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Syed Physio, Ladakh (2026)

22/11/2020

●What Is Piriformis Syndrome?

The piriformis is a muscle that extends from the front of the sacrum. That’s the triangle-shaped bone between your two hipbones in your pelvis. The muscle extends across the sciatic nerve to the top of the femur. The femur is the large bone in your upper leg.

The piriformis helps the thigh move side to side. A piriformis muscle spasm can put pressure on the sciatic nerve and cause symptoms. The result is piriformis syndrome.

●Symptoms of piriformis syndrome

Sciatica is the main symptom of piriformis syndrome. You may experience others, however. Often the discomfort is felt in another part of the body, such as the back of the leg. This is known as referred pain.

Some other common signs of piriformis syndrome include:

numbness and tingling in the buttocks that may extend down the back of the leg
tenderness of the muscles in the buttocks
difficulty sitting comfortably
pain while sitting that gets worse the longer you sit
pain in the buttocks and legs that worsens with activity
In serious cases of piriformis syndrome, the pain in your buttocks and legs can be so severe it becomes disabling. You may become unable to complete basic, everyday tasks, such as sitting at a computer, driving for any length of time, or performing household chores.

●Causes of piriformis syndrome
The piriformis gets a workout every day. You use it when you walk or turn your lower body. You even use it just from shifting your weight from one side to the other. The muscle can become injured or irritated from long periods of inactivity or too much exercise.

Some common causes of piriformis syndrome include:

overuse from excessive exercise
running and other repetitive activities involving the legs
sitting for extended periods
lifting heavy objects
extensive stair climbing
Injuries can also damage the muscle and cause it to press down on the sciatic nerve. Typical piriformis injury causes include:

a sudden twist of the hip
a bad fall
a direct hit during sports
a vehicle accident
a pe*******on wound that reaches the muscle

●Risk factors for this syndrome
Anyone who sits for long periods of time, such as people who sit at a desk all day or in front of a television for extended periods of time, are at a higher risk for piriformis syndrome. You’re also at increased risk if you participate in frequent, rigorous lower-body workouts.

●Diagnosing piriformis syndrome
See your doctor if you experience pain or numbness in your buttocks or legs that lasts more than a few weeks. Sciatica can linger for several weeks or longer, depending on the cause. You should also see your doctor if your symptoms come and go frequently.

Your doctor appointment will include a review of your medical history, your symptoms, and any possible causes of your pain. Be prepared to discuss your symptoms in detail. If you had a recent fall or recall straining a muscle during sports, be sure to share that information with your doctor. It doesn’t matter if you’re unsure that’s what triggered your symptoms.

Your doctor will also do a physical exam. You will be put through a range of movements in order to tell what positions cause pain.

Some imaging tests may also be necessary to help rule out other causes of your pain. An MRI scan or a CT scan may help your doctor determine whether arthritis or a ruptured disk is causing your pain. If it appears that piriformis syndrome is causing your symptoms, an ultrasound of the muscle may be helpful in diagnosing the condition.

●Treating piriformis syndrome
Piriformis syndrome often doesn’t need any treatment. Rest and avoiding activities that trigger your symptoms are usually the first approaches to take.

You may feel better if you alternate ice and heat on your buttocks or legs. Wrap an ice pack in a thin towel so you don’t have the ice pack directly touching your skin. Keep the ice on for 15 to 20 minutes. Then use a heating pad on a low setting for about the same time. Try that every few hours to help relieve the pain.

Over-the-counter painkillers, such as ibuprofen (Advil) or naproxen (Aleve), may also help you feel better.

The pain and numbness associated with piriformis syndrome may go away without any further treatment. If it doesn’t, you may benefit from physical therapy. You’ll learn various stretches and exercises to improve the strength and flexibility of the piriformis.

One simple exercise you can try is to lie flat on your back with both knees bent. Lift your left ankle up and rest it against your right knee. Then gently pull your right knee toward your chest and hold it for five seconds. Slowly return both legs to their starting positions and do the same stretch on the other side. Then repeat both stretches.

In serious cases of piriformis syndrome, you may need injections of corticosteroids to help relieve inflammation of the muscle. You may also find relief after transcutaneous electrical nerve stimulator (TENS) treatment. A TENS device is a handheld unit that sends small electrical charges through the skin to the nerves underneath. The electrical energy stimulates the nerves and interferes with pain signals to the brain.

If you still need relief, you may need surgery to cut the piriformis muscle to ease pressure on the sciatic nerve. However, this is rarely needed.

●Preventing piriformis syndrome
Even though exercise can sometimes cause piriformis syndrome, regular exercise can help reduce your risk. Muscles need exercise to stay strong and healthy. To help prevent injuries that lead to piriformis syndrome, you should do the following:

warm up and stretch before you run or engage in a vigorous workout
gradually build up the intensity of whatever exercise or sport you’re doing
avoid running up and down hills, or over uneven surfaces
get up and move around so you’re not sitting or lying down too long without some activity
If you have already been treated for piriformis syndrome, you may be at a slightly higher risk of it returning. If you follow through on the exercises learned in physical therapy, you should be able to avoid a relapse barring a serious injury.

●Outlook for this syndrome
Piriformis syndrome is an uncommon condition and can be difficult to diagnose. It can usually be treated with some rest and physical therapy.

Staying active, but making sure you stretch before exercising, should help keep your backside and legs feeling better before, during, and after your workout.

22/11/2020

📋Effect of pelvic tilt on and hip knee angle on lower body posture

🔴Lower Body Posture

Maintaining improved upper body posture is much easier when the lower body is properly aligned. It is the lordotic/inward curve of the lower back that positions the upper body over the hips and allows a stable erect posture. Without a lordotic curve, the entire body tends to tilt forward, and posterior muscles such as hip extensors (hamstrings and gluteals) and back extensors are tight and overworked trying to keep the entire body from falling futher forward.

