Melody, a 40 year-old female patient presented to our office with right hip and leg pain for one month.

There was no specific injury. However, the pain started two days after playing tennis for a few hours and had gradually increased.

The pain had begun to interfere with almost every aspect of her life, especially exercising and was rated at a 7/10.

She saw her family doctor who prescribed an anti-inflammatory and suggested an MRI of her lumbar spine if symptoms persisted.

Piriformis Syndrome

Our examination revealed joint dysfunction of the right sacroiliac joint that was tender with pressure. It also revealed tenderness and tightness in the piriformis muscle (behind the hip). Pressure there also elicited her leg pain. All other findings were within normal limits.

Assessment: Because pain was not immediate, it was not due to an injury. Most likely, a sudden movement jammed the sacroiliac joint, creating joint dysfunction. This joint dysfunction effectively weakened the right Gluteus Maximus muscle affecting proper hip mechanics. The altered hip mechanics began to affect the patient’s gait and movement patterns. The smaller piriformis muscle began to compensate and try to take up the slack for the more powerful gluteal muscle. The Sciatic nerve became compressed as it exited from under the piriformis muscle.

The Solution

Our team identified the components of the problem. Corrective joint adjustment were made to correct for the joint dysfunction, specific stretches were given to stretch the piriformis muscle, and specific exercises were given to facilitate the recovery of strength to the gluteal muscle. The condition quickly reverses and the individual is able to return to full activities.

Since the piriformis muscle is pressing on the Sciatic nerve, would addressing the muscle alone correct the issue? No. The piriformis muscles only tightened up to compensate because of the presence of Sacroiliac joint dysfunction. Addressing the muscular issue without addressing the joint dysfunction would fall short of a corrective action.