Piriformis syndrome is a condition caused by compression of the sciatic nerve by the piriformis muscle. This results in pain, tingling and numbness in the buttocks and along the path of the sciatic nerve down the back of the thigh and into the leg. It is often brought on or aggravated by activities like walking. So a common question for those suffering from piriformis syndrome is whether they should walk or not.
What is piriformis syndrome?
The piriformis muscle originates from the front of the sacrum bone and attaches to the upper part of the greater trochanter of the femur. It rotates the hip externally and abducts the thigh when the hip is flexed. Piriformis syndrome occurs when this muscle spasms or swells and compresses the sciatic nerve which passes right underneath it.
This nerve irritation then causes pain and other symptoms along the distribution of the sciatic nerve down the back of the leg. In addition to pain, common symptoms include:
- Tingling or numbness in the back of the thigh, calf, foot
- Weakness in the leg or foot
- Difficulty walking
- Pain or stiffness in the lower back, buttocks, hip
The pain and other symptoms are usually made worse with activities like walking, climbing stairs, running etc. Prolonged sitting may also aggravate the symptoms.
Should you walk with piriformis syndrome?
Walking and other physical activities often exacerbate the symptoms of piriformis syndrome, which can make sufferers hesitant to walk or exercise. However, walking and staying active is still recommended in most cases. Here are some key points to consider:
Benefits of walking
- Prevents deconditioning and muscle weakness
- Maintains range of motion and flexibility
- Promotes blood flow and healing
- Helps manage weight
- Reduces stress and elevates mood
Regular, gentle walking can help to maintain strength and flexibility in the piriformis muscle and surrounding tissues. It also encourages circulation to the affected area and prevents the muscles from becoming overly tense or contracted. Walking is excellent low-impact exercise that does not place undue strain on the piriformis muscle while providing overall health benefits.
Precautions
However, certain precautions should be kept in mind:
- Avoid long distances or brisk walking which may exacerbate symptoms
- Take frequent breaks during walks to rest the piriformis muscle
- Use assistive devices like a cane or crutch if needed for support/stability
- Walk on soft surfaces like grass, dirt trails or tracks rather than concrete
- Wear supportive, well-cushioned walking shoes
- Stretch hip external rotators and piriformis muscle before and after
- Use heat/ice therapy if walking aggravates symptoms
Starting off with short, slow walks of 5-10 minutes at a time is recommended. Gradually increase distance and time as tolerated, taking breaks as needed. Avoid steep inclines or declines initially. Physical therapy can also help determine appropriate walking programs for individual capabilities and limitations.
How can walking help piriformis syndrome?
Though counterintuitive, walking with piriformis syndrome can actually aid recovery and pain management when done correctly. Here are some of the main benefits:
1. Prevents muscle atrophy
Prolonged rest and avoidance of activity can lead to wasting and weakness of the piriformis muscle. Gentle walking stimulates the muscle and prevents loss of strength.
2. Maintains flexibility
Immobility allows the piriformis muscle to tighten up and become hypertonic. Light walking stretches it out and maintains flexibility.
3. Improves blood flow
The contraction and relaxation of the piriformis muscle during walking facilitates circulation of blood to the area. This delivers oxygen and nutrients to aid healing.
4. Relieves spasms
Brief bouts of walking can help “unlock” a piriformis muscle stuck in spasm and relieve trigger point irritation of the sciatic nerve.
5. Manages weight
Walking prevents weight gain that can worsen symptoms. Excess weight puts extra pressure on the piriformis muscle and compress the sciatic nerve.
6. Releases endorphins
Light exercise like walking elevates endorphins and reduces stress hormones. This helps manage pain perception.
So in most cases, walking with piriformis syndrome provides more overall benefit than complete rest. But a gradual, paced approach based on individual tolerance is key.
When should you avoid walking with piriformis syndrome?
