The Piriformis —

Carolyn’s Rant – November 2018

The Piriformis is a real pain in the butt! An old injury made it necessary to replace my left hip with a prosthetic implant recently. I have been on a learning curve to train the new body part to work correctly. You have certain rules to follow for several weeks, such as not crossing your legs, not turning your toes in, and not bending too far. Those rules are all necessary to prevent causing the piriformis to get angry, because if that happens it causes pain, and might even force the new hip joint to pop out of place requiring more surgery. You do not want that to happen!

The piriformis is just a very short pear-shaped muscle with a very important mission. For instance, piriformis holds the hip joint in place, rotates the femur, shifts body weight to the opposite side and prevents falling as you walk. This flat muscle, pyramidal in shape, is situated partly within the pelvis against its posterior wall, and partly at the back of the hip-joint. 

The piriformis is a big problem for many people because their sciatic nerve courses right through the piriformis muscle. That can cause painful sciatica, causing pain in the buttocks and referred pain along the sciatic nerve. It is almost debilitating.

This difficult-to-reach muscle behind the hip joint in the buttocks runs from your sacrum to your thigh bone and is the key to success on hip replacement. The surgeon has to stretch the piriformis to reach the hip ball and socket joint (the nurse told me they have your ankle up by your ear to do this). Then they saw off the joint and insert a metal and plastic replacement. The prosthetic components may be “press fit” into the bone to allow your bone to grow or they may be cemented into place.

Many things can cause chronic hip pain, making common activities painful and difficult, such as walking or getting in and out of a chair or even putting on your shoes and socks. Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, but there are other injuries and even the wear and tear of age. If medications, changes in your everyday activities, or the use of walking supports do not adequately help, you may need to consider hip replacement surgery. (When the pain gets bad enough and limits your activities enough, you will be ready to do it. 

Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. If you have a wonderful surgeon as I did in Dr. Paul Jacob, all will go well. After a night in the hospital, you will head home to do your physical therapy exercises, take 30-minute breaks during the day to put ice on the incision to reduce swelling, and allow that piriformis time to move back into place.

Rant over.