A Literal Pain in the Butt

Jason Schoenborn, PT Continues Education
May 24, 2017
Protect Your Family
July 19, 2017

A Literal Pain in the Butt

By: Kaylee Weber, PT, DPT  Clinic Manager at ApexNetwork in Gillespie, IL

 

 

Ever have a pain in your butt? No, not from your toddlers driving you crazy or a friend or family member making you question your sanity; a TRUE pain in your butt. It’s likely caused from a little muscle called your piriformis. Piriformis Syndrome is a common issue that occurs likely from a direct trauma to the piriformis region, altered pelvic alignment because of muscle imbalances in the hips and core, post-operatively or a change in alignment at the sacral-innominate joint, which can lead to a change in the muscle pull of the piriformis on the hip. But what is the piriformis? It’s a muscle located in the gluteal region that helps to externally rotate your hip (turn your hip out). With piriformis pain, you may also notice irritation or compression of the sciatic nerve, causing nerve pain to follow the track of the sciatic nerve down the posterior aspect of the same side leg of the piriformis pain.

With Piriformis Syndrome, patients likely present with buttock tenderness over the piriformis muscle, pain at the greater sciatic notch as well as surrounding tissues, referred pain down the same side leg following sciatic nerve distribution, pain with passive hip flexion, adduction, and internal rotation (+ FAIR test), and/or pain with contraction of the piriformis muscle. While laboratory testing or imaging may not confirm this diagnosis, using subjective reports with your objective findings during an evaluation will help to best diagnose Piriformis Syndrome once the lumbar spine, hip, and SI joint have been cleared with testing.

To treat Piriformis Syndrome, patients typically respond well to passive stretching of the piriformis, soft tissue mobilization and IASTM techniques, treating muscle imbalances and alignment issues found during objective measurements, using a heel lift on the involved side if a leg length discrepancy is found, and use of modalities for pain relief (ultrasound, ice massage, electrical stimulation). Some therapists have also found patients reporting relief with use of Kinesiotaping techniques. With a home exercise program, patients should be educated on appropriate stretching, core and hip strengthening, and education on posture and appropriate use of modalities at home for pain relief. Patients that truly have Piriformis Syndrome should report centralization of their pain patterns, improved functional scores on given outcome measures such as the Lower Extremity Functional Scale, decreased tenderness to palpation, and no pain with hip flexion/adduction/internal rotation when stretched passively.