Recently I have been writing about myofascial syndromes. The last two blogs have been about Thoracic Outlet Syndrome. Today I would like to discuss Piriformis Syndrome.
Often a client will come in with a pain in the heel. They have seen Doctors who have said something about plantar fasciitis and their Chiropractor has been working the lower calf to relieve tension on the achilles tendon. However the pain persists. Sometimes the source of that obnoxious heel pain is further up the leg, all the way up to a very small but significant muscle named the Piriformis, located deep within the butt, underneath the large gluteal muscle.
The Piriformis is significant because the sciatic nerve runs underneath it, and sometimes through
the muscle itself, as it courses its way through the gluteal region. Because the Piriformis clamps down on the the sciatic nerve, patients experience a variety of discomfort down the leg and all the way to the heel. Sometimes just the heel, other times in the back of the leg. The proof comes in the palpation of the Piriformis muscle. When pressed, it will be very painful.
“I have been foam rolling that area, how come it still hurts?” Ah, the foam roller! Oh how I wish I had invented the foam roller and all its variations. I’d be sitting in the French Riviera retired with a smile on my face. Not because the foam roller is a bad thing, they are very useful to a point.
Have you ever tried to clean a pan with a washcloth when you really need a green scrubby or even the end of a metal spatula to really get the job done? That sometimes happens with foam rollers. They get the surface, but it is impossible to isolate the problem. You need something a little more specific. You need the fingers of a skilled practitioner to isolate the problem and then use various techniques to address the issue. It is tough to isolate such a deep small muscle with the broad surface of a foam roller. You really need an elbow or supported thumb to get to the trigger points and myofascial restrictions.
The next time you have a pain in the butt, a discomfort in your hamstrings or calf or maybe just a very tender heel … think Piriformis Syndrome. You can try to roll it out with a foam roller. You can even use what I use, a tennis ball.
That said, you might just want to roll into my office for a half hour visit to see what I can do.