Piriformis Syndrome

Chiropractic for Piriformis Syndrome

            Chiropractic for the treatment of piriformis syndrome works as either a primary treatment or complimentary treatment. Chiropractors can help in a multitude of ways, especially being that chiropractic treatment in nature encompasses not just the joints themselves, but on all aspects of the spine being aligned. Treatment and prevention are the key elements to being sure that piriformis syndrome is alleviated and doesn’t come back.


Piriformis Syndrome Awareness


            The piriformis muscle is located in deep in the buttocks, running from the sacrum to the top of the femur. This muscle contracts and rotates the thighs outward, providing stability for the thigh and hip through a static contraction. Since the piriformis muscle works in conjunction with multiple other muscles in the buttocks, it is nearly impossible to isolate in muscle testing. Pain can be in various areas, and can often be confused with sciatica, herniated disc, or hamstring tendonitis.


Piriformis Syndrome Symptoms:

  • Pain in the lower back
  • Radiating pain/tenderness to the buttocks and down the leg
  • Pain worsening when the patient walks up or down the stairs
  • Discomfort in prolonged sitting
  • Reduced range of motion in the hip

Although symptoms can vary, the piriformis syndrome pain pattern tends to follow a similar path for most. In the early stages, there is usually numbness, tingling, or pain in the buttocks, and low back or sciatic pain. In the later stages, there is usually pain which extends down the sciatic nerve down to the foot, and leg and muscle pain becomes more severe.


Piriformis Syndrome Causes:

  • Nerve damage
  • Sacroiliac or spinal joint dysfunction
  • Sedentary lifestyle
  • Aggravation of a significant prior injury

Many patients may not realize the significance of this muscle when it comes to moving through their daily life, but it is the target for a high-repetition injury. Not only that, but the symptoms of piriformis syndrome can manifest in muscle tightening, and then worsen into compression of the sciatic nerve. Since it is such a high-use area, it is easy for many people to experience some form of piriformis syndrome in varying degrees in their lifetime.


Chiropractic Benefits in Piriformis Syndrome


            When treating piriformis syndrome, a chiropractor can help in a multitude of ways.   Misalignment of the ligaments, bones, and tendons can lead to irritation of the piriformis muscle making it spasm. Chiropractic will not only treat the surface symptoms, but also, more importantly, the root cause.
Chiropractic works by addressing the misalignments in the lower spine and pelvis that may be causing the piriformis muscle to spasm. Chiropractic treatment allows the muscle to release, and relieve the trapped sciatic nerve. Although reaching the piriformis muscle itself can be tricky, in addition to manipulation, the chiropractic provider can aid in exercises and stretches for the patient to perform at home.


Patient Risk Factors:

  • Posture issues
  • Overuse
  • Muscle spasms

We, as chiropractic providers, have a goal when treating piriformis syndrome to assess the muscles and joints and work out any weak areas, re-align the body, and treat the sciatic pain associated with piriformis syndrome.


Chiropractic Treatment Protocol:


The objective of chiropractic treatment of piriformis syndrome is to restore function of the pelvic spinal joints through manipulation and ergonomic advice. Part of the initial exam should include verifying that the patient’s pain isn’t being caused by something other than the piriformis muscle like a compressed disc. Using an integrated approach working all areas of the body is most beneficial in piriformis muscle treatment. Treatment is not a one-size-fits-all approach, and it is vital that we as chiropractic providers utilize multiple treatment options that we have in our toolbox.


Chiropractic Treatments for Piriformis Syndrome:


  • Chiropractic Adjustment – restore the misaligned nerves to remove stress and bring them back to their correct position.
  • Isotonic Resistance Exercises – exercises centered around the shortening and lengthening of the muscle. Essentially, any exercise involving lifting and lowering or opening and closing the joints would fall under isotonic such as lunges and careful step-climbing. These types of exercises are more beneficial as they involve movement.
  • At-Home Stretches – giving patients the ability to continue treatment at home will only solidify their results, and there are copious amounts of stretches they can utilize for the piriformis muscle.
    • Cross-Arm Stretch – patient is in a seated position with the bottoms of the feet touching each other. They will cross their arms and rest their hands on the opposite leg. Pushing both knees toward the floor until a stretch is felt in the inner thigh, and hold the position for 30 seconds. Relax for a few seconds, and then repeat up to 5 more times.
    • Sit and Bend Stretch – have the patient sit in a straight-backed chair that doesn’t roll, and have them cross one leg over the other resting the ankle on the other leg. The patient will then need to lean forward until they feel a pull down the crossed leg. Hold for 30 seconds, repeat on the other leg, stretching on each leg 3 times.
    • Knee-Up Stretch – patient lies on the floor on their back; be sure to have them lay on a mat, blanket or rug for comfort. Have the patient stretch both legs out, with their arms at their sides. They should bend one leg at the knee and use the hand to pull it toward the opposite shoulder, and hold for 10-30 seconds. Perform the same stretch on the opposite side.
    • Standing Stretch – this is a beneficial stretch because it can be done anywhere that the patient would rather not be on the floor or is unable to sit. Have the patient start in a standing position with feet flat on the floor a shoulder length apart. The back needs to be straight, and the knees unlocked. They will lift one knee, grasping with both hands, keeping the knee parallel to the corresponding hip. Then, pull the knee toward the opposite shoulder until a pull is felt along the side of the buttocks. Have the patient hold for as long as they can, but no more than a minute. Repeat on the opposite leg, doing 3 times on each leg.
  • Trigger Point Therapy – apply a gentle thrust to the trigger points surrounding the piriformis muscle to remove contractions and stiffness.
The body is connected as a whole, and with these stretches combined with traditional chiropractic, it is a something that absolutely is able to be treated. The main goals of these protocols are to improve flexibility and restore muscle strength.


Piriformis Syndrome & Chiropractic 

            Piriformis Syndrome is responsible for anywhere from .3 – 6% of all cases of low back pain or sciatica; roughly about 2.4 million cases per year. That being said, it is a condition that is so easily misdiagnosed or swept under the rug, and then proceeds to get worse turning into full blown sciatica. Chiropractic could be the key intervention for those who are showing symptoms of Piriformis Syndrome in order to nip the problem in the bud. Chiropractic treatment is one of the most effective and integrative modality to work for patients who are seeking relief from Piriformis Syndrome.