Piriformis Syndrome

Resolving Piriformis Syndrome with Active Release Techniques®

Piriformis syndrome is a common cause of posterior hip and leg pain that occurs when the sciatic nerve is compressed or irritated by the piriformis muscle – a muscle located deep in the back of the hip.  As the sciatic nerve becomes irritated it can lead to symptoms such as pain, tingling and numbness along the path of the sciatic nerve, including into the buttocks and down the back of the thigh and lower leg.

Fortunately, Active Release Techniques (ART) – a specialized, hands-on soft tissue treatment technique – has emerged as one of the most effective therapies for Piriformis Syndrome. But before we talk about how ART works so effectively, it is helpful to first discuss what Piriformis Syndrome is and how it develops in the first place.

What is Piriformis Syndrome?

The sciatic nerve runs from the back of the hip, all the way down the back of the leg to the bottom of the foot.   As the nerve passes from the spine into the back of the leg it must pass directly underneath the piriformis muscle (in some people the nerve will actually pass through the middle of the piriformis).

The piriformis muscle is an important hip muscle that plays a key role with respect to hip and pelvic control and stability.   Through a variety of causes such as excessive or repetitive use with certain sports or occupations, previous back or pelvic injuries, or prolonged sitting (sitting can strain the piriformis as it stretches the muscle, which in turn reduces blood flow and leads to tightness and irritation) it is not uncommon for small amounts of strain and irritation to develop within the piriformis.  This strain cause small-scale damage in the muscle know as micro-trauma.  Although only small, this micro-trauma still needs to be repaired, which the body does by laying down new connective tissue in and around the damaged area.  This new tissue (often referred to as scar tissue, or soft tissue adhesions) acts to glue the damaged tissue back together.

While this scar tissue is a normal and necessary part of healing problems can develop when the piriformis muscle is subjected to micro-trauma over the course of weeks or months (i.e. we continue to play the same sports, do the same jobs, or sit all day).  This ongoing micro-trauma will lead to the accumulation of scar-tissue in the piriformis.  As this occurs it will start to make the piriformis tight, stiff, and inflamed, and will start to compress and irritate the sciatic nerve as it passes underneath the muscle.  In many situations as the scar tissue builds up around the piriformis is can actually glue the nerve to the muscle, making it impossible to for the nerve to move and slide under the piriformis, further compromising and inflamming the sciatic nerve.

Other Sites of Entrapment – The “Double Crush” Syndrome

While the Piriformis is the most common site of Sciatic nerve entrapment/irritation it is actually possible for the nerve to become irritated at any point along its path between the spine and the foot.  For example, in addition to the Piriformis, the hamstrings, muscles around the knee, and even the calf muscles can become restricted and damage the sciatic nerve.  Furthermore, when the nerve becomes entrapped at any of these areas it actually becomes more prone to irritation at other sites as well.  This leads to what is referred to as a “Double Crush” Syndrome as the Sciatica symptoms are actually being generated at 2 different entrapment sites.  Obviously, when this occurs both sites must be addressed for complete resolution to be reached.

How Can Piriformis Syndrome Be Fixed?

The Traditional Approach

In an attempt to relieve Piriformis Syndrome a variety of treatment methods are used, either on their own, or in combination with other methods. Some of the more common approaches include muscle relaxants, anti-inflammatory medications, rest, heat, ice, ultrasound, massage, acupuncture, joint manipulation, and stretching and strengthening exercises. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue that develops within the piriformis muscle and around the sciatic nerve.  It is this scar tissue that is causing the muscle to become tight and restricted, and compressing the sciatic nerve, preventing the normal sliding of the nerve at the hip.

Passive approaches such as muscle relaxants, anti-inflammatory medications, rest, ice, acupuncture, and ultrasound, all focus on symptomatic relief and do nothing to address the muscle restrictions and scar-tissue formation.  More active approaches such as joint manipulation, stretching and exercises are often needed for complete rehabilitation of the condition however they themselves do not treat the underlying scar-tissue.  In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from piriformis syndrome.

Our Approach:  ART® – A Better Solution

ART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves.  What makes ART® different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal function of the body.

With respect to Piriformis syndrome the goal is to 1) break-up restrictive scar tissue adhesions at the piriformis (and at other areas of entrapment when a double-crush syndrome is present), and 2) restore normal sliding of the sciatica nerve at the hip.  As the Piriformis regains its health and flexibility, and the pressure is relieved from the sciatic nerve the home stretches and exercises can be prescribed to help ensure a long term solution and prevent reoccurrences.

If you are unfamiliar with ART you can think of it as a type of active massage.  The practitioner will first shorten the muscle, or nerve, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues.  As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment.  When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area.

There are over 500 specific ART® treatment protocols which allow the practitioner to “feel” which structures have become problematic and require treatment.  In this sense, each treatment is also an assessment of the health of the area as we are able to feel where the problem is occurring. There are even specific ART® protocols that have been developed to facilitate proper sliding of the nerves between the muscles and muscle layers.
One of the best things about ART® is how fast it can get results.  In our experience the majority of piriformis syndrome cases respond very well to ART® treatments. Although each case is unique and there are several factors that will determine the length of time it will require to fully resolve each condition, we usually find a significant improvement can be gained in just 5-6 treatments – even in cases of long-standing symptoms that have not fully responded to other treatment approaches.

Get Relief With ART®

To book an appointment to see if ART® will be able to help with your piriformis syndrome simply call our office at (902) 407-7207(902) 407-7207.  For more information on ART®, or for inquiries regarding specific injuries or conditions you can call us, or send us an email at info@kinetesisspineandjoint.ca.