Piriformis Syndrome

Oakland chiropractor Dr. Sandy Baird treats piriformis syndrome
Oakland chiropractor tests for piriformis syndrome

What causes piriformis syndrome?

You may have heard of the piriformis muscle (and piriformis syndrome)but did you know that it’s only one of the six small muscles that perform essentially the same movement?  The six deep external rotator muscles of your hip are the piriformis, superior gemellus, inferior gemellus, obturator internus, obturator externus, and quadratus femoris.  They all allow you to move your leg back and out, and to rotate your leg outward.  When they are functioning properly, they don’t make the headlines.  But when they become aggravated through overuse or injury, they can press on the sciatic nerve (or worse, become “glued” to the nerve thanks to adhesions.)

You may be wondering how they get overused or injured in the first place, right?  Because they are so deep, it’s not like these muscles get “pulled” in the same way you might pull a calf muscle, and you rarely fall on your bum, so what is going on?  The truth: it’s the end result of a long chain of compensations!  Generally, it all starts with tight hip-flexors (either from too much/too soon marathon training, or from chronic shortness due to sitting at a desk for eight hours).  Once the hip flexors become injured, they reciprocally inhibit the muscles on the other side of the joint.  This basically means that the hip flexors “turn off” the GLUTE MAX!  The glutes don’t fire as quickly and as strongly as they should, and this results in symptoms like hip, butt, and leg pain.  What do you think happens when a big muscles stops working?

We are amazingly adaptable humans…a different muscle or set of muscles will try to take over the work.  It’s like one employee with specialized knowledge of a work project becomes ill, so two others on his team take over one of his projects.  They may complete it by the deadline, but it may be riddled with errors.  In the body, we now have a case where one (or more) of the deep rotator muscles (employees trying to be good team players), are trying to bear the load that the gluteus maximus (sick employee) usually bears.  The two muscles have completely different axis of rotation, their force-couples are different, and they were overall designed to perform different actions.  But if they don’t step in, who else will?

Oakland chiropractor Dr. Sandy Baird treats piriformis syndrome
Oakland chiropractor treats piriformis syndrome

Treatment of piriformis syndrome

Once we enter this situation, it’s easy to extrapolate that those small muscles are about to get overworked and aggravated.  An aggravated muscle is constantly contracting, which results in decreased circulation (thus decreased oxygen).  This hypoxia (lack of O2) causes adhesions to form in the muscle.  These are now your immediate source of butt pain, even though tight hip flexors may have been the initial cause.  Active Release Techniques (ART) can help both restore the integrity of the hip flexors as well as reduce adhesions in the specific deep external rotator muscle or muscles that are causing you the pain.  ART also offers specific protocols to reduce the nerve entrapment of the sciatic nerve at the offending muscle, should that condition develop as well.

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