Piriformis Syndrome Massage

Piriformis Syndrome Massage Treatment

PIRIFORMIS SYNDROME – Compression of the sciatic nerve by the piriformis muscle

Piriformis Syndrome Massage: Functions of the Piriformis:

    • The piriformis restrains rapid internal rotation of hip ( occurs with running)
    • The piriformis externally rotates femur when hip is neutral or extended
    • The piriformis horizontally abducts thigh when hip is flexed to 90 degrees

Piriformis Syndrome Massage: Anatomy – What Happens?

  •  The sciatic nerve supplies sensory and motor function to skin and muscles of the posterior thigh, leg and foot.
  •  The Sciatic Nerve is made up of nerve roots L4-S2(S3)- it also contains fibres from both the anterior and posterior divisions of the lumbosacral plexus. The sciatic nerve is comprised of 2 peripheral nerves ( common peroneal and tibial) which travel together until the knee.
  • Piriformis muscle inserts on anterior surface of sacrum and medial greater trochanter.
  • Sciatic nerve travels under the piriformis and goes distally. In 20% of people, the nerve runs through piriformis
  • Increased tension in piriformis can lead to displacement of the sacroiliac (SI) joint ( pulling the SI away towards it <tense piri>) which leads to more trigger points (TP) in piriformis and SI joint dysfunction
  • TP in the piriformis are often at lateral border of sacrum and 1/3 of the way medial from greater trochanter. ( closer to GT ) These TP cause the muscle to shorten and become bulkier, compressing the nerve.

CAUSES of Piriformis Syndrome:

  •  Anomalies in course of nerve ( penetrates piriformis muscle)
  •  Direct and indirect trauma to piri ( infl, ischemia, spasm, adh, tp–all causing mm to tighten)
  •  Infammation in the piriformis or adjacent joints ( hip, SI)
  • Overuse of the piriformis muscle
  • Postural concerns ( flat feet cause internal rotation and adduction of the thighs when walking, piriformis overworks to correct this)
  •  Trigger points in piriformis ( main thing!)
  •  Prolonged compression of the nerve may cause sciatic nerve lesion which in turn causes atrophy of the muscles being supplied by the sciatic nerve

 SYMPTOMS of Piriformis Syndrome:

  • Usually unilateral
  • Pain and paresthesia in the posterior thigh, calf, foot. If severe, loss of strength in lower leg, drop foot.
  • Pain in the lower back, buttocks, hip and post thigh. Possibly in inguinal area and at greater trochanter due to piriformis trigger points.
  • Pain aggravated by: sitting, prolonged hip flexion, adduction and internal rotation, arising from seated position, standing.
  • Pain decreased with passive external rotation of hip.. ( active external rotation will hurt —recruitment of the muscles)
  • Weakness in abduction, flexion and internal rotation of the affected hip
  • SI joint dysfunction due to the shortening and tension in the piriformis

Piriformis Syndrome Massage: OBSERVATION

  • Guarding of affected limb
  • Ataxic gait due to pain
  • Difficulty sitting/standing prolonged due to pain
  • Torsion of hips ( because of SI joint dysfunction ) ( kind of rotated)
  • When Supine, external rotation of the affected leg
  • May be swelling in lower limb with extreme long-term nerve compression

 Piriformis Syndrome Massage: PALPATION

  • Trigger Points and Hypertonicity in the piriformis, also in gluteals, quads, psoas, quadratus lumborum
  • Tenderness over the piriformis
  • Swelling at piriformis or lower limb ( edema- lack muscular pump)

 Piriformis Syndrome Massage: ORTHOPEDIC TESTING

  • AF and PR ROM decreased in internal rotation of the affected hip
  • AR testing of affected hip weak and painful


  • Pace abduction test
  • Piriformis length test
  • Freiburg’s Variation of SLR
  • Gaenslen’s Piriformis  Massage Therapy Treatment

Differentiating Radiating Pain:

 Compression of nerve from herniated disc- similar symptoms. Valsalva’s, Kemp’s, Kernig’s, Slump, SLR (+), no tenderness on the piriformis area, pain in lower back area

 Facet Jt. Irritation — Kemp’s/ Quadrants (+), no tenderness at the piriformis area.

 Piriformis Massage Therapy Treatment:

  • Treat around the Greater trochanter–lots of muscle attachments
  •  Ligaments- sacrotuberous ( ischial tuberosity to the sacrum) to release sacrum..
  •  Fascial work over buttocks ( fascial spreading)
  • Entire gluteal area treated using petrissage
  • Treat glute max thoroughly so piriformis can be reached. Treat glue medius and minimus.
  • General Massage Treatment – Along iliac crest, Around sacrum, Around gr. Trochanter
  • Landmark piriformis, ask patient to externally rotate hip so that the piriformis muscle contracts.
  • Treat piriformis using origin and insertion,  finger kneading, muscle stripping, ischemic compressions to piriformis trigger points – follow up with piriformis stretch
  • Passively rotate patient’s hip internally and externally while applying pressure to piriformis ( with fist works well)
  • To Stretch piriformis – ( move hip into internal rotation)

Piriformis Syndrome Massage: SELF CARE

  • Self stretch to the piriformis
  • Tennis ball to glutes and piriformis
  • Avoid sitting with knees rolling out to the side
  • Sleep with pillow between knees to avoid internal rotation of the hip ( stretching the piriformis for too long will irritate it, better to be in neutral)
  • Take breaks from aggressive activities/ running to stretch
  • Chiro adjustment for SI joint displacement