How often do you hear yourself saying things like: “I have hip pain,” “My lower back hurts,” “Pain is shooting down my leg,” “There’s numbness and/or tingling on the top of my foot,” “I have sciatica,” and so on…
Well, you’re not alone. In fact, these are frequently recited phrases in doctors’ offices, physical therapy clinics and healing centers the world over. When patients present their symptoms to me they offer many of those descriptions and curative measures they’ve been instructed to carry out. Their physician has told them to take anti-inflammatory drugs, such as ibuprophen, or to use ice. Sometime the doctor recommends physical therapy, wherein the therapist designs a series of strengthening exercises to solve the problem.
By the time the problem reaches my office, the patient has already swallowed the over-the-counter pills and gone through a lengthy course of physical therapy or chiropractic care… all with little lasting effects. Sometimes the problem has become worse.
When I hear phrases like those mentioned above, I already know what the person has “tried” prior to seeing me. I also know that they will tell me the problem is not “fixed.” If it was they would not be here. The first thing I do is perform a series of orthopedic tests on their piriformis, a muscle largely overlooked by the mainstream medical community.
The piriformis muscle originates at the front of the sacrum (the part of the spinal column that is directly connected with or forms a part of the pelvis). It passes out of the pelvis through the greater sciatic foramen. It inserts into the upper border of the greater trunchanter (ball) of the femoral shaft (thigh bone). It is used to rotate the thigh laterally when such a motion is called for.
What this means is that this one muscle, if dysfunctional, has the ability to negatively affect a number of places on the hip, low back, legs and feet. Since the piriformis attaches the femur to the sacrum, if it is hypertonic (tight, contracted, in spasm) it can cause the foot to splay. That is, the foot of one or both legs will tend to point outward when walking. And this causes pain in the hip.
If the piriformis is contracted it can compress the sciatic nerve, thus causing what is described as “shooting leg pain.” Often, those who are diagnosed with sciatica actually have piriformis syndrome. Sure their X-rays may show some disc herniation, and the doctors will tell the patient that is the cause and recommend surgery. But this is not necessarily the case.
People live the entire lives with disc herniations and have no pain from them. So the presence of herniation uncovered by magnetic resonance imaging (MRI) when sciatica is present is a correlation and not necessary a cause and effect situation.
When the piriformis tightens it can also cause the hips to rotate either to one side or diagonally, thus causing the pelvis to be askew, which can be a cause of both lower back pain and hip pain.
On the other hand, if the piriformis is too loose or flexible (hypotonic), it will cause slack in the connection of bones and allow play to occur. This can irritate nerves and muscles and cause severe pain.
So how does the piriformis become too tight or too loose? Well, the most common cause is sitting for prolonged periods of time. The human body was designed to stand and walk, not sit with 90-degree flexion at the hips and knees. When sitting, the muscles, tendons and ligaments in the front of the pelvis become hypertonic (shortened), and those on the rear become hypotonic (elongated). Elongated muscles tend to contract naturally as a defense against poor posture and this results in spasms.
Sitting for prolonged periods at a desk or while driving a car also reduces the amount of blood and body fluids moving through the contracted areas of the waist. In Chinese medicine we call this “stasis” or blockage of blood, fluids and energy. And where there is no free flow there is pain. Conversely, where there is free flow there is no pain. If you want to get rid of the pain you need to release the tension and allow flow.
I see hypotonic (hyperextended) piriformis in some yoga practitioners who are either too eager in the stretching exercises or are under the misguidance of an unqualified teacher. Muscles should be stretched only within their normal range of motion. When stretched too far they can become torn or slack and this causes pain and injury.
And while strengthening exercises such as those used in physical therapy are good, strengthening a muscle that is hypertonic is asking too much of it while in its dysfunctional state. It is better to go through a regimen of stretching, Thai yoga massage, muscle energy technique or tui-na Chinese bodywork to first work out the hyper tonicity before strengthening the muscle.
The next time your low back, hip, buttocks, leg, shin or foot is bothering you, ask your physician/healer/therapist about the possibility of the piriformis being the culprit. It just might be, and getting a jump on it early on will shorten the healing process and prevent the problem from becoming chronic.
— Dr. Mark Wiley