strengthening programme for the localised lower back and hip muscles is best, rather than focusing on the typically popular strength exercises such as squatting and deadlifting only.
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 physiotherapy team can help! We offer physiotherapy appointments across 5 locations – Glasgow West End @ 15 Royal Crescent (G3), Mosspark (G52), Clarkston (G76), Newton Mearns (G77), & Kirkintilloch (G66).