Piriformis Syndrome -- Is My Pelvic Floor Involved?

By Dr. Christine Martirez PT, DPT on 10/31/2024

The piriformis muscle plays an essential role in hip movement and pelvic stability. Despite its small size, dysfunction in this muscle can lead to pain, instability, and even pelvic floor dysfunction due to its close relationship with the pelvis and surrounding musculature. If you’re experiencing deep hip or glute pain, lower back discomfort, or pelvic issues, addressing piriformis dysfunction with the help of pelvic floor physical therapy can provide significant relief.

Anatomy of the Piriformis Muscle

The piriformis muscle originates at the anterior (front) surface of the sacrum, one of the main bony structures of the pelvis, and inserts on the greater trochanter of the femur (thigh bone). This location allows the piriformis to play a major role in external hip rotation, helping to stabilize the hip joint and support movements like walking, running, and balancing. The sciatic nerve usually runs beneath or through the piriformis muscle, which is why dysfunction in the piriformis can lead to sciatica-like symptoms.

• Origin

  Anterior surface of the sacrum

• Insertion

  Greater trochanter of the femur

• Innervation

  Superior gluteal nerve and ventral rami of the lower spinal nerves (from sacral nerves S1 and S2)

How the Piriformis Relates to the Pelvic Floor

Since the piriformis originates on the sacrum, it shares close anatomical and functional connections with the pelvic floor muscles. The pelvic floor muscles provide stability and support for pelvic organs, and they maintain essential bodily functions like bladder and bowel control. Dysfunction in the piriformis can directly impact pelvic alignment and pelvic floor function, potentially leading to discomfort or dysfunction in both the pelvic floor and the piriformis itself.Because the piriformis works closely with other deep hip rotators and pelvic muscles, an imbalance in its function can alter posture and create stress in the pelvic floor region. Tightness or dysfunction in the piriformis can create tension in the pelvic floor, which may lead to symptoms like pelvic pain, urinary urgency, or difficulty with bladder and bowel control.

Symptoms of Piriformis Dysfunction

Piriformis dysfunction often presents as deep gluteal or hip pain, but symptoms can also refer to the lower back, groin, or pelvic region. Some common signs of piriformis dysfunction include:

• Deep, aching pain in the buttocks or hip

  that may radiate down the leg

• Numbness or tingling

  along the back of the thigh, similar to sciatica

• Discomfort when sitting

  for long periods

• Pain that worsens with activity

  especially walking or climbing stairs

• Pelvic pain or dysfunction

  such as urinary urgency, low back pain, or discomfort with bowel movements

These symptoms arise from the piriformis muscle compressing or irritating the sciatic nerve, or from tension transferred to the pelvic floor due to the piriformis’ connection with the sacrum and pelvic muscles.

How Piriformis Dysfunction Relates to Pelvic Floor Dysfunction

The piriformis muscle’s insertion on the sacrum creates a mechanical link to the pelvic floor. When the piriformis is tight or inflamed, it can pull on the sacrum, altering pelvic alignment and placing stress on the pelvic floor. This connection may result in several issues:

• Increased Pelvic Floor Tension

  A tight piriformis can lead to overactivity in the pelvic floor muscles, especially those involved in stabilizing the pelvis.

• Postural Imbalance

  Dysfunction in the piriformis can cause uneven pelvic alignment, impacting core stability and placing additional stress on the pelvic floor.

• Nerve Irritation

  The sciatic nerve’s close relationship to the piriformis means that dysfunction in this muscle can irritate the nerve, leading to pain and tension in the pelvis and potentially impacting pelvic floor function.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy is an effective treatment approach for piriformis dysfunction, particularly when pelvic symptoms are also present. Here’s how pelvic floor therapy can help:

1.

Muscle Release Techniques

A pelvic floor therapist can use manual therapy techniques to release the piriformis and surrounding muscles, relieving tightness and improving flexibility. Manual release is especially effective for targeting deep muscles and fascia in the hip and pelvic region that contribute to piriformis dysfunction. These releases can also reduce sciatic nerve irritation, alleviating radiating pain.

2.

Pelvic Alignment and Posture Correction

Pelvic floor therapists can identify any postural misalignments or compensatory patterns contributing to piriformis and pelvic floor dysfunction. By correcting these imbalances, a therapist can help alleviate strain on the piriformis and improve pelvic floor stability.

3.

Neuromuscular Re-education

Exercises aimed at neuromuscular re-education help retrain the body to engage the correct muscles for stability and movement. A pelvic floor therapist can guide you through exercises to improve coordination and strengthen the pelvic floor, core, and hip muscles. This can provide better support for the pelvis, reducing the risk of further piriformis strain.

4.

Strengthening and Flexibility Exercises

Pelvic floor therapy may include a regimen of stretching and strengthening exercises designed to improve balance in the pelvic region. For example, strengthening exercises for the glutes and deep hip rotators, combined with pelvic floor muscle training, can help reduce compensatory tension in the piriformis and improve movement efficiency.

5.

Education on Body Mechanics

Body mechanics play a significant role in managing piriformis dysfunction. A pelvic floor therapist can help you develop an awareness of your posture, lifting techniques, and activity modifications that can prevent further aggravation of the piriformis.

Piriformis dysfunction isn’t always the obvious answer when it comes to hip and pelvic pain, but its close connection with the pelvic floor makes it an important area to address. By working with a pelvic floor physical therapist, you can receive a holistic approach to managing piriformis-related pain, improve pelvic stability, and reduce the risk of recurring pelvic and hip issues. Addressing the piriformis and pelvic floor together can provide lasting relief and help you return to your regular activities with more ease. If you’re experiencing persistent hip or pelvic pain, consider pelvic floor physical therapy as an essential part of your treatment and recovery.

Suffering from piriformis syndrome? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.

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