Pyramidal Syndrome: Causes and Treatments (Exercises)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

What if your buttock pain that radiates down your leg comes from the piriformis muscle? Piriformis syndrome, often confused with sciatica, could be the source of your problem.

What is pyramidal muscle syndrome, and how do you recognize it? How long does it last? What are the ways to treat it?

This easy-to-read article tells you the difference between piriformis syndrome and other conditions that cause leg pain, and offers treatment strategies to help you get better.

Definition and anatomy

Before discussing piriformis syndrome, it is worth discussing the anatomy of the piriformis muscle (also known as the piriformis muscle). It is a small muscle located in the deep part of the buttocks which has a direct relationship with the sciatic nerve.

The pyramidal muscle originates from the sacrum and attaches to the greater trochanter of the femur. It allows rotation of the hip and contributes to the stability of this joint in a standing position.

The sciatic nerve originates from the L4 to S3 vertebrae of the spine, where the nerve roots of these vertebrae join to form the sciatic nerve.

One of its peculiarities is that the sciatic nerve passes directly under the fibers of the pyramidal muscle. In some people, however, the nerve passes directly through the fibers of this muscle.

In some situations, the muscle may be compressed, spasmed, injured, tight, or swollen. In short, any impairment of the pyramidal muscle can lead to pyramidal syndrome (also called piriformis syndrome), and cause symptoms directly to the muscle or nearby structures (such as the sciatic nerve).

Symptoms of the disease

Here are the typical symptoms associated with pyramidal muscle syndrome:

Pain and stiffness in the buttock
Irradiations to the back of the thigh, calf and foot (like a sciatica)
Numbness, tingling or burning sensation in the lower limb
Worse pain when climbing stairs or climbing a slope
Pain worse after prolonged sitting (especially when crossing the legs)
Decreased hip range of motion
Relief of symptoms while lying down

Diagnosis of pyramidal syndrome

There is no single test that can diagnose piriformis syndrome. Moreover, it is common to see nothingmedical imaging despite the presence of pain.

If a test of x-ray, scanner or MRI, it is more to eliminate disc or nerve damage than to identify a pyramidal muscle syndrome.

Moreover, since the symptoms are similar to sciatica, the herniated disc or sacroiliac dysfunction, it is not uncommon to overlook this diagnosis.

It should be mentioned that this diagnosis is not unanimous among doctors and the scientific community.

The following are clinical features that may indicate involvement of the pyramidal muscle:

Painful hip movement
Pain reproduced on palpation of the pyramidal muscle
Pain when stretching the pyramidal muscle
Pain on contraction of the pyramidal muscle
In extreme cases, a trigger point infiltration may be given to the piriformis muscle to see if symptoms decrease.

How long does pyramidal syndrome last?

The question of the prognosis and the duration of healing is certainly legitimate, but it is difficult to answer it in an exact way.

First, it must be remembered that the intensity of the pain is not necessarily proportional to the severity of the condition. Even if the symptoms are intolerable, healing can be accelerated with proper treatment.

Hope that reassures you!

On the other hand, the duration of the symptoms generally influences the prognosis. If you've had pain for months, it has "crystallized" in your brain, which means it will take more time to disappear.

Then, the location of the pain is often related to the severity of the attack. Most often, the further the symptoms radiate into the leg, the more advanced the condition. And above all, if the irradiations do not respond to any treatment aimed at centralization of symptoms, it is estimated that the healing time will be longer.

Finally, it should be noted that back pain is multifactorial. This means that several factors can influence pain and healing. Surprisingly, we discovered that the stress, le lack of sleep or inactivity could aggravate the symptoms of low back pain.

With this in mind, taking care of the emotional component and others can greatly influence the duration of the symptom of the pyramidal muscle.

Rehabilitation of pyramidal syndrome

Rehabilitation for pyramidal muscle syndrome is based on a gradual approach aimed at controlling pain and inflammation, then toning and softening the pyramidal muscle.

Here are some treatment modalities used in the treatment of this syndrome:

Medication

Personalized medications as anti-inflammatories and painkillers can act on pain. In addition, muscle relaxants can reduce tension and spasms in the pyramidal muscle.

Heat/Ice

Ice is generally used to calm inflammation and pain. Heat, on the other hand, relaxes tense muscles.

To learn more about using ice vs heat, read the following article.

Massage and passive treatments

A qualified therapist can use various massage techniques to relax the pyramidal muscle (myofascial release, trigger point, etc.).

Besides massage, passive stretching of the pyramidal and surrounding muscles can provide significant relief. Hip mobilizations can also help.

Alternative treatments

Although there is little scientific evidence supporting these kinds of modalities, alternative techniques are often used to treat piriformis syndrome.

Alternative treatments include:

Exercices

Once the pain is under control, it is important to maintain the pyramidal muscle to avoid the risk of recurrence. Of the activities strengthening and stretching such as these allow you to resume daily activities:

One-sided bridge

Lie on your back
Extend the non-painful leg so that the knee is straight and maintain full extension.
Raise the buttocks off the ground by pushing off with the heels of the affected leg.
Slowly lower back to the starting position.
Do these movements for about twenty repetitions. Take breaks as needed.

Stretching of the pyramid

Lie on your back.
Cross the symptomatic leg so that the heel rests on the opposite leg.
Pull the non-symptomatic leg towards you. At this point, you should feel a stretching sensation behind the symptomatic buttock.
Hold the stretch for 30 seconds, then repeat 3 times, taking breaks between each set

Infiltration

In some extreme cases, the doctor will try to resort to infiltration to relieve the symptoms. This is usually the last resort before the surgery.

There are several possible types of infiltration. Although the main one is cortisone infiltration at the injured site, it is possible to use botox injections for the relaxation effect caused.

Conclusion

Piriformis syndrome is a condition that affects the pyramidal muscle. Symptoms felt in the buttock and leg often stem from secondary irritation of the sciatic nerve anatomically connected to the pyramidal muscle.

The diagnosis is not easy to make, mainly because sciatica of disc origin, or even damage to the sacroiliac joint, can cause similar symptoms.

The treatment aims to calm inflammation, reduce muscle tension and indirectly nervous pressure, tone and soften the pyramidal muscle.

A health professional is best able to treat this syndrome, and reduce the healing time.

Good recovery !