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Piriformis syndrome occurs most frequently between ages 40-60 and is more common in women than men. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome; , possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the pelvis of women. Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%.
The most common symptom of patients with piriformis syndrome is increasing pain after sitting for longer than 15 to 20 minutes. Many patients complain of pain over the piriformis muscle (ie, in the buttocks), especially over the muscle’s attachments at the sacrum and medial greater trochanter. Symptoms, which may be of sudden or gradual onset, are usually associated with spasm of the piriformis muscle or compression of the sciatic nerve; these symptoms include radiating/shooting pain or tingling or numbness in the back of the thigh, leg, or foot. These symptoms must be evaluated by a healthcare provider to differentiate the possible causes. Patients may also complain of difficulty walking and of pain with internal rotation of the involved leg, such as occurs during cross-legged sitting or walking. X-rays or an MRI offer little help in directly diagnosing piriformis syndrome but may be used to rule out other causes of sciatica such as a herniated disc in the lumbar spine.
There are many functional abnormalities that may have either caused or resulted from this condition. Once the diagnosis has been made, these underlying, perpetuating biomechanical factors must be addressed.
Functional biomechanical deficits associated with piriformis syndrome may include the following:
Functional adaptations to these deficits include the following:
Piriformis syndrome is a unique cause if sciatic nerve irritation (neuritis) or sciatica. The condition, which can mimic lumbar disc herniation, usually is caused by irritation of the sciatic nerve due to spasm and/or contracture of the piriformis muscle. Piriformis syndrome is also referred to as “pseudosciatica”, “wallet sciatica”, and “hip socket neuropathy”.
It frequently goes unrecognized or is misdiagnosed in clinical settings. Piriformis syndrome can “masquerade” as other common somatic dysfunctions, such as intervertebral discitis, lumbar radiculopathy, primary sacral dysfunction, sacroiliitis, sciatica, and trochanteric bursitis.
(Image from http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=4214fc65d020761633286131e407d037)
The proper understanding of piriformis syndrome requires knowledge of the anatomy and anatomical variations in the relationships between the sciatic nerve and the piriformis muscle.
The piriformis muscle is flat, pyramid-shaped, and oblique. This muscle originates on the front of the sacrum and inserts at the greater trochanter of the femur. With the hip extended, the piriformis muscle is an external rotator of the hip; however, with the hip flexed, the muscle becomes a hip abductor.
In most of the population, the sciatic nerve exits the pelvis deep along the lower surface of the piriformis muscle. However, many developmental variations of the relationship between the sciatic nerve in the pelvis and piriformis muscle have been observed. In as much as 22% of the population, the sciatic nerve pierces the piriformis muscle, splits the piriformis muscle, or both, predisposing these individuals to irritation of the sciatic nerve.
From http://www.anatomyatlases.org/AnatomicVariants/NervousSystem/Images/70.shtml
Piriformis syndrome can be caused by a variety of issues. The underlying mechanism is from irritation to the sciatic nerve. Below are some causes of irritation to the sciatic nerve as it passes the piriformis muscle:
1. Muscular problems
2. Postural
3. Traumatic
4. Partial or total nerve anatomical abnormalities
5. Other causes can include the following:
Many dance medicine specialists and dancers have begun to use Kinesiotape as a staple to manage their injuries. Developed 
more than 25 years ago in Japan by chiropractor Dr. Kenzo Kase, the Kinesiotape method drew worldwide interest when the U.S. Olympic volleyball player Kerri Walsh wore the tape to support her shoulder during the 2008 Games in Beijing. Now many elite athletes, including dancers use Kinesiotape. Unlike traditional athletic tape, the latex-free Kinesio stretches easily, and permits greater range of motion, making it popular with dancers. It allows the dancer to perform while still protecting them from further injury. “The old way of taping was stiff and tried to support ligaments, but we have learned it gave less support than we suspected,” says Dr. Rebecca Clearman, M.D, “Kinesiotape, on the other hand, helps dancers self-correct. (For instance) if a dancer is hyper-extending, it can serve as a reminder at the end of the range to not go as far.”
Kinesiotape can be used to stimulate or relax a muscle, depending on the direction of the recoil of the stretched tap. Whether relaxing or activating, the tape gets placed along the line of the muscle. For activating, the direction of the tape goes from muscle origin to insertion. The tape’s degree of stretch determines the strength of the recoil action, so each application can be tailored to a dancer’s needs.
It’s like a brace, but better, because of it allows greater range of motion and also provides proprioceptive input (joint balance). Kinesiotape comes in a variety of brands and can be purchased by the consumer, however initially the tape should be applied by a dance medicine professional with knowledge of dance mechanics. After several sessions the injured dancer can learn to put the tape on properly by himself/herself.
Kinesiotape is not a magic bullet. Proper diagnosis of the injury by a qualified healthcare professional is always the first step and during recovery, proper rehabilitation and correction of biomechanical errors are keys.
-Dr. Rose is a San Diego Chiropractor and a Certified Chiropractic Sports Practitioner®. He is a member of the International Association of Dance Medicine and Sciences and has experience with ballet dancers from youth to professional.
At Proform Sports Chiropractic, we help create lifelong musculoskeletal health, emphasizing physical activity and exercise throughout life. Our goal is to prevent injury and achieve optimal health, mobility, and quality of life throughout each person’s lifespan.
Our two primary areas of interest are musculoskeletal injury prevention and rehabilitation. Our offfice focuses on on injury prevention and on effective treatment and rehabilitation that are essential to putting the person back on the path to optimal health.
