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98 m a s s a g e & b o d y w o r k s e p t e m b e r / o c t o b e r 2 0 1 6 technique SCIENCE OF NERVES is still somewhat controversial. In fact, some medical professionals don't believe the condition exists. 2 However, there is strong evidence to suggest that not only does this condition exist, it is often underrecognized as a cause of gluteal and lower extremity pain and dysfunction. So let's take a deep dive into this subject and see what is really going on. ANATOMY Image 1 shows the piriformis muscle in relation to the surrounding pelvis. Note that the muscle attaches to the anterior facet of the sacrum, crosses the sacroiliac joint, crosses the hip joint, and then eventually attaches to the greater trochanter of the femur. Because it crosses both joints, there are biomechanical challenges that play a part in the condition. You can see in Image 1 that the superior portion of the muscle passes very close to the greater sciatic notch. The small space above the piriformis muscle is called the suprapiriformis foramen, and this narrow space plays a key role in nerve compression, as we will see shortly. Just below the piriformis muscle is the sacrospinous ligament, which is a stiff and unyielding structure. It is also important in creating nerve compression problems in this region. Piriformis syndrome is usually described as compression of the sciatic nerve by the piriformis muscle. While the sciatic nerve is the nerve most frequently involved, there are actually five nerves that could be compressed in this condition. Let's take a look at these various nerves and the regions where they are susceptible to compression. In Image 2, you see the superior gluteal nerve courses through the narrow opening Unraveling the Complexities of Piriformis Syndrome By Whitney Lowe Cultural colloquialisms develop from real-world experiences. When something is difficult or annoying, we characteristically refer to it as a "pain in the butt." And, well, that is the perfect description for piriformis syndrome. Sciatica is a poorly defined condition that generally refers to any pain sensation felt in the gluteal region or down the lower extremity along the path of the sciatic nerve. Many of these gluteal pain cases are caused by dysfunction of the piriformis muscle, a crucial deep rotator of the hip. Although there is no clear-cut definition, the term piriformis syndrome describes gluteal pain involving the piriformis and compression of nearby nerve and vascular structures in the pelvis. Sciatica (sciatic nerve compression symptoms) is usually ascribed to dysfunctions in the lumbar spine, such as herniated discs or other causes of nerve root compression. However, sciatica-like symptoms may also originate from the piriformis region. One study suggests that 5–6 percent of sciatica cases could likely involve piriformis syndrome, making it close to 2.4 million cases of the condition per year. 1 With something that occurs so often, it would seem likely that we'd have a very clear understanding of the condition, but that's not the case. The concept of piriformis syndrome and entrapment of neurological structures in the pelvic region Sacrospinous ligament Greater sciatic notch Piriformis Piriformis in relation to other nearby structures. Image is from 3D4Medical's Essential Anatomy 5 application. 1

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