Active Trigger Points in the Piriformis Muscles Can Literally Be a "Deep" Pain in the Butt
The piriformis leaves the pelvis by passing through the greater sciatic foramen.
Internal surface of sacrum. Sacrotuberous ligament.
Superior border of greater trochanter of femur.
Laterally rotates hip joint. Abducts thigh when hip is flexed. Helps hold head of femur in acetabulum.
Ventral rami of lumbar nerve, L(5) and sacral nerves, S1, 2.
BASIC FUNCTIONAL MOVEMENT
Example: taking first leg out of a car.
REFERRED PAIN PATTERNS
Two strong zones of pain: (1) 3–4 cm zone lateral to coccyx; (2) 7–10 cm zone posterolateral buttock/hip joint. Also broad spillover of diffuse pain between (1) and (2) and down thigh to above the knee.
Constant “deep” ache in buttock, sciatica (pseudosciatica), vascular compression posterior legs, low back/buttock pain (worse when sitting), often starts after a fall or sitting on wallet when driving, foot/rectal/sacroiliac pain, sexual dysfunction (dyspareunia), piriformis syndrome (sciatica, local, and pelvic pain)—up to six times more common in women, pain worse on sitting.
Prolonged driving, trauma from fall, cycling/motorcycling, standing on one leg, hip surgery, sitting cross-legged, hip/knee/ankle injury/ fracture, leg casts, high-heeled shoes, pelvic inflammatory disease (PID), sexual intercourse position, childbirth, arthritic hip, sacroiliac joint dysfunction, PSLE, improper/ old orthotics.
Sacroiliitis. Lumbar radiculopathy. Coccydynia. Osteoarthritic hip. HLA (human leukocyte antigen)— B27 condition. Spinal stenosis. Discopathy (lumbar).
Leg length discrepancy, gluteal muscles, quadratus lumborum, attachment trigger point (origin) hamstrings, gemelli, obturators, quadratus femoris, levator ani, coccygeus.
Treating Hip Pain and Dysfunction
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