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PiriformisMusculus piriformis

Flat, pear-shaped deep hip muscle running from the front of the sacrum to the greater trochanter that laterally rotates the hip.

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LatinMusculus piriformis
Origin
  • Front (pelvic) surface of the sacrum, by three slips attached around the 2nd to 4th sacral segments
  • Upper margin of the greater sciatic notch and the ilium near the posterior inferior iliac spine
  • Capsule of the sacroiliac joint, and sometimes the sacrotuberous ligament
Insertion
  • Upper border of the greater trochanter of the femur (its tendon joins those of the gemelli and obturator internus)
Action
  • Laterally rotates the extended hip
  • Abducts the flexed hip
  • Helps steady the head of the femur in the hip socket
  • When the hip is flexed to about 90° or more, its rotation action reverses and it helps medially rotate the hip
NerveNerve to piriformis (branch of the sacral plexus) (S1–S2)
GroupDeep hip rotators
NameLatin piriformis, 'pear-shaped'.

Palpation

  1. Client prone with a bolster under the ankles; stand beside the hip.
  2. Find the side of the sacrum (roughly level with the PSIS and below) and the top of the greater trochanter. Piriformis runs along an imaginary line between these two points.
  3. Sink in slowly with flat fingers or a soft fist through gluteus maximus. Feel for a firm band running across the buttock along that line.
  4. Bend the client's knee to 90° and ask them to press the foot inwards against your hand (hip lateral rotation); the band firms under your fingers.

Landmarks: Sacrum · Posterior superior iliac spine · Greater trochanter

The piriformis is the best known of the Deep hip rotators. It lies under Gluteus maximus and runs almost sideways across the buttock, from the Sacrum to the Greater trochanter. Clients commonly report a deep, tender spot in the middle of the buttock, and slow, sustained Compression through gluteus maximus is a comfortable way to work this area in a relaxation routine. Work gradually and check pressure often, because the area can be sensitive.

The piriformis is an important landmark because of its close relationship with the sciatic nerve, the largest nerve in the body. The nerve leaves the pelvis through the same opening (the greater sciatic foramen) and in most people passes just below the piriformis. In a minority of people, part or all of the nerve passes through the muscle instead. Wikipedia gives figures of about 80% below and 17% through. Keep this in mind when using sustained pressure in the middle of the buttock, and ask the client to tell you straight away about any tingling, numbness or pain spreading down the leg.

Sources differ on the nerve roots. The Wikipedia articles on the piriformis nerve and the lateral rotator group give S1–S2 (used above); the Wikipedia piriformis article gives L5–S2.

Techniques

  • Effleurage — Long, gliding strokes with the whole palm that spread the medium, warm the tissue and link the other strokes together.
  • Compression — Pressing straight down into a muscle with the palm, fist or forearm, holding briefly, then releasing and moving on.
  • Circular friction — Small circles made with the finger or thumb pads that move the skin over the deeper tissue without sliding, to work a specific spot.
  • Passive stretching — The therapist gently moves a relaxed limb to lengthen a muscle to a point of mild stretch and holds it there, with no effort from the client.

Works with

  • Gemelli — Two small, paired deep hip muscles, above and below the obturator internus tendon, that help it laterally rotate the hip.
  • Obturator internus — Fan-shaped deep hip muscle that starts inside the pelvis, turns around the back of the ischium and laterally rotates the hip.
  • Quadratus femoris — Flat, four-sided deep muscle between the ischial tuberosity and the back of the femur that strongly laterally rotates and adducts the hip.
  • Gluteus maximus — The largest and most superficial buttock muscle, and the main extensor of the hip.

Opposes

  • Gluteus minimus — The smallest and deepest of the three gluteal muscles, lying under gluteus medius, that abducts and medially rotates the hip.
  • Tensor fasciae latae — Small muscle at the front of the outer hip, just below the ASIS, that tightens the iliotibial band and helps flex, abduct and medially rotate the hip.

Same group

  • Gemelli — Two small, paired deep hip muscles, above and below the obturator internus tendon, that help it laterally rotate the hip.
  • Obturator externus — Flat, triangular muscle covering the outside of the front of the pelvis whose tendon wraps under the neck of the femur to laterally rotate the hip.
  • Obturator internus — Fan-shaped deep hip muscle that starts inside the pelvis, turns around the back of the ischium and laterally rotates the hip.
  • Quadratus femoris — Flat, four-sided deep muscle between the ischial tuberosity and the back of the femur that strongly laterally rotates and adducts the hip.

Sources

  1. Wikipedia: Piriformis muscle
  2. Wikipedia: Piriformis nerve
  3. Wikipedia: Lateral rotator group