Treating Piriformis Syndrome with Active Release Techniques
Piriformis syndrome is a common cause of posterior hip and leg pain that occurs when the sciatic nerve is compressed or irritated by the piriformis muscle – a muscle located deep in the back of the hip. As the sciatic nerve becomes irritated it will will lead to symptoms such as pain, tingling and numbness along the path of the sciatic nerve, including into the buttocks and down the back of the thigh and possibly into lower leg.
Fortunately, Active Release Techniques (ART) – a specialized, hands-on soft tissue treatment technique – has emerged as one of the most effective therapies for Piriformis Syndrome. But before we talk about how ART works so effectively, it is helpful to first discuss what Piriformis Syndrome is and how it develops in the first place.
Active Release Techniques (ART) makes use of specialized treatment protocols specifically developed to release entrapped and irritated nerves. As a result, ART has emerged as one of the most effective treatment methods for treating Piriformis Syndrome.
What is Piriformis Syndrome?
The sciatic nerve runs from the back of the hip, all the way down the back of the leg to the bottom of the foot. As the nerve passes from the spine into the back of the leg it must pass directly underneath the piriformis muscle (see image above). In some people the nerve will actually pass through the middle of the piriformis.
The piriformis muscle is an important hip muscle that plays a key role in moving and controlling the hip and pelvis. Through a variety of causes such as excessive or repetitive use with certain sports or occupations, previous back or pelvic injuries, or prolonged sitting (sitting can actually reduces blood flow to the piriformis muscle which leads to to tightness, irritation, and eventually pain) it is not uncommon for small scale damage to develop within the piriformis muscle. This damage is referred to as micro-trauma. (At first this micro-damage is not painful, but can become painful over time, as we will discuss below). Although only small, this micro-trauma still needs to be repaired, which the body does by laying down new connective tissue in and around the damaged area. This new tissue (often referred to as scar tissue, or soft tissue adhesions) acts to glue the damaged tissue back together.
Muscle damage and tightness in Piriformis Syndrome is associated with scar-tissue adhesions. To treat these adhesions stretching is not enough. Hands-on treatment such as Active Release Techniques therapy is needed to work out the muscle adhesions and release the entrapped sciatic nerve.
While this scar tissue is a normal and necessary part of healing problems can develop when the piriformis muscle is subjected to micro-trauma over the course of weeks or months (i.e. we continue to play the same sports, do the same jobs, or sit all day). This ongoing micro-trauma will lead to the accumulation of scar-tissue in the piriformis. As this occurs it will start to make the piriformis tight, stiff, and inflamed, and will start to compress and irritate the sciatic nerve as it passes underneath the muscle. In many situations as the scar tissue builds up around the piriformis is can actually glue the nerve to the muscle, making it impossible to for the nerve to move and slide under the piriformis, creating further damage to the sciatic nerve.
How Can Piriformis Syndrome Be Fixed?
The Traditional Approach
In an attempt to relieve Piriformis Syndrome a variety of treatment methods are traditionally used. Some of the more common approaches include muscle relaxants, anti-inflammatory medications, rest, heat, ice, ultrasound, massage, acupuncture, joint manipulation, and stretching and strengthening exercises. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem. The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue that develops within the piriformis muscle and around the sciatic nerve.
Passive approaches such as muscle relaxants, anti-inflammatory medications, rest, ice, acupuncture, and ultrasound, all focus on symptomatic relief and do nothing to address the cause of the problem. More active approaches such as joint manipulation, stretching and exercises are often helpful, however they themselves do not treat the underlying scar-tissue (remember these adhesions are the main problem with the muscle and nerve). In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from piriformis syndrome.
Exercises to stretch the muscle sciatic nerve may be helpful in some cases, but without first addressing the scar-tissue adhesion exercises will be limited and slow to provide relief for piriformis syndrome.
Our Approach: ART – A Better Solution
ART stands for Active Release Techniques. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. What makes ART different from other treatments is that it is designed to identify and address scar tissue adhesions that are interfering with the normal function of the body.
With respect to Piriformis syndrome the goal is to 1) break-up restrictive scar tissue adhesions at the piriformis, and 2) restore normal sliding of the sciatica under the piriformis muscle. If you are unfamiliar with ART you can think of it as a type of active massage. The practitioner will first shorten the muscle, or nerve, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture and tension of the tissue to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area.
How Long Will It Take To Feel Better?
One of the best things about ART is how fast it can get results. Each treatment takes about 15 minutes, and although each case is unique and there are several factors that will determine the length of time it will require to fully resolve each condition, we usually find a significant improvement can be gained in just 4-5 treatments – even in cases of long-standing symptoms that have not fully responded to other treatment approaches.
Get Relief With Active Release Techniques.
To book an appointment to receive ART treatment for your piriformis problem simply call our office, or book an initial appointment online. For more information on ART, or for inquiries regarding specific injuries or conditions you can call us, or simply fill out our contact form.