YogVritti : Asanas for Piriformis Syndrome

piriformis1

A majority of population today suffers from different issues pertaining to lower back, hips and buttocks. In this blog series we will try to explore the administration of asanas in various such ailments.
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 muscle

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 skillful utilization of hip joint to lift and rotate the legs, piriformis plays a very important role is defining the efficiency and output.

Location

Piriformis is a pyramid shaped muscle with its origin in the anterior portion of both the sacrum and ileum, 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)

piriformis-fig1

Function:

  • Externally rotates the hip joint
  • Stabilizes the sacroiliac joint
  • Abduction of femur when hip joint is flexed.

It has to be noted however, that when hip is in a neutral position 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

Sciatica nerve is one of the longest nerves 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 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 supplies to the lower leg and foot. To conclude Sciatica nerve connects the regions of lower extremities with the spine.

piriformis-fig2Now 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.

  1. Mostly it’s passing from below the piriformis. (70-85)
  2. In some cases it can split into two with one branch passing through the piriformis. (11%)
  3. Or it can split in two and wraps around the muscle. (0.86%)
  4. It can also entirely pass through the belly of piriformis.(0.13%)
  5. Also it can exit above the muscle. (0.8%)

It should be noted that the penetration of sciatic nerve through the muscle can exist without any painful conditions. However such a variation might be predisposed to piriformis syndrome due to any injury.

Piriformis Syndrome

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 spasmodic state of the muscle. Surgery is also considered to be a line of treatment, however, not accepted unanimously.

Diagnose

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 that how muscle is behaving while being stretched in an 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 spinal disc or any pathological conditions of 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 provides 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 piriformis. Please be advised to do them under an expert guidance.

1. Garudasana (Eagle Pose) & Virasana (Hero Pose) : Internally rotates and adducts the hip joint which proves to be a counterposture for the natural actions of piriformis i.e. external rotation and abduction.

garudasana-virasana
2. Gomukhasana (Cow-Face Pose) & Raja Kapotasana (King Pigeon Pose) are beneficial as the piriformis functions changes to internal rotation at a hip flexion of 90 degree and beyond, these asanas work as perfect couterpostures in such a condition.
gomukhasana
3. Parivritta Trikonasana : looking at the anatomy of the posture, we can see that the hip joint is being internally rotated and adducted, while being flexed. The muscle is stretched effectively in this counteraction.

parivritta-trikonasana
4. Supt Padangushthasana : The internal rotation variation of supt padangushthasana also helps in stretching the muscle in a horizontal adduction.

supt-padangushthasana
6. Marichyasana III : works by adducting and flexing the hip joint and stretching the muscle eventually.

Further to balance the muscle on both side and to neutralize the tension and distress the sacroiliac joint, Setubandhasana (bridge pose) can be used.

setubandhasana

How you incorporate these postures into your practise 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.

Regards

Image Courtesy : Jeevmoksha Yoga Gurukul
For Jeevmoksha Yoga
Acharya Vinay