I see a handful of patients every week who are diagnosed with “piriformis” syndrome. The traditional understanding is that the piriformis muscle sits right over the sciatic nerve, and if the piriformis muscle gets tight that it will irritate and mimic symptoms of sciatica. Traditional Piriformis syndrome classified as “pain and numbness in your glutes and maybe down the back of your leg”. Unfortunately I see people get diagnosed and treated for piriformis syndrome but it never fully goes away when they receive steroid injections. The good news is there is a better approach that can actually help get rid of piriformis syndrome once and for all.
The Problem with The Diagnosis of Piriformis Syndrome
It’s hard for both physicians and patients alike to understand the intense complexity of the body. It’s easier to come up with a description for one part that hurts and call it good. In conventional medicine we like to look at each little part of the body as a completely separate piece that just functions on it’s own. But in reality the body and specificially the musculoskeletal system functions is systems where all of the pieces work as functional units.
Any change in one part of the unit affects the relative tension, biomechanics and structural integrity of another part of the system.
I call this “parting it out,” and this is definitely the case with a piriformis injection. Even though there are likely other reasons the piriformis is a problem, our “easy fix” medical care system loves an easy-to-understand label.
But the problem is you can keep injecting the problem child and it will contunally come back if you don’t fix the real cause.
So let’s dive deeper to understand what most doctors think is happen and then understand what is REALLY happening.
Overview of the Piriformis Muscle
The piriformis is a muscle that goes from the front of the tailbone to the outside of the hip. See the picture below. The sciatic nerve is the biggest nerve in the body and it starts in your low back, travels down your glutes and the back of your leg to your foot. In some people this nerve pierces through the piriformis. In most people it exits in front of and below the muscle.
If the sciatic nerve is irritated by the piriformis muscle, the foot or leg can go numb or the muscles it supplies can develop pain and problems. Other times patients just develop a “pain in the butt” where the piriformis and sciatic nerve sit.
What do most doctors do if your piriformis is tight or you have piriformis syndrome?
Let’s dive into what most docs throw at you and then we’ll cover how Dr. Hanson, DACM takes a different approach to “piriformis” syndrome and why his approach is likely a better, more permenant option.
The traditional piriformis stretch and physical therapy
The goal is to take tension off the muscle and strengthen up the surrounding muscles. Get ready to stretch everyday and go to physical therapy 3x a week for a couple of months. It may or may not help – no gurantee.
When stretching doesn’t help, steroid injections are next
The idea here is to use very high dose steroids to calm down the irritated nerve and take pressure off of things to provide relief. Unfortunately these don’t work that well and there are quite a few side effects from steroid injections, which is why your doctor will only try this a couple of times a year.
At this point you’re probably feeling like you’ve tried everything and your doc feels the same way. That’s because they are missing the bigger picture and aren’t asking the important question – why is my piriformis tight in the first place?
Why is my piriformis tight?
Well first let’s understand that according to MRI research, Only about 25% of patients had evidence that the sciatic nerve was involved in “piriformis syndrome”. But 86% of the patients had either an enlarged muscle or tendinopathy in the muscle tendon.
So what could make the muscle enlarged or beat up?
Well when we understand that the low back, hips and glutes all work together as a functional unit to stabilize our lumbar spine, we can understand that the piriformis muscle along with a bunch of ligaments help to stabilze the SI joint. Here’s a study from the 1990’s that talks about this stabilization process. It makes sense that any muscle attached to the tailbone has a role in stabilizing the joint that sits there (SI Joint).
So if your SI joint ligaments are loose and not creating stability then the failsafe system our body has is to start locking down and tightening the muscles around it – hence the piriformis muscle getting tight.
So how does Dr. Hanson treat a tight piriformis?
Again, we have to look at the interconnectedness of the musculoskeletal system and ask the question why to come up with a real plan.
If the piriformis is getting tight and beat up because your SI joint is unstable, then how could we every relieve the tightness by just treating the symptom (the tight muscle)?
It’s like trying to fix the leak in a boat by focusing on putting in a better bilge pump instead of just plugging up the leak.
The way your regular orthopedic doctor and even physical therapist is going to approach piriformis syndrome just has no common sense to it.
So how do we tighten down these loose ligaments and relax your tight piriformis??
This can be something as simple as interventional dry needling or prolotherapy directly into specific ligaments. This is something Dr. Hanson performs in his clinic in Tampa, FL on a daily basis with excellent results.
The good news
You have options and don’t have to spend months or years going on a roundabout journey of useless therapies. You just need to step back and ask – why is this happening? Unfornately most of medicine just looks at symptoms and never digs deeper to find the root cause and unforantely most insurance companies don’t reimburse providers for treatments that actually work.
This happens every day with piriformis syndrome. So why is the piriformis tight? It’s usually instability in the sacrum where the muscle is attached.
Fix the instability and the muscle can calm down. Dr. Hanson does this on a daily basis.