Pain is almost considered to be an inevitable part of living, and those of you who experience chronic pain may not even remember what it’s like to function without it. Unfortunately, as a result, many continue through life regularly augmenting movement patterns and discontinuing participation in enjoyable activities to avoid pain. Many also consider pain just a symptom of old age and relegate themselves to continued suffering for the rest of their days.

Often, the roots of chronic pain lie within the musculoskeletal system of the body. Whether it’s a result of an old football injury or too many hours spent hunched over the computer, the body begins to adapt to avoid pain, and eventually these compensation patterns lead to muscular imbalances that can affect the body’s function. For example, over time a computer technician will adopt a posture that includes rounded shoulders and a forward head. Because this posture is observed for hours on end, the muscles begin to adapt. The muscles of the chest and front of the shoulder will shorten, while the muscles of the mid back will lengthen. This postural malalignment causes various structures to be placed in precarious positions and initiates excessive wear and tear of both the soft and hard tissue structures. The former football player who experienced a knee injury in his youth will have developed compensation patterns to avoid placing excess pressure on the affected knee. Again, these faulty movement patterns will cause premature breakdown of various structures.

One painful issue that tends to result from faulty movement patterns is known as piriformis syndrome (PS), a term used to describe symptoms commonly associated with sciatica. PS, though difficult to diagnose (very little research is present on the subject), can be a tremendously painful and debilitating problem for many people from all walks of life. The general consensus is that strength and flexibility deficits can cause the piriformis muscle to become inflamed, therefore initiating compression of the sciatic nerve. The pain may radiate to the lower leg and is often exacerbated by walking, running, squatting, prolonged sitting and any other similar activity.

“In sports medicine, I generally see PS in my long distance biker and runner patients,” says Catherine Logan, MSPT, and physical therapist based in Boston.

Very little evidence of its existence is reported; however, it is estimated that PS accounts for at least 5 percent of all lower back pain. In one study, 45 of 750 patients with lower back pain were found to have PS. Often seen as a “diagnosis of exclusion,” PS is undetectable through traditional medical screening methods such as electrodiagnostic testing. It is estimated that each year in the United States, 1.5 million people seek out MRI scans in the lower back and gluteal region to uncover the root cause of butt and leg pain. Despite common hypotheses, 1.2 million of those scans fail to uncover information that indicates that the pain originates from the spine. And for the 300,000 that elect to have surgery each year as a result of positive scans, 25 percent of those surgeries fail to relieve any of the pain.

Before understanding any musculoskeletal disorder, it’s important to know the structures involved. The piriformis muscle is small, flat and triangular, and runs parallel deep beneath the superficial butt muscles. One of six hip rotator muscles, the piriformis originates at the base of the tailbone and inside surfaces of the pubic bone, and connects to the top of the thigh bone. The sciatic nerve – the longest nerve in the body – has a close relationship with the piriformis in that it often runs beneath it and, in 15 percent of the population, actually penetrates the muscle.

With so little definitive research on the subject, it is difficult to propose specific causes of PS. However, leading physicians and physical therapists often attribute it to some type of blunt trauma to the gluteal area. Others conclude that faulty walking or running patterns and improper foot positioning (fallen arches) can lead to PS. The foot is the first line of defense against ground reaction forces. Poor alignment of the foot causes these forces to be unevenly distributed throughout the rest of the body and pain ensues. The specifics of what exactly takes place and the various disruptions of movement patterns are beyond the scope of this article; however, it is important to understand that the foot plays a significant role in the presence of chronic pain.

If you are concerned that you may be suffering from PS, it is advised that you seek the guidance of a qualified medical professional before beginning any exercise program. Considering the seeming lack of success surrounding invasive surgical techniques, you may be referred to a qualified physical therapist or corrective exercise specialist who can design a program to help realign the structures of the body and reduce inflammation of the piriformis. Logan employs a variety of tactics in assisting to clients reduce PS symptoms.

“My typical protocol might include moist heat, soft-tissue mobilization, trigger point release, massage, stretching and electrical stimulation,” Logan says. “Patients are also given strengthening exercises individualized to their weakness and their recreational needs.”

Justin Price, corrective exercise specialist and co-owner of The BioMechanics in San Diego, uses similar techniques, but aims specifically at correcting clients’musculoskeletal imbalances.

“I cannot say if they were piriformis syndrome or not as I am unable to physically examine their sciatic nerve and its source of impingement,” he says. “However, I can say that the protocol I used (which included myofascial release, neuromuscular facilitation, stretching and strengthening exercises) in all cases alleviated the symptoms.”

Another suggestion is to take a closer, more thoughtful look at footwear. If the foot is incapable of withstanding the pressures of walking or other similar activity and buckles inward, you’ll want to have a shoe that can help prevent this from taking place. A qualified professional can help you to better understand your unique movement patterns and alignment, and can offer suggestions for more supportive footwear. She or he may also recommend purchasing a high quality orthotic insert to prevent the arch from falling upon impact. Though this may not “cure” PS, it can definitely help return the body to a more neutral position and relieve stresses placed on hard and soft tissue structures.

The pain associated with PS can be severe; however, there are many options afforded to the sufferer to help reduce or eliminate the symptoms. It may take a bit of research and consultations with professionals, but pain does not have to be an inevitable part of life.