27/02/2018
Muscle of the Day - Piriformis
A Pain In The Butt...Quite Literally!
(60-seconds reading time)
The Piriformis muscle, located in the area of the rear hip, is an interesting muscle in a number of ways. It has an attachment to both the pelvic surface of the sacrum bone and also the superior border of the greater trochanter of the femur bone.
The sacrum is a large, triangular-shaped bone which is the major intersection between our upper body, via the lumbar spine, and our lower body, via the Sacroiliac Joints (SIJ) and the Ilium (Pelvis).
If the Piriformis muscle becomes neurologically dysfunctional, it can cause numerous pain and movement problems in the area.
Two issues that can be caused include joint compression or 'jamming' of the Sacroiliac Joint (SIJ) and/or Sciatic nerve entrapment, whereby the large Sciatic nerve can be irritated by the 'tight' Piriformis muscle.
I saw a female client for the first time yesterday that struggled to walk into the clinic, and complained of all sorts of nerve and muscle pain in the area of her left buttock, left SIJ, and left lower back.
Previously, she had visited two different GP/Medical Doctors and been given conflicting diagnoses, including ‘something is structurally wrong with your back/spine’ and ‘something's irritating the nerves in your back/hip area'.
Ultimately, she had been sent away with a prescription for strong painkillers and had been taking different variations for some time.
No mention was made of looking into the problem further from a medical point of view, or referring her for imaging etc, despite her experiencing persistent nerve and muscle pain in her left buttock area for several months.
In her injury history, one event stood out to investigate during her initial session. Previously, she had a bad fall onto her sacrum/coccyx area, with a significant enough force to cause loss of bladder control upon impact.
After ruling out any 'red flags' through questioning and orthopaedic assessments, we found the answer to WHY she was experiencing 'sciatica' and rear butt pain!
Using NeuroKinetic Therapy (NKT), we were able to assess the neurological function of two of the primary muscles that were causing the all of the issues.
We identified a 'Facilitated' or overworking Left Piriformis muscle and an 'Inhibited' or underworking Left QL (Quadratus Lumborum) lower back/hip muscle.
We also found that due to the Piriformis muscle being very hypertonic (high tone) and ‘tight’, it was pressing on and irritating the sciatic nerve during certain positions and movements.
The client was assigned two corrective exercises to perform - release and ‘relax’ the overworking Piriformis, then importantly, activate and gently strengthen the underworking QL lower back/hip muscle.
It’s important with issues such as Sciatic nerve pain to identify the underlying cause. I’ve have seen many clients over the years that were merely given prescription painkillers to treat the pain and symptoms, yet rarely were the causes looked at and corrected.
In the pictures, you can see how the sciatic nerve passes just in front of (i.e. anteriorly) to the Piriformis muscle (with the majority of people).
I explained to the client that she will have to be diligent with her home exercises as she’s had the issues for some time.
Let’s see what her brain and body do with the new information and movement patterns in the area over the coming days :)
