What Are The Warning Signs And Causes Of Piriformis Syndrome?
Piriformis syndrome is a disorder of the muscular system where the piriformis muscle compresses the sciatic nerve. The piriformis muscle sits near the hip joint in the buttocks. This muscle is responsible for performing actions that involve the rotation of the thigh away from the body. The piriformis muscle also provides stability to the hip joint. The sciatic nerve is a major long and thick nerve that passes through or adjacent to the piriformis muscle. The sciatic nerve runs down the back of the leg, and branches out into numerous smaller nerves that eventually reach the feet. Piriformis syndrome is difficult to diagnose due to a lack of validated diagnostic tests. Symptoms alone, an MRI, or the FAIR test can all be utilized to make a diagnosis. Treatment involves the avoidance of triggering activities, pain management, and prevention of complications. Various factors can cause piriformis syndrome, and it can manifest in several ways.
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Sciatic Nerve Pain
An individual who has piriformis syndrome may experience sciatic nerve pain as a symptom of their condition. The sciatic nerve is the lengthiest nerve in the human body. The lower back is where the sciatic nerve begins and eventually divides so it can run adjacent to or through both hips. From the hips, the sciatic nerve descends both sides of the body through the buttocks, legs, and feet. The sciatic nerve is responsible for providing a nerve gateway between an individual's spinal cord to the muscles and skin of their thighs, legs, and feet. Most individuals affected by piriformis syndrome describe the resulting sciatic nerve pain to be an electrical sensation or shooting pain in their buttocks that only happens on one side of their body. The sciatic pain may radiate down the back of the patient's leg, and it can sometimes affect the calves and hamstrings. The sciatic nerve pain that occurs in piriformis syndrome patients may become worse when they sit in certain positions or engage in some activities. Sitting on hard surfaces with or without the feet elevated, engaging in movements that involve rotation of the body repeatedly, and lifting heavy or cumbersome objects while pivoting the hips can all result in the worsening of piriformis syndrome precipitated sciatic nerve pain.
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Tingling Or Numbness
Piriformis syndrome patients often experience the symptoms of tingling or numbness as a result of the effect the muscle has on their sciatic nerve. Numerous mechanisms can cause the piriformis muscle to press down and compress an individual's sciatic nerve. The sciatic nerve is responsible for providing sensation in the buttocks, thighs, calves, and feet, with the transmission of signals to and from the spinal cord and brain. When an individual's piriformis muscle squeezes on the sciatic nerve, the nerve impulse signals between these regions can become disrupted or impaired in transit. When signals cannot make it from the tissues of the leg back to the brain, a patient can experience sensations of numbness that occur in an isolated region, or that affect a large part of the leg. When the nerve transmissions get disrupted, only some of these impulses make it back to the brain. Partial or broken up signals that involve sensation in the limbs can cause the patient to experience tingling. This feeling is the same as what occurs when a limb falls asleep. Numbness and tingling are commonly the very first manifestation of piriformis syndrome an affected individual notices.
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Overuse Or Sprain Causing Inflammation
When an individual suffers muscle overuse or sprain causing inflammation, the result can be piriformis syndrome. Anyone who engages in regular physical activities can experience adverse effects from overuse of the muscles. When exercise becomes too much too soon for an individual's body, the small fibers in the muscles can experience what is called microtrauma or small tears. In addition, the overstretching or overextension of a muscle may cause the individual to experience a sprain, which occurs when the ligament that attaches a muscle to the bone becomes torn, twisted, or overstretched. Both a sprain and other microtrauma injuries from overuse will cause an immune response in the patient's body. The immune system responds to substances released by damaged cells. The blood vessels dilate to increase blood flow, fluid leaks into tissues to the site to isolate the injury, and white blood cells rush to the damaged tissues. The combination of all of these events is called inflammation. When the piriformis muscle incurs injury from overuse or experiences a sprain, the muscle itself and surrounding tissues swell up. This swelling can compress the sciatic nerve, resulting in piriformis syndrome.
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Trauma To The Buttocks
Piriformis syndrome can occur due to an individual experiencing trauma to the buttocks. Trauma or injury to any tissue causes an inflammatory response by the body. The inflammatory response is a cascade of events that occurs to repair and heal damaged tissues. When cells of connective tissue become extensively damaged, the tissues that form during the cellular repair process are different than the tissues present before the injury. This new tissue is often referred to as scar tissue and is made out of new collagen fibers. Scar tissue is different than the original connective tissues in the way it arranges itself in an unmethodical, mismatched configuration instead of the interlocked and aligned fiber arrangement of the original tissue. Sometimes scar tissue from an injury forms adhesions, or bands of scar tissue that inappropriately connect to other, healthy neighboring tissues. When an individual is affected by an injury or trauma to the buttocks, the cellular damage is repaired with this scar tissue. Adhesions can form between an individual's sciatic nerve, piriformis muscle, and the top of the greater sciatic notch. This malfunction can compress the sciatic nerve and result in piriformis syndrome.
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Hematoma
A collection of blood or a hematoma in the piriformis muscle can cause an individual to experience piriformis syndrome. A hematoma can occur in a muscle when a vein or artery wall becomes injured. The injured vessel leaks blood into the surrounding tissues and begins to clot. The clotting blood that is displaced causes damage to neighboring cells. This damage summons an inflammatory response to the hematoma. The swelling that occurs as a result of the inflammatory response can cause the sciatic nerve to become compressed by the piriformis muscle. Because clotted blood is not a soft and pliable substance, the clot itself may be large enough to compress the nerve. A hematoma can also cause the leakage of other fluids into surrounding tissues or edema. Edema places more pressure on the muscle and takes up space while also pressing on neighboring blood vessels and nerves. Edema from a hematoma can displace the piriformis muscle, causing it to press down on the affected individual's sciatic nerve. It is a combination of one or more of these mechanisms that can cause an individual to experience piriformis syndrome.