Hello, I have been recently been diagnosed with piriformis syndrome, which is causing sciatica, and problems with the sarcum. (preventing sprinting) I am ok to weight train though. My first stage of rehab is heat applied by hot water bottle.
Could anyone give me a link to an online diagram of the piriformis muscle (I don’t need a description of where it is I know roughly) so I know exactly where to heat?. Or could someone tell me how to feel it with fingers??
Also, what would be the best substitute for tempo work?
I don’t know any good anatomy web sites, but I imagine that if you query using Google, you should be able to find something useful. Also, I would say that the best substitute for tempo is Hydrotherapy. If you want to know why, just do a search on this forum for Hydrotherapy and you should find previous helpful info that this community has conveyed. Get in that pool!
This is a muscular problem which causes sciatic or leg pain. It is often mis-diagnosed because it can mimic other problems such as disc herniations which also present with leg pain. The good news is once properly diagnosed it's usually quite easy to remedy.
The Anatomy (images)
The piriformis muscle is a tiny muscle located deep in the buttock, underneath all the Glute muscles. It originates on the lateral aspect of the sacrum and inserts into the head of the femur. It aids in external rotation of the hip. Lie on your back with your feet pointing towards the ceiling. Rotate your foot outwards to point to the side. That's what the piriformis muscle does. Seems pretty insignificant on it's own, but problems arise because of the piriformis muscle's relationship to the sciatic nerve.
The sciatic nerve is the largest nerve in the body. At it's largest point it's about the width of one's thumb. It originates in the low back from numerous roots and then runs down the leg to supply all nervous system functions to the leg. On it's way down the leg, it passes underneath the piriformis muscle. Some anatomic variations do exist: In some people the nerve passes over the piriformis muscle, in some it splits and passes around the piriformis and in others it passes through the piriformis. Problems arise when the piriformis muscle becomes tight because it will often compress the sciatic nerve which gives pain into the distribution of the nerve.
Signs and Symptoms
Deep aching in the buttock and thigh on the involved side. Usually not beyond the knee.
Pain is often aggravated by sitting, squatting or walking.
Affected leg is often externally rotated (toes point out) when relaxed, such as when lying face down on the bed with your feet over the end of the mattress.
Right leg often affected after driving a long distance if the foot has been in external rotation while depressing the gas pedal.
Often causes low back pain
Some reports suggest a 6:1 female to male predominance
What’s Going On
If the leg has been externally rotated for an extended period of time (such as when driving) the piriformis muscle can shorten. When you try to straighten out the involved leg the muscle compresses the sciatic nerve. If compressed long enough the nerve will cause aching in the leg and even pain in the low back.
The leg doesn't necessarily have to have been externally rotated for a long time - piriformis syndrome may be a result of faulty foot or spinal mechanics, gait disturbances, poor posture or sitting habits or any other factor that could cause that muscle to function abnormally.
What To Do About It
Your first approach should be through stretching. Because this muscle isn't usually stretched it may just be tight from running, etc. To stretch your RIGHT piriformis, start off by lying on your back. Bend your knees and cross your right leg over your left so your right ankle rests on your left knee in a figure four position. Now, bring your left leg towards your chest by bending at the hip. Reach through and grab your left thigh to help pull things towards your chest. Here's a photo to help you picture this.
If you haven't stretched your piriformis in the past, that may be all you need to do. If stretching alone doesn't help then you'll need to have someone check your pelvic and foot mechanics. As with ITB Syndrome, pelvic mechanics can play a role in piriformis syndrome. Because the piriformis muscle originates on the sacrum it can be directly influenced by poor pelvic mechanics. The good news is that it's usually easily fixed. If your feet are contributing to the situation, you may need to get different running shoes or maybe orthotics. Also, you'll want your doctor to review your work and non-work postures and positions to see if anything that you're doing regularly may be contributing to the tightness of the muscle. Here it is once again in a nutshell.
Stretch the Piriformis muscle (see Stretching for more detail)
Address faulty pelvic or foot mechanics
Address postural or work related contributing factors
Return to running gradually. Build up slowly to pre-injury training level.
14 months and going, I need to sort this out now. :mad:
I did a search again on the internet, this time UK only sites, and found less contradictory information than a worldwide search.
Possible treatment methods other than stretching/strengthening.
TENS
Microcurrent treatment (saw that on this site)
Interferential current stimulator (IFC) (same as above?)
Acupuncuncture? (probably only for pain but who knows?)
Massage
Ultrasound
ART? (I’m not sure what this is used for exactly though)
Painkillers/NSAIs, Ice, Heat (superficial method - hot bath/hot pack) have had no effect so far. Neither have stretches so far, but I don’t expect it to overnight, and I haven’t stretched the adductors yet, which are tight, and might be the cause of the problem (I tore an adductor on the same leg 30 months ago).
Which ones should I go for (remember this is to treat muscle spasm and pain)? If I was rich i would have them all!
