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Piriformis sydrome and Pilates


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Pain in the butt, or searing pain down the back of your leg and foot? It may be Piriformis Syndrome. How can you find it what it is? Can your Pilates teacher help? Share the slides and find out!

Published in: Health & Medicine
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Piriformis sydrome and Pilates

  1. 1. The sciatic and peroneal nerve, pictured above, is a thickest and longest nerve in the body. Sometimes both of these nerves pass the underside of the piriformis muscle before dividing (first picture on left),and sometimes they divide and only the sciatic nerve passes through the piriformis muscle (second picture above). Other times they both pass through the piriformis muscle before travelling down the back of the leg, and eventually branching off and ending in the top and the sole of the feet.(See third photo below). Compression of these nerves, particularly in the instances of pictures 2 and 3 above, can be caused by spasm of the piriformis muscle. The anatomy
  2. 2. Note the large Gluteus Maximus which covers the deep hip rotators Note the piriformis muscle, lying deep to the Gluteus Maximus Anatomical features
  3. 3. Piriformis Syndrome Signs and Symptoms Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are not due to piriformis syndrome. Piriformis Syndrome Diagnosis There is no definitive test for piriformis syndrome. In many cases, there is a history of trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting. Diagnosis of piriformis syndrome is made by the patient’s report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted or tender piriformis muscle can be found on physical exam. Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.
  4. 4. How can Pilates help? First, establish that your client has piriformis syndrome. If so, in consultation with their physical therapist, commence a program of stretching, and then strengthening the entire gluteal region. Which exercise should I start with? Gentle, contract/relax stretching, with several days in between for recovery is a skillful way to start. Try the stretches below, and see how you or your client responds. Send information to their physical therapist too, and get the OK from them before commencing.
  5. 5. Lying Hamstring stretch with adduction
  6. 6. piriformis You can see the piriformis muscle below, deep under the Gluteus Maximus
  7. 7. Here’s a perspective from below the reformer. You can see the piriformis muscle, and how it will be stretched, if the leg is taken across the body. Piriformis muscle
  8. 8. If you want to introduce a contract/relax element to the stretch, it’s simple.
  9. 9. Now lets try a stretch on a box
  10. 10. To enhance the stretch, lets add the contract/relax component
  11. 11. Try this approach for 3 to four weeks, practicing one of the stretches every second day, at least twice on that day. Practice it for the full length of time suggested. Gauge your progress, and relay that back to your Pilates teacher and Physical therapist. Therapy is an evolving process. No one knows how you will respond to their treatment, we only have the history of others as our guide. For a general guide on releasing sympathetic nervous system tension and muscle pain, please refer to our “Five Tibetans” article