▷ Piriformis syndrome
Pain in the buttocks due to inflamed piriformis muscle syndrome: causes, symptoms, treatment
Pain in the buttocks radiating to the thigh characterizes piriformis syndrome. So you can walk again without pain.
Those who suffer from piriformis syndrome are familiar with the discomfort after long runs or when getting up after sitting for a long time: The pulling pain from the buttocks to the thigh is annoying and unfortunately often persistent. The piriformis syndrome is one of the back pains. Has its cause in a trauma or a too weak or shortened musculature. Stretching exercises and muscle relaxation via ultrasound or trigger point treatment help just as much as strengthening exercises against the complaints. Other common names for the piriformis syndrome are
Deep gluteal syndrome or pelvic outlet syndrome.
Where is the piriformis muscle?
The piriformis muscle is a muscle of the deep layer of the hip muscles and lies below the gluteal muscles. It originates from the sacrum. Attaches to the thigh. The largest nerve in the human body, the Sciatic nerve, lies in the immediate vicinity of this muscle.
What are the symptoms of piriformis syndrome??
A stabbing pain in the buttocks with severe nerve pain, which can radiate to the middle of the posterior thigh, is the main symptom of piriformis syndrome. Numbness and tingling that extends to the toes may also be associated with piriformis syndrome, although neurological deficits do not occur compared to disc damage.
If prere is applied laterally with several fingers to the gluteal muscle between the sacrum and the head of the thigh, this is usually very painful. In piriformis syndrome, lumbar back pain can also occur (d. h. Those in the lumbar region), which in most runners after prolonged periods of sitting aggravate. In some cases, however, pain is also possible after walking for a long time, when bending over, squatting or doing knee bends.
What are the causes of the piriformis syndrome??
The typical pain is caused by Inflammation of the piriformis muscle, which consequently pinches the sciatic nerve. In the technical jargon one speaks of a constriction syndrome of the nervus sciadicus.
Trauma may or may not be the cause. While the piriformis syndrome often occurs after a fall on the buttocks or coccyx, a development after heavy physical stress during sports or unaccustomed physical strain is rarer. History of diseases of the spine. Surgeries can promote the development. May also be related to preexisting inflammation of the sacroiliac joint for some time. In runners, the inflammation usually occurs due to overuse and/or improper running technique associated with a Weakness of the gluteal musculature (gluteal muscles). Women seem to be affected by the piriformis syndrome more often than men.
Can muscle shortening be the cause of piriformis syndrome?
In muscle physiology, a distinction is made between Muscles that cause "shortening tend and those that weaken with time. The piriformis muscle belongs to the first group and thus tends to "shorten" and an excessively high muscle tone. Basically, muscles do not lose length, i.e. do not become shorter in structure. The cause of the feeling of a shortened muscle is rather an "alarm signal" of the brain when a muscle has not been stretched for a long period of time.
How to detect piriformis syndrome?
Diagnosis of piriformis syndrome is made by Muscle testing, neurological testing, and imaging techniques like MRI, CT or an ultrasound examination. In the anamnesis it is to be distinguished from other clinical pictures, which can cause also pulling pain into the legs. This includes herniated discs with nerve involvement and lumbar back pain. Concrete diagnostic criteria for the findings of the syndrome do not exist yet. Triggering factors, pain area and pain-triggering postures can be informative for the doctor or physiotherapist when assessing the findings.
A test you can do yourself at home with a second person: Sit on a table. Let the legs hang hip width. Your partner sits down in front of you with a chair, places his hands on the right and left sides of your thighs and exerts slight prere inwards. You try to push your legs apart against the prere of your partner's hands. If the prere is painful, it could be piriformis syndrome.
For another test lie on the healthy side. Keep the lower leg extended while bending the upper leg about 100° at the knee joint and resting it in front of the body. Now raise your bent knee upwards. Can you provoke with it the pain in the buttocks? Then this test is considered positive in relation to the piriformis syndrome. However, according to studies, these passive tests are far from sufficient to diagnose piriformis syndrome with certainty.
How to treat piriformis syndrome?
Anti-inflammatory drugs relieve piriformis syndrome pain and reduce inflammation. First take a break and cool down the sore spot with ice water soaked towels. Treat both legs, even though in most cases only one side is affected by the piriformis syndrome. in case of slight discomfort, which already allows training and competitions again, the use of a so-called cooling towel is often pleasant after the athletic load.
If the piriformis syndrome is advanced, i.e. has existed for a long time, you should consult a physiotherapist who can treat the muscle spasms that have developed with ultrasound and a myofascial trigger point treatment can be treated to help relieve tension.
As a rule, piriformis syndrome involves one side of the body conservative treatment is sufficient. If, contrary to expectations, this therapy does not help against the piriformis syndrome, it is possible to intervene surgically by releasing the tension created on the tendon of the piriformis muscle.
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How to prevent piriformis syndrome?
Always adjust the amount of exercise you do to your current abilities. As a rule of thumb, increase your running by no more than 10 percent per week and make sure your running shoes fit well. Furthermore, strength training is neglected by many runners, but it is very important, especially if you run a lot. Exercise your pelvic floor muscles at least three times a week, because the strength of the hip muscles is crucial for the correct posture of the pelvis. And a positive side effect that should convince you: Your running performance increases due to a stronger pelvis.
Does surgery help with piriformis syndrome?
Surgery is only recommended if all conservative measures for treating piriformis syndrome have been exhausted. This includes physiotherapeutic treatments. Pain-relieving medicinal injections. The best results are achieved by a Combination of both measures reached. Physiotherapeutic stretching and strengthening exercises can be supplemented by ultrasound treatments, heat applications and cold applications.
Surgery to treat piriformis syndrome involves cutting the attachment of the piriformis muscle near the femoral head. Alternatively, a detachment of the muscle tie from the surrounding connective tie Made. The results of these surgical techniques range from very good to hardly any change.
What exercises help with piriformis syndrome?
Our strength exercises for a better running style consist of exercises that relieve prere on individual muscles such as the piriformis by specifically strengthening the gluteal and core muscles, thus helping to relieve pain. In piriformis syndrome, the focus should be on the single-leg bridge. You don't necessarily have to pull the leg on one side up to the belly, but you can also place one foot on the thigh of the other leg by rotating the hip outwards. To mobilize the piriformis muscle with simultaneous Strengthening the gluteal muscle on the opposite side.
The heel lift mainly stresses the calf muscles. Perform the exercise with one leg. Strengthen the weaker side increasingly. A one-sided strength deficit in the calf muscles can promote increased tension in individual muscles such as the piriformis.
Side rolling stretches and mobilizes muscles in the lower abdomen and back, as well as the pelvic area. With lateral pelvic raises, you strengthen the oblique abdominal muscles and the muscles that stabilize the pelvis.
Pain in the course of the piriformis can also occur due to a lack of mobility in the hip joints. You can mobilize your hip joints, for example, with the hip rotation exercise in the sitting position.