Expectations related to Piriformis syndrome and Iliacus dysfunction

Piriformis syndrome

Piriformis syndrome, a relatively unknown condition in which an injury to the piriformis muscle causes buttock discomfort, that is frequently accompanied by leg pain. And it was first described by Yeomen in 1928.

Symptoms of Piriformis syndrome

Sitting or activity of the lower extremities aggravates the main symptom of buttock pain, which might include leg discomfort.

In the absence of low back or hip abnormalities, other common findings include buttock soreness extending from the sacrum to the greater trochanter, piriformis muscle sensitivity on rectal or pelvic examination, and worsening of symptoms by prolonged hip flexion, adduction, and internal rotation. Leg length disparity, weak hip abductors, and discomfort on resisted hip abduction in the sitting posture are all possible symptoms.

The piriformis muscle’s impingement on the sciatic nerve has been identified as a possible cause of the condition. Concurrent disorders include myofascial involvement of adjacent muscles and lumbar facet syndromes.

Lack of definitive investigation regarding the diagnosis of piriformis

Because no definite studies have been recorded, the diagnosis of piriformis syndrome is largely clinical. Although there have been occasional reports of their efficacy, bone scans and electro diagnostic tests do not appear to be beneficial in general.

Both conservative and surgical treatments have been recommended, and both have been thoroughly documented in individual studies. No one appears to have outlined a complete method to treating this disease, to date.

Failed back surgery syndrome

I’ve seen so many people with “failed back syndrome” or “failed back surgery syndrome” that I can’t count. The patient, in essence, has lower back and/or leg discomfort for which they have undergone significant back surgery.

Partial disc removals, laminectomies, and fusions utilizing bone, rods, or even metal cages have all been used to support the back. The pain would purportedly be relieved as a result of this. In some situations, such operations are successful; but, in many cases, they are not. And in many of these later situations, the cause of failure is straightforward: misdiagnosis.

X-rays or MRIs that reveal arthritic or degenerative abnormalities in the spine can mislead even the most cautious surgeons.

If a patient shows up with back or leg pain that appears to follow certain patterns “such as sciatica,” and an X-ray or MRI reveals disc problems or arthritic changes in a region of the spine that corresponds to that nerve and could explain the pain, it’s easy to conclude that surgery to the region will likely relieve the pain.

However, because there are several other possible explanations for the discomfort, doctors should do a thorough physical check to rule out any other possibilities.

Results of Physical examination

Physical examination frequently discloses the true source of back pain, even after surgery has failed to cure it. Piriformis Syndrome, which is caused by a muscle spasm in the buttocks, frequently generates sciatica-like sensations. 

Quadratus Back discomfort is frequently caused by the contraction of the Lumborum muscle, a big muscle that runs from the bottom two ribs to the pelvis. Hip discomfort, back pain, and sciatica can all be caused by sacroiliac (SI) joint dysfunction or damaged ligaments in the lumbar spine or SI joint.

After botched back surgery, a highly-trained physician, such as one educated in osteopathic hands-on diagnostic and manipulative medicine procedures, as well as prolotherapy, can frequently repair the issues left behind. Perhaps more significantly, such a physician would have been able to filter through all of the information, including the aberrant X-rays that revealed coexisting spine issues, to discover the true source of the discomfort.

Surprisingly, many of the reasons are not related to the spine and cannot be treated only by chiropractic treatment. Many of the people I’ve encountered have been visiting chiropractors for years, yet their QL spasms have gone unnoticed. Chiropractors are also unable to treat many ligament problems effectively because they are unable to do prolotherapy.

Many of these patients might have avoided needless surgery and rehabilitation, as well as the consequences of back surgery, which we shall discuss in a future blog if they had seen a well-trained osteopathic physician.

If you have persistent back or leg pain or sciatica, you should seek treatment from an osteopathic manipulative medicine specialist before contemplating surgery.

Piriformis release

Piriformis Syndrome — The Complete Injury Guide - Vive Health

Stretching the piriformis muscle may be done in a variety of ways. Lay on your back with both feet flat on the floor and both knees bent, for example. Pull the right knee to the chest, grab it with the left hand, and pull it towards the left shoulder, holding the stretch. Rep on the other side.

Another option is to lie flat on your back with both feet on the floor and both knees bent. Place the right leg’s ankle over the left leg’s knee. Hold the stretch by pulling the left thigh toward the chest. Rep on the other side.

