Piriformis syndrome is caused by tightness in the piriformis muscle. This can cause pain directly as the muscle gets small, very tender tight spots in it called trigger points. It can also cause pain as the sciatic nerve runs either through or very close to this muscle.
If the muscle is short and tight it can have a knock on effect and cause some sciatic nerve irritation.
A diagnosis can be made by an experienced health care professional using the straight leg raise test as shown below:
This test lets your physio work out if its the sciatic nerve that is the problem or not. Your physical therapist will lift your leg up and may push your ankle toward your nose or turn your hip inwards.
If the ankle movement changes your pain you may have sciatica.
If the test is positive it does not mean that you definitely do have sciatica. However, if it is negative it’s likely that you don’t have a sciatic nerve problem.
The best start is always to examine your posture, in particular the way you sit. As this problem is so commonly caused by driving positions I would have a really good look at the position your leg is in when you are sitting in the car.
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if the answer is yes then you may need to try adjusting the seat position.
If you can't change anything then avoiding the postural stresses and strains that caused it initially may be a good idea. This can mean avoiding sitting or standing for long periods with your foot turned out for a while.
If you have a short, tight muscle then stretching it out is usually very helpful. Combining postural changes with stretches of the muscle usually does the trick.
Try warming the muscle first with heat therapy - it will make it much easier to stretch out and be less uncomfortable. 20 minutes should do the trick but be very careful not to burn yourself.
Do not lie on your back compressing the heat source and make sure you wrap it up well so there is no chance of a burn.
Here is a video demonstration of a favourite stretch of mine
Sometimes the tight muscle needs to be released with deep soft tissue work, similar to acupressure, called trigger point release.
It is possible to self treat this muscle using the back knobber - one of my favourite tools for managing trigger points.
Sometimes this syndrome is caused by the muscle tightening in response to a problem with your hip joint, or more commonly as a result of sacroiliac joint dysfunction.
If this is the case diagnosis of the exact cause is needed otherwise the treatment suggested above will only give you short term symptom relief - your physiotherapist can advise.