🔴Goals and Preliminaries for Correcting Lower Body Posture:

Goals:
— For flatback and swayback postures, increase lumbar lordosis and bring the upper body over the hips for firm support.

— For hyper-lordotic lower backs, reduce the lumbar lordotic curve.

— For swayback, strengthen weak abdominal muscles (external obliques) that have allowed the upper body to shift backwards, and pelvis to shift forwards.

— For hyper-lordotic back, to strengthen weak abdominal muscles (external obliques) that have allowed the pelvis to tilt far forward.

— Remind oneself frequently not to hypre-extend the knees.

1️⃣ Tilt of pelvis

The pelvis is attached to the base of the lumbar spine by the Sacrum, a large, thick vertebra–like bone that connects to the curved plate–shaped Iliums of the pelvis via strong ligaments and two Sacroiliac Joints. These joints and ligamentous connections interlock the sacrum and iliums, which allow very little independent movement; in effect, both move as one. If the pelvis tilts forward, the sacrum, with lumbar spine attached, is also pulled forward resulting in excessive inward (lordotic or anterior) curve of the lower back. If the pelvis tilts backward, the sacrum and lower spine back are pulled backward, which results in straightening of the lumbar curve as seen in Flat Back Posture.

🔑Effect of pelvic tilt
Pelvic Tilt is determined by the relative strengths and weaknesses among four groups of muscles that attach to the pelvis: Abdominals and Hip Flexors at the front of the pelvis/hip, and Low Back Extensors and Hip Extensors at the back of the pelvis/hip

2️⃣Angle of hip and knee joints

Backward bending or extension of the hips and knees is limited, but this limitation gives stability to the body in standing position so that the legs can't "buckle backwards" (Kendall et al.) But in swayback posture the hips and knees have a slight backward bend/ hyperextension that causes the hips to hyper-extend and the pelvis to shift forward ahead of the feet. This is an unstable position and without a counter-balancing weight or body part behind the feet, the body would fall forward. The counter-balance is provided by the upper torso, which shifts backwards to compensate.

🔴Muscles That Control Pelvic Tilt.

ℹ️ Two opposing muscle groups attach to the anterior (front) half of the pelvis:
1️⃣ Abdominals (Re**us Abdominis, External oblique) exert upward pull on pelvis.
2️⃣ Hip Flexors (Re**us femoris, Tensor fasciae latae, Iliopsoas, Sartorius) exert downward pull.

ℹ️ Two opposing muscle groups attach to the posterior (rear) half of pelvis:

3️⃣ Low Back Extensors exert upward pull on the pelvis.
4️⃣ Hip Extensors (Gluteus maximus, Hamstrings) exert downward pull.

With all four groups of muscles in balance, the pelvis is held in neutral position, giving the lower back a slight lordotic (anterior) curve. This alignment of the lumbar vertebra results in 80 – 90% of upper body weight being supported by the column of thick round vertebral bodies, and gel-filled discs between the vertebral bodies, in a uniform manner, while the remaining weight (10 – 20 %) is supported by the more delicate rear facet joints.

⚠️When pelvic muscles are unbalanced, the pelvis may tilt forward or backward depending on which muscle groups are too weak and/or elongated and which are too strong and/or shortened relative to their antagonist muscle group.

ℹ️When pelvis tilts forward, the resulting hyper-lordosis transfers too much weight/force to the rear facet joints, causing more pressure on rear facet joints leading to osteophyte formation leading to narrowing of nerve channels etc.;

ℹ️When the pelvis tilts backwards the resulting flat or kyphotic lower back transfers too much force to the front edges of both vertebral bodies and the discs in between; causing the discs to wear unevenly and develop micro-tears in the over-stressed areas, which leads to premature loss of fluid and disc height. However, a kyphotic lower back may open up facet joints enough to improve symptoms of nerve root impingement.

🔴Types of Faulty Lower Body Posture and Specific Muscle Imbalances:

ℹ️Hyper-lordotic Back: Some or all the following imbalances contribute to a hyper–lordotic lumbar curve: Weak anterior abdominal muscles (esp. External Oblique) allow the anterior pelvis to tip down and forward. Tight hip flexor muscles (esp. the Iliopsoas) pull the anterior pelvis down and forward. Tight Low Back Extensors pull upward on the posterior pelvis and weak Hip Extensors cannot counter the pull.

ℹ️Flat Back: Tight Hamstrings pull pelvis down in back (and elongated/weaker low back extensors allow it), thus producing posterior pelvic tilt, which straightens the normal lordotic curve. Strong abdominals pull up on anterior pelvis further accentuating posterior tilt and weak hip flexors allow it.

ℹ️Sway Back: Short, tight Hamstrings pull down on posterior pelvis, tilting it backward and flattening the normal lordotic curve. Weak, elongated one-joint hip flexor, the iliopsoas, cannot oppose. The External Oblique abdominal is elongated and weakened from accommodating to the backward sway of the upper trunk.

🔑To correct pelvic tilt to neutral
the pelvis can be deliberately tilted frontward or backward depending on type of faulty posture:
perform: posterior pelvic tilt exercise, pelvic tilt exercises.
But if hip or back muscles are tight, changing pelvic tilt may seem impossible or may cause muscle tingling or soreness.
⚠️Best to see a doctor in case of radiating nerve pain.
Otherwise, specific exercises directed at the 4 muscle groups that determine pelvic tilt, either to help stretch over–tight, shortened muscles, or strengthen opposing weak, elongated muscles, are needed. The specific exercises to use depends on whether excessive anterior or posterior pelvic tilt needs to be correcte

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Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They maintain health for people of all ages, helping patients to manage pain and prevent disease.

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