Piriformis muscle imbalance conditions can cause pain and functional disability. However, muscle imbalances often are incorrect diagnostic verdicts. In fact, we observe muscle imbalances as some of the most frequently misdiagnosed of all musculoskeletal pain conditions, particularly by complementary care providers who rely on highly subjective evaluation methods.
Muscle imbalances remain very controversial in the larger healthcare sector. Much of the information passed along to laymen patients is incorrect and even some care providers are quite confused as to what exactly muscular imbalances truly are, why they occur and how they can create symptomology in the piriformis tissue and elsewhere in the body.
This essay will seek to address all of these crucial issues, including explaining muscular imbalances, their causes and symptoms, as well as detailing how the piriformis can be involved in several distinct scenarios.
Piriformis Muscle Imbalance Facts
Muscle imbalances occur when one muscular tissue becomes stronger than its matched antagonistic pairing. Each muscle is designed to move or stabilize a region in one direction, while its antagonistic pairing provides movement or stabilization in the opposite way. When one tissue becomes too weak and the other becomes overly strong, the muscles tend to fight against each other, with the stronger one pulling on the weak one and not allowing the region to remain in balance or anatomical symmetry.
Muscle imbalances rarely provide objective diagnostic evidence and are therefore ruled to be functional issues through subjective opinion based on clinical observation and specific, but not conclusive, testing. We find that about 10% to 30% (depending on area of the body affected) of all muscle imbalance diagnoses are correct to some degree, while the rest are completely fabricated. When it comes to piriformis and general lateral rotator group imbalances, our statistics place the rate of misdiagnosis at around 90%.
Muscular Imbalance Consequences
True muscular imbalances in the lateral rotator group can cause functional issues, hyperlaxity or hypertension in the piriformis muscle tissue. Results might include weakness in the ability of the muscles to properly move and regulate motion in the hip, pain upon specific leg movement, pain upon bearing weight, pain upon general ambulation and the possibility of the piriformis going into spasm and compressing the sciatic and/or pudendal nerves. This last possible consequence is diagnosed as piriformis syndrome and produces a diverse range of pseudo-sciatica expressions in the buttocks, legs and/or feet.
Piriformis imbalances can also affect many of the surrounding and related tissues which move and regulate movement of the leg. Severe imbalances can result in hamstring trauma, hip trauma, sacroiliac trauma and even lower back injury if the piriformis muscle fails to perform its intended anatomical functions adequately.
Piriformis Muscle Imbalance as an Effect
Piriformis muscle pain conditions might not involve actual imbalances in the piriformis itself or in other tissues of the lateral rotator group. Instead, muscular imbalance elsewhere in the body might provide a cascade-effect up or down which eventually influences the piriformis muscle and causes it functional pain or cramping with subsequent constriction of the sciatic nerve.
Imbalances in the leg muscles can work their way upwards in consequences, undermining the effectiveness of the piriformis in performing its intended functions. Likewise, imbalances in the hip, buttocks and paraspinal muscles can work their way downwards and similarly affect the ability of the piriformis to perform ideally or at all.
We see many instances where chronic tension and imbalances in the postural muscles causes collateral negative consequences in the lateral rotator group due to changes in typical healthy posture and gait. However, we also have observed many patients who have been diagnosed with such functional issues, yet we found no evidence of any imbalances occurring. In many of this latter category of patients, we did find evidence of oxygen deprivation causing cramping in the lumbar muscles, as well as in the piriformis muscle, implicating ischemia as the true origin of symptoms over a wide anatomical area.