A majority of population today suffers from different types issues pertaining to lower back, hips and buttocks. One of such disorders is called the piriformis syndrome. It is characterized by an acute pain in the hip region which radiates down towards the back of legs and finally into the feet. This pain can be precipitated by any rigorous activity including long distance running, any activity involving long duration sitting or by simplest action of climbing up the stairs. To say the reasons can be any, but the pain inflicted is sometimes unbearable and lends a person unable to perform physical actions with ease. At the same time such pain also irritates the nervous system thereby generating a lot of stress in the personality.
Piriformis is an all important muscle in the hip region which is responsible for lifting and rotating the leg away from the body, thereby bringing movement. It also maintains the posture while shifting the body weight from one leg to the other and helps in stabilizing the sacroiliac joint. In lot of sports involving skillfull utilization of hip joint to lift and rotate the legs, piriformis plays a very important role is defining the efficiency and output.
Piriformis is a pyramid shaped muscle with its origin in the anterior portion of both the sacrum and ilium, and also from the joint capsule of the sacroiliac joint. It inserts on the upper medial (towards the midline) portion of the greater trochanter (head of femur). (figure 1)
It has to be noted however, that when hip is in a neutral positon piriformis acts as external rotator. Whereas when the hip joint is flexed to or beyond 90 degrees, this muscle acts as an internal rotator.
To conclude, it’s a muscle which is directly or indirectly involved in almost all the action at the level of hips and thighs.
Sciatica nerve is one of the longest nerve in the human body. It is a cluster of many different nerves branching out from vertebral foramina in the lumbar spine and then merging as one single nerve, as thick as a thumb. This nerve passes through the greater sciatic foramen in the pelvis and runs down at the back of the thighs before branching into two different nerves at the level of the knee, called Tibial Nerve and Common Peroneal Nerve. These two nerves supply to the lower leg and foot. To conclude Sciatica nerve connects the regions of lower extremities with the spine. (figure 1)
Now to connect the above two descriptions, Piriformis is situated at the site where sciatica nerve exit the sciatic foramen. It is arranged diagonally to the sciatic nerve which runs vertically just underneath this muscle. This arrangement can be different in different individuals as classified below on a scale of 100. (figure 2)
It should be noted that the penetration of the sciatic nerve through the muscle can exist without any painful conditions. However, such a variation might be predisposed to piriformis syndrome due to an injury.
Piriformis syndrome is characterized by an acute pain running from the hip joint down all the way in the back of the leg to the foot. It is believed to be caused by a spasm of piriformis muscle which irritates the sciatic nerve passing through or adjacent to it. This spasm can be an outcome of any athletic injury or traumatic condition caused by that. The treatment includes stretching the piriformis as well the associated surrounding hip rotator muscles to get rid of the spasmodic state of the muscle. Surgery is also considered to be a line of treatment, however, not accepted unanimously. The
Piriformis syndrome is diagnosed through certain physical examinations, one of them being FAIR TEST. It stands for Flexion Adduction and Internal Rotation. This test allows us to locate any spasmodic conditions in the muscle. While testing for piriformis syndrome, we try and detect for any painful conditions while the muscle is used while internally and externally rotating the hip joint. Also, it is examined how muscle is behaving while being stretched in adduction. Also, radiological scan like MRI can be useful to have clarity on the issue. It should be noted that there can be other reasons for sciatica pain as like the hernia of a spinal disc or any pathological conditions of the hip joint, which should be ruled out to determine the possibility of piriformis syndrome, through proper diagnosis.
How Asanas Work here
As we are well aware that asanas provide us with all sort of movement and range for the joints to be covered while practicing them. Here we are putting up a small list of asanas that can be used to stretch & improve the function of the piriformis. Please be advised to do them under expert guidance.
Garudasana (Eagle Pose) & Virasana (Hero Pose): internally rotates and adducts the hip joint which proves to be a counter-posture for the natural actions of piriformis i.e. external rotation and abduction.
Further to balance the muscle on both sides and to neutralize the tension and distress the sacroiliac joint, Setubandhasana (bridge pose) can be used.
How you incorporate these postures into your practice depends upon several factors, but over the period of time, with perseverance and patience, they will help you out to bring back the lost harmony and efficiency in your hip joint action as a whole.
Jeevmoksha Yoga Gurukul