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Ta k e 5 a n d t r y t h e A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 69 The Piriformis and Piriformis Syndrome The piriformis is one of the six deep lateral rotators of the hip joint. However, because of its attachment to the sacrum and its relationship to the sciatic nerve, the piriformis is considered to be the most important muscle of this group for manual therapists and movement professionals. Piriformis syndrome occurs when the piriformis is hypertonic (tight) at baseline tone and compresses the sciatic nerve as the nerve passes between the piriformis and the neighboring superior gemellus. There is a lot of fuss about the fact that in approximately 15 percent of individuals, the relationship of the sciatic nerve to the piriformis is different: part or all of the sciatic nerve can travel through the piriformis or superior to it, between the piriformis and gluteus medius. However, an argument can be made that these variations are not more likely to cause compression of the sciatic nerve than the usual presentation. This is because, with these variations, the sciatic nerve is less likely to be compressed since it is actually farther from the pelvic bone, a much harder structure than a tight muscle. Regardless of the presentation, if the piriformis is sufficiently tight, the sciatic nerve can be compressed. This compression would create the symptoms of sciatica, similar to those that would occur if compression of the nerve roots of the sciatic nerve were compressed by a pathologic disc. The piriformis is seen bilaterally. The gluteus medius and superior gemellus have been ghosted in on the left. Permission Dr. Joe Muscolino, The Muscular System Manual: The Skeletal Muscles of the Human Body, 4th ed. ( Elsevier, 2017 ). The piriformis in the posterior pelvis, along with the other muscles of the deep lateral rotator group of the hip joint. Permission Dr. Joe Muscolino. Artwork by Giovanni Rimasti. 1 2 Gluteus medius Piriformis Piriformis Superior gemellus Superior gemellus Obturator internus Inferior gemellus Quadratus femoris Quadratus femoris (cut) Obturator externus Learn more in the author's video- based online course, "Stretching the Piriformis," in the ABMP Education Center: www.abmp.com/ce