Síndrome del Piramidal: causas y tratamiento.

Hoy en este artículo hablaremos del Síndrome del Piramidal: causas y tratamiento. Dicha dolencia afecta a gran parte de la población. Veamos pues, todo lo relacionado con este síndrome.

 

MÚSCULO PIRAMIDAL

 

El piramidal o periforme es el conjunto de fibras musculares de la pelvis que se originan en la cara anterior del sacro y se insertan en el extremo superior del fémur, quedando cubiertas por el glúteo menor.

La dolencia de este músculo se suele confundir con la ciática, porque al contracturarse o al sufrir un espasmo comprime al nervio ciático.

 

 

CÓMO DIFERENCIAR UN SÍNDROME PIRAMIDAL DE UNA CIÁTICA.

 

El piramidal o periforme, a diferencia de la ciática, aparece por sobrecarga, entonces se asociará mayormente a deportistas que realicen deporte de carrera o actividad física.

Dentro de este bloque, existen factores de riesgo:

  • Corredores de “fin de semana”: no corren durante la semana y el fin de semana hacen una tirada larga, realizando un esfuerzo poco habitual.
  • Uso de calzado inadecuado: cuando el calzado no se adapta a nuestra pisada y si hay una alteración de la biomecánica es recomendable el uso de plantillas.
  • La actividad laboral: cuando nos obliga a estar un número elevado de horas sentado y se hace incorrectamente.

Hay otro bloque de pacientes fuera del deporte con esta patología, como pueden ser:

  • Debido al sobrepeso.
  • Artoplastia de cadera.
  • Escoliosis o dismetría anatómica.

 

 

SÍNDROME PIRAMIDAL: SÍNTOMAS

 

El síntoma más característico es el dolor o fuerte molestia punzante en la zona de la nalga, sensación de pinzamiento, que a veces se acompaña de un hormigueo o acorchamiento.

A veces puede aparecer como un latigazo, quemazón e incluso como un dolor sordo.

Este dolor puede bajar por el miembro inferior con una amplitud distinta dependiendo de:

  • Músculo piramidal espasmado, con puntos gatillo activo: da un dolor desde la nalga hasta la cara posterior del muslo, sin sobrepasar la rodilla.
  • Puntos gatillo del piramidal activando los de la musculatura adyacente: siendo más frecuente en el glúteo menor y medio, el dolor puede bajar hasta el tobillo (por la cara posterior de la pierna).
  • Atrapamiento del nervio ciático por el músculo piramidal: el dolor pasa a todo el miembro inferior, recorriendo el mismo trayecto del nervio.

Otros síntomas pueden ser:

  • Si estamos sentados, necesitemos cambiar frecuentemente de postura para aliviar el dolor.
  • Dificultad para cruzar las piernas.
  • Aumento del dolor al estar un tiempo sentado, de pie, durante la marcha, al levantarse desde la posición sentado y llevar carga.
  • Existe una rotación externa del miembro inferior afectado en posición de cúbito supino y con frecuencia encontramos un acortamiento de dicha pierna.

 

SÍNDROME PIRAMIDAL: CAUSAS

 

Las causas del síndrome piramidal son:

Mala praxis deportiva:

No respetar el tiempo de descanso, no realizar calentamientos o estiramientos, etc…

Todo esto hace que el piramidal esté sobrecargado. Se agota y no puede recuperarse, provocando una contractura dolorosa.

Escoliosis o dismetría anatómica de los miembros inferiores.

Van a provocar que el músculo este en tensión por la necesidad del cuerpo de encontrar el equilibrio mediante la compensación.

 

Disfunciones pélvicas o sacras.

El piramidal es un músculo muy importante en la movilidad de los miembros inferiores, en el control pélvico y crea un eje virtual para la movilidad sacroilíaca, interviniendo también en sus posibles disfunciones.

 

Operaciones quirúrgicas en la región abdominal y la cadera.

Las operaciones, de forma frecuente provocan la formación de adherencias. Éstas alteran la estructura y dinámica del tronco.

El músculo piramidal se contraerá de manera anormal para intentar mantener el equilibrio de todo el cuerpo.

 

TRATAMIENTO DEL SÍNDROME PIRAMIDAL

 

Este síndrome no deja de ser una contractura de la musculatura rotadora externa y abductora de cadera.

Su tratamiento consiste en devolverlo a su posición inicial mediante fisioterapia y estiramientos.

El objetivo del tratamiento debe ser eliminar las causas que favorecen el espasmo muscular. Por otro lado, es relajar el músculo piramidal con algunos de los siguientes métodos:

  • Técnicas no invasivas: tratar contractura con técnicas de presión en puntos gatillo miofasciales.
  • Técnicas invasivas: con punción seca.
  • Masaje de descarga.
  • Trazos neuromusculares: en las bandas tensas del músculo.
  • Valoración de la musculatura adyacente: glúteos, musculatura pelvitrocantérea, isquiotibiales.
  • Estiramientos pasivos o activo-asistidos de la musculatura afectada.
  • Valorar las estructuras óseas de inserción del músculo.
  • Pautar ejercicios para realizar en casa.

 

Así pues, como siempre, el mejor tratamiento es la prevención:

  • Calentamiento inicial.
  • Estiramientos al final.
  • Visita al fisioterapeuta cada mes.
  • Deporte (gimnasio, piscina o bicicleta).

 

 

 

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