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Your Guide to Piriformis Syndrome

This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.

Introduction

Piriformis syndrome is a condition where the piriformis muscle tightens and irritates the sciatic nerve. The tightness may be due to repetitive strain, an overuse injury, or direct trauma to the muscle.

Anatomy

The piriformis is the small muscle that helps rotate and stabilise the hip joint. It originates from your sacrum (tail bone) and attaches to your femur (thigh bone). It lies deep within your gluteal muscles which form your buttock. The sciatic nerve passes under the piriformis muscle and in a small percentage of people the sciatic nerve actually passes through the muscle making the nerve more susceptible to compression or irritation.

Symptoms

People with piriformis syndrome usually complain of buttock pain which may radiate to the back of the thigh, calf , ankle or foot depending on the severity of the compression or irritation. The pain may increase when the piriformis muscle is put on stretch or during a forceful piriformis muscle contraction like running. Other activities such as sitting, climbing stairs and squatting may also cause piriformis syndrome. Los of hip range of movement may also occur.

What Happens If I Don`t Fix My Piriformis?

It is important to address the underlying cause of your piriformis tightening to prevent future recurrences. If it is due to overuse your physio wil look at your training schedule, footwear and types of terrain used during training to see if these factors may be contributing. Your stretch routine is also important. Failure to fix these issues will predispose you to recurrent problems.
If there is a muscle imbalance problem where some muscles are weak and/or tight and you do not fix this then you may find your symptoms may worsen or recur with continued activity.

How Long Does It Take To Get Fully Better?

Your recovery time will depend on your particular history and the degree of inflammation and muscle imbalance that may exist. Your inflammation may settle in the first 1-2 weeks depending on the severity. Generally, stretching and strengthening gains are made over a 4-8 week period. Starting treatment early significantly improves recovery times. Sometimes other factors such as your foot biomechanics or core stability must be looked at to reduce the risk of future problems, and this may influence your recovery period.

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Your journey to peak performance with Central Physio

Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.

Phase 1: Optimise and Control Inflammation

Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Therefore, the first goal is to reduce the inflammation and pain in your piriformis.

Your physio will usually advise you on modification of your activity and exercise as well as anti-inflammatory medication if needed. Hands-on treatment may include specific local massage, piriformis releases, and stretches. Your home program may include trigger-point releases using a trigger point ball.

Phase 2: Restore Muscle Length

When your piriformis is tight it causes a lot more compression and stress to your sciatic nerve. This can cause the nerve to become irritated and produce leg pain resembling sciatica. Muscle tightness also puts extra stress on tendons where they attach to the bones, and can make the job of other muscles harder and cause too much load on joints. Tightness in your piriformis can also cause compensatory movement changes in your leg, foot, hip, pelvis and spine. Therefore it is important to get your full piriformis length back to stop all this from happening.

Your physio will use techniques including heat, stretches and specific releases for your priformis and other structures to regain your flexibility. If your normal exercise has been a significant cause of your piriformis tightness then often a quick but effective stretch or trigger-point routine will need to be included with your regular exercise on an ongoing basis.

Phase 3: Specific Muscle Strengthening

Weak muscles are a major problem when recovering from an injury. Often muscles are weak because they are not being used properly, they have been damaged, or they have been inhibited after an injury. When strengthening muscles you must strengthen the correct muscle and in the way the muscle would normally be used.

Often weakness in your gluteals (hip muscles) and core stabilisers are major reasons why your piriformis has become overworked and tight. Your physio will guide you through a specific strength program to ensure you achieve a complete recovery.

Phase 4: Correct Biomechanics

Your biomechanics (how you move) play a big role in causing, treating and preventing piriformis pain. When you have poor hip or foot  biomechanics your body is not working as well as it could, and this puts extra strain on your hip muscles. Correcting your biomechanics is an important step in helping your current problems settle down, and also in minimising the chance of more problems in the future.

Techniques used to correct biomechanics include specific muscle strengthening drills, Gaitscan Custom Orthotics, supportive taping and examining training techniques. We often make extensive use of video to help you see and correct movement problems. Your physio may also recommend a Biomechanical Assessment with our exercise physiologist to help determine which movement patterns may have contributed to your current problem, which movement patterns may cause problems in the future and how you can improve your movements patterns to enhance your performance.

Phase 5: Functional Strengthening and Return to Sport

This is the last phase of your recovery plan and is essential for getting back to your previous level of performance and preventing re-injury. You need to be able to move at full speed and with full force in training first, before returning to your normal level of sport. Persisting background weakness or poor co-ordination will lead to inferior performance and increased risk of re-injury.

This phase is achieved by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. Exercises are tailored specifically to your activity to ensure correct technique, co-ordination and strength are restored.

Many clients find that seeing one of our Exercise PhysiologistsStrength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.

For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.

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