At first, each piriformis stretch should be held for 5 seconds, then progressively extended to 30 seconds, with three repetitions each day.

Now what should one expect from Iliacus Dysfunction

Iliacus muscle or Iliopsoas muscle

The iliacus muscle has a triangular form, is flat, and fits perfectly into the iliac fossa, which is the curved surface of the biggest pelvic bone. It’s also known as the iliopsoas muscle, which it shares with the psoas major muscle.

Figure, Psoas Major and Minor Muscles and Iliacus Muscle. Contributed by T.  Silappathikaram] - StatPearls - NCBI Bookshelf

Two-thirds of the way up the iliac fossa, a part of this muscle is connected to it. The inside section of the iliac crest, the top, outer piece of the pelvic bone, is connected to another portion. Other fibers of this muscle are connected to the iliolumbar and anterior sacroiliac ligaments, which are situated at the base of the sacrum, as well as the anterior iliac spines, which are bony projections near the iliac margins.

The lateral or outside side of the psoas major muscle, which extends from the lumbar spine in the lower back to the lower pelvis, is where these muscle fibers converge and insert on the tendon. The femur bone, often known as the thighbone, has some of these fibers.

Iliacus Dysfunction 

Iliopsoas Syndrome: Symptoms, Causes, Diagnosis, Treatment

It comes in a variety of sizes and forms, for example, if you have chronic or recurrent pain, tingling, numbness, aching, or hot/cold sensations in the lower abdomen, groin, buttocks, down the leg, hip joint, lower back, sacroiliac joint, across the top of the hip bone, wrapping around to the lower back or buttocks, and these symptoms have not responded to injections, physical therapy, rest, or other treatments, and the diagnosis has been inconclusive.

Shortness of Iliacus muscle

The iliacus can shorten with time, which is a relatively frequent issue. This can be caused by lengthy periods of sitting and/or driving, as well as a lack of frequent stretching. Because the iliacus muscles are extremely powerful, shortness in this muscle can be a particularly stubborn issue in athletes who don’t stretch sufficiently.

A strong, flexible, and resilient muscle is desirable, but not a strong, dense, short, and inflexible muscle. Long periods of sitting with a shortened iliacus, or just a lack of stretching over time, might cause the iliacus to adapt to a shorter length. This is the normal condition of a muscle once it has acclimated to a specific length.

The iliacus has difficulty reverting to its natural resting length after it has become acclimated. And there, my friend, is where the trouble begins.

Results of chronically contracted iliacus

When a muscle is unable to recover to its usual, healthy resting length, it enters a condition of chronic contraction, which has a variety of negative effects. It can make you ischemic, which means your blood flow is reduced. Imagine your clinched fist’s white knuckles. There is no blood flow in that area. An ischemic muscle is frequently painful.

Trigger points can form in a constricted iliacus, which relates to pain that radiates from the muscle or is felt in other regions of the body. Trigger points in the iliacus can relate to the groin, hip, and leg sensations, among other things. It can also cause hip joint mobility to be distorted. For example, mobility in the front of the hip joint may be limited or restricted, putting additional strain on other hip muscles.

A shortened iliacus can result in a variety of compensatory or distorted bodily movements. If a tight iliacus, for example, limits mobility in one hip, the other hip, spine, or other portions of the body may be forced to compensate and modify their usual movement pattern.

It can also cause pelvic torsion, which causes a functional leg-length discrepancy and a disturbance in the body’s neutral connection with gravity.

Stretching out chronically contracted iliacus

Yes, it’s possible to extend it out. A muscle that has adapted to a set pattern, on the other hand, may readily revert to its tight, adapted condition. This is why we might become stuck in a cycle of continual stretching that never seems to end.

Furthermore, many of us still stretch in a static manner, which might activate the Protective Stretch Reflex. You’ve probably experienced this defensive reaction if you’ve ever held a muscle in a static stretch for 30-60 seconds or longer and felt your body shaking and the muscle resisting you.


The Protective Stretch Reflex is designed to protect you from catastrophic harm, yet it can be activated in as little as 5 seconds of stretching.

As a result, I strongly advise you to use Active Isolated Stretching instead. Instead, we employ a repeated 2-second stretch using this stretching approach.

Furthermore, in the case of piriformis syndrome, massage the piriformis muscle may assist alleviate piriformis syndrome symptoms. Self-massage and stretches regularly can assist relax the muscle and relieve strain on the sciatic nerve. A foam roller, tennis ball, or any similar-sized ball can be used.