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The Pesky Piriformis

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As someone who has suffered terribly from a crippling case of sciatica in the recent past I felt compelled to get to know the culprit in order to better understand the crime.  The piriformis muscle is the most powerful player in external rotation of the leg, particularly in classical ballet.   In addition, the piriformis is responsible for abducting the femur (lifting the leg away from the midline) while the hip is in flexion, an important function to transfer one’s weight into the opposite leg while walking.  It lies beneath the gluteus maximus, nestled in with its counterparts in external rotation known as the “deep six.”  The shape of the piriformis resembles a pyramid, its namesake.

The piriformis is one of the “deep six” external rotator muscles in the hip.

What sets the piriformis apart from its fellow external rotators is that it lives above the sciatic nerve, the largest nerve in the body, instead of beneath it.  In the event that the muscle becomes inflamed, goes into spasm, or is chronically shortened, undue pressure is put upon the sciatic nerve that can result in what is commonly thought to be sciatica but is actually piriformis syndrome.  To make matters worse, in approximately 15-30% of the population the sciatic nerve actually passes through the piriformis, dividing it into two parts and increasing the chance of piriformis syndrome. Women are also believed to be at a greater risk, due to the steeper degree at which the femurs angle in to the midline from the acetabulum in female hips.

According to Gabe Mirkin, M.D., in his article aptly titled Pain in the Butt: Piriformis Syndrome: “You probably shouldn’t do any exercise that causes you to bend at the hip while keeping your knees straight, because this will stretch the sciatic nerve.” Ah-hem, Uttanasana 108 times a day, anyone?  Runners and cyclists are also good candidates for this condition due to the repetitive contraction and release of the piriformis muscles while propelling them forward through space.  Sitting at a desk or in a car with the legs apart and externally rotated are also situations that would cause contraction in the piriformis for extended periods of time, irritating to most of us as well as the sciatic nerve.

In my research on the piriformis I came across an amazing and moving article that shed a lot of light on my conundrum.   In How To Get Rid of That Pain In Your Butt by Dr. Clay Hyght, he discusses how common it is to associate symptoms of sciatica with disc herniation, but that it may not be the primary cause at all. Apparently about 50% of people over 30 have herniated disks but don’t know it, so an MRI is likely to find one.  The shots, the surgery, the money, the possible addiction to powerful pain pills, and time it takes to recover, still might not take care of the problem if it is, in fact, the pesky piriformis muscle.  Needless to say I’m glad I trusted my instincts on that one, Wahe Guru!

Before even considering surgery or other invasive treatments for prolonged sciatica, get on a steady regimen of deep, therapeutic massage and physical therapy with a body worker familiar with the elusive piriformis syndrome.  Therapeutic yoga stretches and strengthening exercises for the abdominals, hip-flexors, and pelvic floor are also recommended as piriformis syndrome exercises and treatment, since they might help to take some of the workload off the poor piriformis. An old fashioned dose of R & R wouldn’t hurt either.  Using these self-care techniques can help others, like myself, to finally establish peace in the piriformis.

Read part 2 of this article about the Pesky Piriformis.

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