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Piriformis Syndrome

What is the piriformis?

Before delving into problems with the piriformis, it’s worth establishing where (and what) it is. A small, pyramid-shaped muscle found in the hip, it connects the front of the sacrum (the base of the spine) to the top of the femur (thigh bone). It is part of the lateral rotator group of muscles that control the leg’s rotation away from the body and works alongside your two smaller glute muscles (gluteus medius and minimus) to stabilise your pelvis.

‘It helps to prevent the pelvis from dropping when you’re walking or running and helps prevent the femur from rotating inwards,’ says Aid. ‘The muscle’s job is both lateral and as an outer stabiliser of the hip.’

What is piriformis syndrome?

‘Piriformis syndrome is a bit of a vague terminology,’ explains Aid. ‘It can just be the muscle itself becoming quite tight from overuse or direct trauma, but some people interpret it as a cause of sciatica– in a proportion of the population, the sciatic nerve runs through the muscle belly of the piriformis, [and constriction of the sciatic nerve] can give pain all the way down the back of the leg.’

Common symptoms of piriformis syndrome are pain deep in the buttock region, but discomfort can also be present in the lower back, hip, and back or side of the leg.

‘The severity will affect people differently,’ says Aid. ‘Some people will just [feel it] when they’re working the muscle – so walking, running, things like squats or lunges, or when that muscle is stretched or being compressed it might be aggravated. Sitting cross-legged can particularly irritate it because it will be stretching the muscle lying on that side. Obviously, if it’s really severe, the pain can be constant.

If it’s just the buttock pain, you can probably try [stretches and exercises],’ but she adds that if it is sciatica, it’s best to see a specialist. Other symptoms of the irritated nerve include ‘lower-back pain, pain that radiates all the way down the leg, any sort of pins and needles or numbness down the leg, or any weakness – like dragging the leg or tripping up.’

What causes piriformis syndrome?

Piriformis syndrome is a classic overuse injury, which makes running a prime trigger of the condition. ‘There’s a lot of pelvic rotation, a lot of impact going through the legs,’ says Aid.

She explains that it could be that your piriformis itself is weak, your glutes are weak (meaning your piriformis is forced to compensate to pick up the slack), or the whole lateral complex might not be working as it should.

‘Statistically, it’s slightly more common in women because of the Q [quadriceps] angle of women’s legs,’ she adds. ‘Their femur bone goes inwards a bit. It’s why women are more prone to a lot of lower-limb injuries.’

How can pilates help ?

Pilates can progressively help sciatic pain and piriformis syndrome. The evidence based exercises help improve your posture and promote more efficient movements. You can use specific Pilates movements to strengthen and tone your piriformis and gluteus medius muscles which help alleviate these conditions. If your gluteus medius is weak the piriformis muscles must compensate to keep your body on a stable position. This overcompensation can cause tightness and compression leading to these conditions. Two Pilates classes a week should help so strengthen and stretch the correct muscles alleviating the painful symptoms.

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