This muscle is not simple, it is very good at compressing nerves

Author: Chen Yin Shenzhen Traditional Chinese Medicine Hospital

Reviewer: Cao Xuemei, Chief Physician of Shenzhen Traditional Chinese Medicine Hospital

Lao Li has been feeling something is wrong lately. He feels a dull pain in his buttocks when he walks, goes up and down stairs, or bends over. Occasionally, it feels like a knife cutting. The pain extends down to his calf, and the outside of his calf feels numb. Even his perineum feels uncomfortable. He needs to rest for a while after walking a certain distance before continuing. The pain forces him to limp, and he is tortured to the point of being unable to sleep at night. When Lao Li presses his buttocks, he feels obvious tenderness and seems to be able to feel a swelling. Lao Li suspects that all this was caused by an electric bike hitting his buttocks on the road two days ago.

Mr. Li went to the hospital for a check-up, and the doctor told him that his problem was most likely caused by external force that damaged the piriformis muscle, causing congestion and edema, and compressing the sciatic nerve, which in turn triggered a series of symptoms, medically known as piriformis syndrome.

1. Causes of Piriformis Muscle Damage

The causes of piriformis muscle damage include trauma, poor sitting posture, and drug injections. Traumatic bleeding, adhesions, and scar formation in the buttocks can lead to damage to the piriformis muscle; maintaining a bad posture for a long time, sitting for a long time, or overusing the buttocks muscles can lead to chronic strain of the piriformis muscle, inflammation, and adhesions, which can then compress the sciatic nerve; drugs can cause the piriformis muscle to degenerate, contract the fibers, and the posterior wall of the acetabulum can be fractured and displaced, and the bone callus is too large, which can all cause the sciatic nerve to be compressed at the piriformis muscle. In addition, in a small number of people, the sciatic nerve has a variation in its course when it leaves the pelvis and passes through the piriformis muscle. When the hip is externally rotated, the strong muscle contraction can cause excessive pressure on the sciatic nerve, which can cause chronic sciatic nerve damage over time.

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(The piriformis muscle originates from the outside of the anterior sacral foramen and ends at the greater trochanter of the femur, which can extend, abduct and externally rotate the hip joint)

2. Self-examination method for piriformis syndrome

You can use the following simple test to initially assess whether you have piriformis syndrome:

1. Straight leg raising test Perform the straight leg raising test while lying flat on your back to observe whether you experience sciatica when you raise your lower limbs. If sciatica occurs when your lower limbs are raised less than 60°, it is a positive result.

2. Piriformis muscle tension test: Lie down and externally rotate the knee joint to tense the piriformis muscle to see if sciatica is induced. This is one of the important tests for diagnosing piriformis syndrome.

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The symptoms of piriformis syndrome may be similar to other diseases such as lumbar disc herniation and sciatica, so self-testing may be inaccurate. It is recommended to go to the hospital for relevant examinations such as X-ray, MRI, electromyography, etc. when positive indications appear. These examinations can help rule out other diseases and observe whether the piriformis muscle has changes such as inflammation, edema or scar formation.

Treatment of piriformis syndrome

Once piriformis syndrome is diagnosed, the following treatments may be offered:

1. Drug treatment Commonly used drugs include aspirin, muscle relaxants, glucocorticoids, botulinum toxin, lidocaine, etc. These drugs can relieve the patient's symptoms, but they must be used under the guidance of a doctor.

2. Physical therapy such as infrared therapy, low and medium frequency current therapy, ultrasonic therapy, etc. can improve local blood circulation and relieve adhesion and spasm.

3. Traditional Chinese medicine treatments such as acupuncture and massage can stimulate specific acupoints on the buttocks to relieve piriformis muscle spasms and adhesions.

4. Surgery For patients who are ineffective with conservative treatment or have severe symptoms, surgical treatment can be selected, such as cutting the piriformis muscle to relieve the compression of the sciatic nerve. However, there is a risk of recurrence after surgery, and follow-up treatment such as adhesion lysis is required.

The prognosis of piriformis syndrome is generally good with timely and effective treatment. However, some people may have residual symptoms and may not recover for a long time. In addition, trauma, long-term sitting, and diseases of the tissues around the waist and buttocks may cause the disease to relapse. Therefore, appropriate functional exercises are needed after treatment to consolidate the therapeutic effect and reduce recurrence.

4. Symptom relief methods for piriformis syndrome

Effective relief methods for piriformis syndrome mainly include the following aspects:

1. Piriformis muscle stretching exercise

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① Cross-legged stretch: The patient sits on the ground with his legs straight, then places the affected lower limb on top of the healthy knee joint, uses both hands to forcefully adduct and internally rotate the thigh to the maximum extent, holds for a few seconds, and then relaxes. This action can stretch the piriformis muscle, helping it relax and relieve tension.

② Hip external rotation stretch: The patient sits on the ground, places the affected lower limb on the healthy knee joint, puts both hands on the outside of the knee joint, and actively externally rotates the knee joint to the maximum extent, holds for a few seconds and then relaxes. This action can also effectively stretch the piriformis muscle and increase its flexibility and range of motion.

2. Buttocks muscle strengthening exercises

① Hip bridge: Lie on your back with your legs bent to shoulder width, place your hands on both sides of your body, and then lift your hips up to form a straight line. This movement can strengthen the hip muscles, including the piriformis muscle, thereby reducing their burden and relieving pain.

② Side-lying leg lift: Lie on your side, support your head with one hand, place the other hand on the ground, then lift the upper leg until it is parallel to the ground or slightly higher, then slowly lower it. This movement can exercise the muscles on the outside of the buttocks and thighs, and also has a certain relieving effect on the piriformis muscle.

③ Stand in a single-leg squat position, take a step forward with one leg, then slowly squat until the other leg almost touches the ground, and then slowly stand up. This action can exercise the strength and stability of the lower limbs and buttocks muscles, and help relieve the pressure on the piriformis muscle.

④ Air Cycling: Lie on your back, bend your legs and do the cycling action, and push your feet back and forth. This training can strengthen the core muscles and lower limb muscles, while reducing the pressure on the piriformis muscle and promoting its recovery.

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⑤ Yoga modified pigeon pose: bend your left leg forward, sit on the left hip, stretch your right leg backward, and press your body down. This yoga move can relax the piriformis muscle, relieve nerve compression, and promote recovery.