The piriformis is a busy muscle. It is involved in almost every motion of the hips and legs.
The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. The piriformis enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs.
Specifically, the piriformis muscle is part of the lateral rotators of the hip, along with the quadratus femoris, gemellus inferior, gemellus superior, obturator externus, and obturator internus. The piriformis laterally rotates the femur with hip extension and abducts the femur with hip flexion. Abduction of the flexed thigh is important in the action of walking because it shifts the body weight to the opposite side of the foot being lifted, which keeps us from falling. The action of the lateral rotators can be understood by crossing your legs to rest an ankle on the knee of the other leg. This causes the femur to rotate and point the knee laterally. The lateral rotators also oppose medial rotation by the gluteus medius and gluteus minimus. When the hip is flexed to 90 degrees, piriformis abducts the femur at the hip (Netter’s Clinical Anatomy, 2010)
Sometimes the piriformis muscle can press against and irritate the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve. This referred pain is known as sciatica. Seventeen percent of the population has their sciatic nerve coursing through the piriformis muscle (instead of beside or around it). This subgroup of the population is predisposed to developing sciatica. Sciatica can be described by pain, tingling, or numbness deep in the buttocks and along the sciatic nerve. Sitting down, stretching, climbing stairs, and performing squats usually increases pain. Diagnosing the syndrome is usually based on symptoms and on the physical exam. If diagnosed with piriformis syndrome, the first treatment involves progressive stretching exercises and regular massage. If the pain continues, corticosteroids are often administered.
Protecting Your Piriformis
Problems with your piriformis muscle usually come from improper form during sports or movement that repeatedly stresses the piriformis muscle, such as running or lunging. Avoid running or exercising on hills or uneven surfaces. Warm up properly before activity and increase intensity gradually. Use good posture while running, walking, or exercising. If pain occurs, stop the activity and rest until pain subsides.
Regular massage therapy, especially if you notice slight pain or tenderness in the area, can also work wonders. Talk with your massage therapist about when and how the pain or discomfort displays itself and how you’ve tried coping with it in the past. Your therapist will plan a session that targets the muscle group and related trigger points.
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