What is Piriformis Syndrome (Hip Pain)? Can it be fixed with Manual Therapy?

Piriformis syndrome is hip pain caused by muscle spasm in the piriformis muscle and can be successfully improved with soft tissue manipulation and stretching. 

What is Piriformis Syndrome (Hip Pain)?

The hip pain caused by muscle spasm caused by the pressure of the piriformis muscle in the hip region on the sciatic nerve is called piriformis syndrome. The priformis muscle can also irritate the sciatic nerve and cause pain, numbness and tingling along the back of the leg and towards the foot. 

What is the Piriformis Muscle?

The piriformis is a flat, narrow muscle. It begins in the lower spine and extends from the hip to the upper surface of the thighs. Stretching on either side of the body, the piriformis muscle passes over the sciatic nerve and assists in nearly every movement of the lower body. The piriformis muscle, which provides rotational movement of the hip, is an important muscle for the sciatic nerve. 

What are the Causes of Piriformis Syndrome? 

There are many conditions that cause the piriformis muscle to press on the sciatic nerve and lead to piriformis syndrome. However, the most common causes of piriformis syndrome can be listed as follows;

• Inflammation and swelling that may occur in the piriformis muscle or surrounding tissues
• muscle spasm 
• Deformations that may occur in the priformis muscle 

The priformis muscle is an active muscle that provides and controls hip and leg movements. Any of the following conditions may cause deformation of the piriformis muscle, leading to the occurrence of piriformis syndrome. 

• Climbing stairs, walking or running without having strong enough piriformis muscles
• Injury to the hip or leg, such as from a fall or car accident 
• Lifting a heavy object incorrectly
• Not warming up enough before exercise or not stretching properly after
• Exercising excessively or practicing repetitive movements, such as long-distance running 
• sitting for a long time

Although rare, abnormal anatomy can also cause piriformis syndrome. Priformis syndrome seen in this way is called primary piriformis syndrome. Being born with an abnormal sciatic nerve or having an abnormal piriformis muscle or sciatic nerve are examples of primary piriformis syndrome. 

What Are the Symptoms of Piriformis Syndrome?

Piriformis syndrome generally causes acute tenderness in the hip, and pain similar to sciatic pain in the back of the thigh, calf and foot. It is possible to list the symptoms of typical piriformis syndrome as follows;

• A dull ache in the hip
• Pain similar to sciatica in the thigh, calf, and back of the foot 
• Pain when climbing stairs or hills
• Pain that increases after sitting for a long time
• Decreased range of motion of the hip joint 

Symptoms of piriformis syndrome often get worse after sitting, walking, or running for a long time. In such cases, lying on your back can reduce the severity of the pain. 

How Is Piriformis Syndrome Diagnosed?

Diagnosis of priformis syndrome is based on a review of the patient's medical history, physical examination, and medical testing if deemed necessary. The diagnosis of piriformis syndrome is important because it is often differentiated from diseases such as herniated disc, lumbar slip or hip joint dysfunction, which show similar symptoms. 

How is a Physical Examination Performed in the Diagnosis of Piriformis Syndrome?

In the diagnosis of priformis syndrome, physical examination, hip and leg mobility control is performed to understand whether hip and leg movements cause low back or sciatic pain, and if there is pain, its frequency and severity are determined. On physical examination, pain will typically reappear with each movement of the hip.

How to Examine the Medical History in the Diagnosis of Piriformis Syndrome?

During the physical examination, the patient's medical history is reviewed to assist in diagnosing piriformis syndrome. The medical history includes an in-depth examination of a person's symptoms, such as which positions or activities make symptoms better or worse, how long the symptoms have been present, whether they started gradually or over time from an injury, and what treatments have been tried. 

How Is Piriformis Syndrome Treated?

Strengthening the piriformis muscle is very important in the treatment of piriformis syndrome. In piriformis syndrome, which can generally be treated without the need for surgery, permanent relief of symptoms can be achieved by following the following ways;

• Manual therapy techniques applied to strengthen the piriformis muscle and peripheral muscles and increase mobility
• Medical exercise programs to stretch and strengthen the piriformis muscle with a physiotherapist
• Medical massage therapies applied to relax the piriformis muscle and provide healthy blood circulation 

Does Piriformis Syndrome Heal With Manual Therapy?

Piriformis Syndrome is caused by the hardening of the piriformis muscle, and symptoms can be successfully relieved by stretching technique combined with soft tissue manipulation. Before starting the application with manual therapy, it is aimed to relax the muscle by applying heat therapy on the tense piriformis muscle. 

It is important to apply manual manipulation with light and then moderate pressure in applications for the improvement of piriformis syndrome with manual therapy. The aim in manual therapy is to reach the piriformis and surrounding muscles, work on the piriformis as much as possible and try to regain the functionality of the muscles. 

Manual therapy techniques applied in piriformis syndrome specifically aim to mobilize the sacroiliac joint and work on the mobilization of the lower spine. With the medical exercise programs applied together with manual therapy, it is aimed to increase the range of motion, strengthen the muscles and return people to their normal lives in a healthy way. 

What are the Ways to Prevent Piriformis Syndrome?

It is possible to prevent piriformis syndrome with basic health strategies and correct postures. You can prevent priformis syndrome by following the suggestions and strategies below and making it a part of your normal life routine, and you can also protect yourself from many muscle, joint and spine disorders. 

• Exercise regularly to keep your muscles healthy and strong. 
• Focus on good posture, especially when sitting, driving or standing. 
• Try to lift heavy objects properly by bending your knees and squatting, and make sure you keep your back straight. 
• When lifting heavy objects, hold the object close to your body and do not bend while lifting. Always remember to warm up before exercise and physical activities and then stretch your muscles.
• When you have to sit for a long time, take short breaks by standing, walking or stretching your muscles.