What is the piriformis?
Piriformis is a small rotator cuff muscle in your hip joint (YES, your hips have rotator cuff muscles too!!). It wraps around the head of the femur (hip bone) and performs functions like stabilization when your hip is in motion. Besides piriformis, there are several other small muscles that are part of our hips’ rotator cuff, including – superior and inferior gemellus, obturators, and quadratus femoris. Unlike other big muscles of the hip, such as the glutes, these muscles are located quite deep inside the joint.
Why do people suffer from piriformis syndrome?
Although there are an array of reasons for this, such as trauma, injury, and GENETICS (altered placement of sciatic nerve, which makes people more susceptible to this condition), most people develop this condition over a period of time. The slow progression of the condition can be attributed to the tightness of small deep rotator cuff muscles and WEAKNESS OF LARGE MUSCLES, such as the glute med, min, and max.
Let’s elaborate on this:
SITTING PAIN- Muscles are short and tight
Tightness causes oversensitivity in muscle tissue, meaning the area is more susceptible to pain and has lower pain thresholds.
Why you ask? It’s our brain! Our brain has a tendency to adapt to pain responses, and when pain continues for a long period of time, the threshold of activities/intensity that could stimulate the pain receptors in our body reduces.
Let’s say you might only have pain when sitting. Over time, this could progress to pain when you first wake up in the morning, and eventually to pain even when you’re not doing anything at all — known as pain at rest.
ACTIVITY PAIN
Muscles get tight for a reason: When a person spends less time moving, their big antigravity muscles like the glutes get weaker, think of it as the disuse theory. The less you use the muscle, the weaker it gets.
However, when demanded to act, such as when walking or standing, people often feel pain as the muscle is no longer able to keep up with the demands of daily life.
Why does tightness/weakness/movement cause pain?
Like any other biological system, our bodies must have an equilibrium for optimal functioning. This equilibrium is often disturbed when factors like tightness, inflexibility, weakness, and injury come into play. In this particular case, tightness stimulates a very important nerve called the sciatica in our hip, leading to symptoms of pain, weakness, cramping, and burning.
Is the piriformis really the culprit?
Although the name piriformis syndrome indicates a problem with the muscle itself, in some cases it is ACTUALLY NOT THE CULPRIT! In these cases, people often suffer from nerve root compression in their lower backs, which causes referred pain (pain in the zone of nerve supply). This distinction is extremely important because if not made, it can lead to misdiagnosis.
Is stretching the ultimate therapy for treating piriformis?
While stretching helps in relaxing the muscles, one must ask oneself why the muscles got tight in the first place. Stretching without any supplemental strengthening, often in the case of piriformis syndrome, will yield poor results. This is to say, one of the reasons for the muscle fatigue/shortening in this case is overworking of small muscles (THE DEEP ROTATOR CUFF) and weakness of big muscles (THE GLUTE COMPLEX).
Now we know why it happens and what to do when it does, the next question is “HOW TO DO IT”? For that, stay tuned for part 2!
