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 Learn How to Find Trigger Points in Piriformis

 

 

 

 

 

Active Trigger Points in the Piriformis Muscles Can Literally Be a "Deep" Pain in the Butt 

The piriformis leaves the pelvis by passing through the greater sciatic foramen.

ORIGIN

Internal surface of sacrum. Sacrotuberous ligament.

INSERTION

Superior border of greater trochanter of femur.

ACTION

Laterally rotates hip joint. Abducts thigh when hip is flexed. Helps hold head of femur in acetabulum.

NERVE

Ventral rami of lumbar nerve, L(5) and sacral nerves, S1, 2.

BASIC FUNCTIONAL MOVEMENT

Example: taking first leg out of a car.

REFERRED PAIN PATTERNS

Two strong zones of pain: (1) 3–4 cm zone lateral to coccyx; (2) 7–10 cm zone posterolateral buttock/hip joint. Also broad spillover of diffuse pain between (1) and (2) and down thigh to above the knee.

INDICATIONS

Constant “deep” ache in buttock, sciatica (pseudosciatica), vascular compression posterior legs, low back/buttock pain (worse when sitting), often starts after a fall or sitting on wallet when driving, foot/rectal/sacroiliac pain, sexual dysfunction (dyspareunia), piriformis syndrome (sciatica, local, and pelvic pain)—up to six times more common in women, pain worse on sitting.

CAUSES

Prolonged driving, trauma from fall, cycling/motorcycling, standing on one leg, hip surgery, sitting cross-legged, hip/knee/ankle injury/ fracture, leg casts, high-heeled shoes, pelvic inflammatory disease (PID), sexual intercourse position, childbirth, arthritic hip, sacroiliac joint dysfunction, PSLE, improper/ old orthotics.

DIFFERENTIAL DIAGNOSIS

Sacroiliitis. Lumbar radiculopathy. Coccydynia. Osteoarthritic hip. HLA (human leukocyte antigen)— B27 condition. Spinal stenosis. Discopathy (lumbar).

CONNECTIONS

Leg length discrepancy, gluteal muscles, quadratus lumborum, attachment trigger point (origin) hamstrings, gemelli, obturators, quadratus femoris, levator ani, coccygeus.

 

 

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