PIRIFORMIS SYNDROME
One of my patients who has been a avid runner for a number of years, tells me that after his run the other day he developed a strange pain in his right buttock that extended down the middle of his hamstring.

The pain is still present today and, while not severe has kept him from running. He describes the pain as a constant ache. It hurts when he sits for a long period of time and when he is in a squatting position. He’s not sure what is happening and asks what might be wrong and how he can take care of it.

Does this sound familiar? The likely culprit is Piriformis Syndrome--a fairly common injury, but it can affect individuals who have an active lifestyle.

If you haven't heard of Piriformis syndrome then you might recognize it as the term sciatica. Sciatica is a condition that can cause an irritation, compression or inflammation of the sciatic nerve.

The sciatic nerve is the longest nerve in the human body and is approximately the same size as a finger in diameter. It originates from a number of nerve roots that come off the spinal cord and extends down the posterior leg, where it supplies nerve sensation and movement functions.

• The signs and symptoms of sciatica, which generally affect one side, are:
• Constant pain in the buttock and posterior leg, especially with sitting.
• Burning, tingling or numb sensation that runs down the leg.
• Weakness and difficulty in moving the leg.
• Shooting pain down the leg that makes standing difficult.
• The pain that is associated with sciatica can range from fairly minor to quite severe and debilitating.

There are a number of different things that can cause sciatic pain such as:

• Herniations or degeneration of a lumbar disk
• Narrowing of the spinal canal
• Forward slippage of one vertebral body on another
• Chronic poor posture
• Sprain or strain of the low back or pressure from the Piriformis muscle, which is located in the butt.

The last cause of sciatica as mentioned above is referred to as Piriformis syndrome. The sciatic nerve passes beneath the Piriformis muscle and travels to the posterior upper leg. In a small percentage of the population, the sciatic nerve may pass over the top of the Piriformis or through it. Any type of acute or chronic injury to this muscle that causes it to swell and irritate or compress the sciatic nerve will cause sciatic pain.

The Piriformis is located on the posterior side of the pelvis area and lies beneath the gluteus maximus--the main buttock muscle. It’s main function along with a few other small muscles, is to laterally rotate the hip and leg.

Piriformis syndrome is frequently found to affect women more than men. In the fitness realm, it affects runners more than any other group, but it can occur in any type of physical activity or pursuit. Overuse, prolonged sitting, trauma such as a fall on the butt, muscle imbalances, muscle tightness or lack of flexibility could cause the Piriformis to put pressure on the sciatic nerve.

The primary signs and symptoms that could indicate there is pressure on the sciatic nerve would be pain in the buttocks, numbness, tingling or weakness that extends down the leg from the buttock area. The pain that is present is generally not very severe. Primarily, it is just a dull, deep, annoying ache. It can become worse at night and also when climbing stairs, walking up a hill or when trying to workout. The numbness and weakness that extends down the back of the leg rarely goes beyond the knee and there will be a difficulty in laterally rotating the affected leg because of weakness and/or pain.

The first thing to do for treatment is to back off on the amount of weights you are lifting and temporarily eliminate any cardiovascular activity the may continue to irritate the Piriformis, for example Stairmasters, running or biking. The second thing to do is increase your flexibility of the Piriformis and hamstrings as well as the gluteal group. There are several stretching exercises that you can learn. See a trainer or a physical therapist to get an accurate understanding of the proper body mechanics.

Piriformis syndrome can be easily prevented by maintaining good flexibility of the hip and upper leg muscles, maintaining good strength of the hip and upper legs, making gradual increases in workout duration and intensity, replace orthotics, if they are used, when needed to maintain proper bio-mechanical function.

If you follow these preventative and treatment recommendations and maintain an optimal level of fitness, that pain in the butt should never bother you again!

Knowledge is prevention