Piriformis syndrome.

Piriformis syndrome occurs in athletes in the hip-bill region (6:1, more often in women than men in the age range 30-40 years). The injury is manifested by a dull pain in the upper, deep part in the gluteal muscle. The piriformis muscle is shaped like a flat stretched pear shape and is located in the gluteus region (buttock region). Piriformis syndrome can lead to loss of strength and stiffness. Under the piriformis muscle runs the sciatic nerve, which runs from the low back to the leg. Pressure on the sciatic nerve can lead to various symptoms, often manifesting as a nagging sensation. These complaints can be felt in the back and buttock and in some cases radiate to the leg. Prolonged sitting can increase symptoms, and in some cases there is talk of "wallet syndrome," where sitting with a wallet in your back pocket puts constant pressure on the nerve. In this blog, we'll tell you more about piriformis syndrome and what you can do about it (with us)!

Piriformis syndrome is a nagging pain in the buttock region caused by the sciatic nerve. The N. Ischiadicus arises from the lower back, through the buttock and runs down to the leg. Radiation symptoms can occur due to constant pressure on the nerve, in some cases there is tingling this can sometimes also lead to a numb feeling. 

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Causes and risk factors


General have women An increased risk of piriformis syndrome in the age range 30-40 years. A shortened/thickened muscle may be present and is a risk factor in its development. In addition, increased muscle tension also a possible cause for the development of piriformis syndrome. Because there is a local irritatie is of the piriformis muscle, a protective mechanism of the body may be a palpable thickening (fluid or hydrops in Latin). Adhesions can occur as a result of too much tensile force, for example when in an early rehabilitation phase (after hip surgery - example) too fast too much tensile strength of the tissue is required. For this reason, building up slowly after surgery/injury is essential within physical therapy. 

This may result in a high degree of rigidity (decreased flexibility) of this tissue. Other risk factors/causes that may play a role in the development of piriformis syndrome are; wrong footwear (indirect wrong walking pattern), decreased muscle strength in the thigh/bill region (hip abductors) allowing a Trendelenburg gait pattern may occur, misalignment of the big toe (halux valgus) or as previously described an overuse (overload) complaint. 

Complaint pattern

Complaints can manifest themselves variously. A stabbing pain in the buttock (feeling like sitting on your wallet), pain at the hip (overall) or radiating symptoms to the back of the thigh, bending/stretching which will lead to worsening of symptoms and possibly reduced strength on one side of the lower body. In piriformis syndrome, symptoms are often unilateral (unilateral). Loss of strength is explainable, when people unconsciously move differently or less, which can cause muscle loss. For this reason, continued movement is essential to prevent muscle deterioration (reduction).

Treatment interventions.

Patients are treated by exercise therapy accompanied by partial rest. In the first phase of recovery it is diminishing returns (pain) one of the most primary treatment goals through adapted exercise. When looking at a pain score, a score of 4/10 (NPRS) is acceptable during rehabilitation. An ultimate goal is no or minimal symptoms NPRS 0/10-2/10. 

The racks of the piriformis is one of the treatment interventions offered alongside exercise therapy, in order to increase muscle length (and decrease muscle stiffness) in this way. 

Mobilize can be both active and passive and may be applied basically every day. Mobilizing can be subdivided into directing or end-side mobilizing, where we start with directing (increasing degrees of movement) and eventually want to train to a maximum position (larger degrees of movement and end-side movements, similar to the unaffected side), where there will no longer be any movement restrictions.  

In addition to active/passive mobilizations, strength training conductive wise are built up according to the pain score (Numberic Pain Rating Scale). 

In an extreme case, a corticosteroid injection, when adapted exercise offers no solution and the piriformis syndrome remains present. This is decided by the general practitioner in consultation with the physical therapist in an extreme case.

Rehabilitating together
At Fysio Fitaal we help you get back on the track, field or inside the gym as soon as possible! Together with you we look for the cause, by means of a movement research, both active and passive. Besides a motion analysis we also use image analysis through a runner analysis. In which we directly analyze and go through the entire movement chain. Together we will start exercise therapy step by step, in order to let your body get used to the strain and reduce the complaints. After which you will be back on track.  

Do you recognize yourself in these complaints and are you looking for a (sports) physio? Send an email to info@fysiofitaal.nl. 

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Ruben Luijkx

Owner Physio Vital
Physical therapist, MSC. Manuel therapy

With a solid foundation in scientific knowledge, Ruben combines the latest insights with his practical experience to ensure the best results. As owner of Physio Fitaal, Ruben has created a patient-centered environment that works with innovative techniques and a data-driven approach. Whether you are an elite athlete looking to return to the field or someone recovering from knee surgery, Ruben will guide you to a full recovery, with attention to your individual needs and goals.

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