The piriformis muscle is a small, pyramidal-shaped muscle deep in the buttock near the center. It arises from the front side of the sacral bone at the base of the spine and extends across the buttock to attach at the top of the femur near the hip. It lies beneath the biggest gluteal muscle called the gluteus maximus. This muscle is a rotator of the hip. It rotates the hip internally or externally depending on the position of the hip. It also helps with stability at the hip.

The sciatic nerve is a bundle of nerve fibers that originate from the base of the spine and innervates many of the leg and foot muscles. Generally this nerve runs just beneath the piriformis muscle exiting the pelvis below the belly of the muscle but anatomical variations exist wherein the nerve travels over or through the muscle belly of the piriformis and sometimes even splits around it. When piriformis syndrome is thought to be caused by these anatomical anomalies of nerve orientation it is called primary piriformis syndrome but it is unclear how often these variations in nerve position actually cause symptoms.

The most common type of piriformis syndrome occurs due to compression of the sciatic nerve by the piriformis muscle. This can occur due to several causes of which the most common include:

• Spasm or inflammation of the soft tissue around the buttocks due to trauma
• Muscle spasms of the piriformis following back surgery
• Piriformis muscle spasms due to lumbar or sacral joint pathology
• Piriformis muscle spasms due to overuse
• Shortening of the piriformis muscle due to biomechanical factors which compresses or irritates the sciatic nerve

• Pain felt deep in the buttocks
• Numbness in the buttock or down the leg
• Persistent low back pain that may be radiating
• Paresthesias/tingling or abnormal sensations in the buttock or leg
• Pain with prolonged sitting
• Tenderness to palpation over the area
• Increased pain after activities like stair climbing, bending, squatting or walking

If you decide to work with a physical therapist to help with your Lordosis issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your Lordosis PT sessions yet in the comfort of your own home.

HOW IS ABNORMAL LORDOSIS DIAGNOSED

Your physical therapist will ask you about the symptoms you are experiencing, what changes you have noticed in your posture and spine and how long you have been experiencing your symptoms. They will also perform a physical exam which usually includes observation of spinal alignment from the front, back and side as well as palpation or hands-on assessment of the spine and pelvis. Typically you will be asked to perform spinal motions such as bending, twisting or extending so your PT can observe how your spine moves and they may even take some measurements. Often this examination is enough to diagnose changes in lumbar lordosis but when needed, imaging such as an x-ray may be recommended.

PHYSICAL THERAPY INTERVENTIONS FOR LUMBAR LORDOSIS

Your physical therapist will design an individualized treatment plan to address changes in lumbar lordosis. Your symptoms, goals and underlying cause of the change in lordosis will indicate which treatments are best. Below are some common treatments to address this condition:

Modalities and manual therapy techniques to reduce pain and inflammation, increase blood flow, improve tissue health and spinal mobility. This may include soft tissue mobilization, joint mobilization, IASTM, myofascial release techniques, electrical stimulation, ultrasound, ice/heat and laser therapy.

Muscle control, strength and endurance training to improve muscle performance to support your spine in better alignment.

Mobility and stretching exercises to restore normal range of motion and flexibility in the spine, and surrounding musculature to help increase or reduce lumbar lordosis.

Motor control and coordination training to ensure proper muscle activation and control around the spine as you progress back to normal activities.

Balance training: Balance training may be indicated to help accommodate for changes in center of gravity that can occur when spinal curvature changes.

Gait training to restore normal walking if changes in lordosis have affected your walking.

Have you noticed your posture changing? Are you experiencing back pain or difficulty walking, you might be experiencing changes in spinal curvature. Working with a skilled physical therapist can help improve your symptoms and address changes in your spine. To schedule your initial evaluation with a physical therapist on our team, call Evolve Physical Therapy today.