The piriformis is a small muscle in the back of the hip that runs from the base of the spine (the sacrum) to the top of the femur. It assists in hip rotation and balance, reinforcing the femoral neck and preventing it from bending when we walk or run. However, since it sits directly atop the sciatic nerve, the largest nerve in the body, spasms or excessive pressure from the muscle can compress the nerve, causing leg pain and other symptoms.
In a small proportion of the population, the sciatic nerve actually runs directly through the piriformis muscle, increasing vulnerability to sciatic nerve injury. When the muscle is overused or insufficiently stretched before exercise like running, it can respond by tightening, putting painful pressure on its surrounding tendons and irritating the sciatic nerve. This repetitive stress injury is called piriformis syndrome, resulting in a deep aching in the lower back, buttock, and thigh.
Fortunately, massage therapy can soften the muscle to reduce this nerve tension. Students in OVCMT’s massage therapy training learn various techniques with extensive hands-on practice to treat patients with this condition.
Here is how a typical treatment plan could look.
Piriformis syndrome is common among runners and cyclists or can result from repeated bending and lifting, squatting while putting down a heavy object, or external pressure, such as prolonged sitting on a wallet. It may also be caused by improper footwear, poor posture or sitting habits, a shifting centre of gravity during pregnancy, or driving long distances. Without sufficient lateral stretching and strengthening exercises, repeated forward movements or inactive gluteal muscles may lead to weak hip abductor and tight adductor muscles, causing the piriformis muscle to contract and tighten.
It is more commonly experienced by women than men, presenting symptoms including numbness, tingling and shooting pains in the hip and down the posterior leg. It may result in swelling or loss of muscle strength, making prolonged sitting or standing painful. Students in massage courses can distinguish the condition from other forms of sciatica like a herniated spinal disc through various range of motion tests, such as determining whether there is weakness or pain when the seated patient pushes their knees apart while some resistance is applied.
Massage therapy treatments for this condition focus on reducing tightness in the piriformis muscle, taking caution not to further compress the region of nerve entrapment. Clear communication with the client is essential, to receive consent for working on the gluteal area and advising them that treatment may be temporarily uncomfortable. This treatment generally begins with superficial effleurage and other warming techniques to reduce muscle tension.
One technique used by massage therapists is applying direct pressure to the length of the piriformis with a tennis ball or the back of their fist, holding until some tissue relaxation is felt. Once the area is loosened, myofascial trigger point treatment and longitudinal stripping techniques can help reduce tension. If the nerve region is too tender for direct pressure, muscle energy technique stretching is an effective option. In OVCMT’s college of massage therapy, students acquire knowledge of musculoskeletal anatomy, from which they can also educate patients about proper stretching, sitting, and sleeping positions for relieving piriformis syndrome symptoms.