While walking is recommended for most, there are some instances where it may need to be avoided temporarily:
- Acute flare-up with severe pain
- Difficulty walking without support or assistive device
- No pain relief from rest and medication
- Numbness, weakness or difficulty moving the leg
- Worsening symptoms with any walking
In such cases, take a break from walking and focus on rest, ice therapy, medication and gentle stretches until the acute flare settles. Consult a doctor if symptoms do not improve in a few days.
Sudden weakness or difficulty moving the leg could indicate nerve damage and requires prompt medical attention. Avoid walking and strenuous activity until evaluated.
Tips for walking with piriformis syndrome
Here are some helpful tips to make walking easier and safer with piriformis syndrome:
Warm Up
Do some gentle stretches for the piriformis muscle and hip rotators before starting your walk. This helps prepare the muscles and prevents spasms.
Use Assistive Devices
A cane, walking poles or crutches can provide stability and take pressure off the piriformis muscle.
Mind Your Gait
Concentrate on taking shorter strides and maintaining proper walking posture.
Wear Proper Shoes
Cushioned walking or running shoes provide shock absorption and support.
Walk on Soft Surfaces
Choose grass, dirt trails or tracks which are easier on the joints. Avoid concrete initially.
Go Slow
Start with 5-10 minutes of slow walking and gradually increase pace and distance.
Take Breaks
Stop and rest as needed to give the piriformis muscle a chance to relax.
Use Ice After
Apply ice packs to the painful area for 15-20 minutes to reduce inflammation.
Stretch Afterwards
Gently stretch the piriformis and hip rotators again after walking to maintain flexibility.
Exercises and stretches to do along with walking
Adding in some targeted stretching and strengthening exercises can enhance the benefits of walking with piriformis syndrome:
Piriformis Stretches
- Seated piriformis stretch – Cross ankle over knee, gently pull thigh towards chest
- Supine piriformis stretch – Lying on back, rest ankle on opposite knee and pull thigh to chest
- Pigeon pose – On all fours, bring one leg forward with knee bent 90 degrees and foot flat
Hold stretches for 30 seconds, 5 reps each. Do regularly throughout the day.
Hip External Rotator Stretches
- Seated – Cross ankles and gently press knees towards floor with elbows
- Figure-4 stretch – Cross one ankle over opposite knee and gently press thigh away
- Prone hip internal rotation – Lying on stomach, bend knee out to side and rotate hip inwards
Hold for 30 seconds, repeat 5 times.
Glute Strengthening Exercises
- Glute bridges
- Seated band hip abduction
- Side-lying hip abduction
- Prone hip extension
Do 2-3 sets of 10-15 reps, 2-3 times per week to strengthen the glutes.
When to see a doctor
See your doctor promptly if:
- Symptoms do not improve with a week of rest, ice, OTC medication
- Persistent or worsening numbness, weakness in the leg
- Difficulty walking or instability
- Bowel/bladder incontinence
- Unexplained weight loss
- Fever or other signs of infection
Emergency medical care is needed for sudden onset of numbness, weakness and difficulty moving the leg as this may indicate nerve damage or neurological emergency.
Diagnostic tests like x-rays, MRI and EMG may be required to evaluate piriformis syndrome and rule out other causes like disc herniation or spine conditions. Your doctor can tailor appropriate treatment which may include medication, physical therapy, injections or surgery in refractory cases.
Conclusion
Piriformis syndrome can make walking painful and challenging. However, regular gentle walking within limits is highly beneficial and recommended as it prevents worsening of symptoms from immobility and muscle weakness. Appropriate precautions like using assistive devices, choosing softer surfaces, wearing suitable shoes and stretching before and after can make walking more comfortable. Adding exercises to strengthen the glutes and improve flexibility provides additional advantages. Avoid walking only during acute flare-ups with severe pain. See a doctor if problems persist for more than a week or sudden neurological symptoms appear. With a thoughtful, paced approach, walking can significantly aid recovery from piriformis syndrome.