Piriformis Syndrome

Janet D. Pearl, MD, MSc

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Piriformis Syndrome

What is Piriformis syndrome?

Piriformis syndrome is a neuromuscular disorder characterised by pain deep in the buttocks. The piriformis muscle is in the buttock region and travels from the pelvis to the outer hip. This muscle is responsible for rotation of the hip, allowing the thigh, foot and knee to point outward. The sciatic nerve usually passes between this muscle and other adjacent muscles of the hip.  Symptoms occur when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle causing referred pain, tingling, or numbness down the leg, otherwise known as “sciatica”.

Cause of Piriformis Syndrome

A number of factors can affect the piriformis muscle, causing buttock pain, and may affect the adjacent sciatic nerve. Suspected causes inclue muscle spasm in the piriformis muscle, and tightening of the muscle or swelling of the piriformis muscle in response to injury or spasm. The most common cause of piriformis syndrome is injury or strain to the buttocks.  Acute or chronic injury to the muscle can occur either through direct trauma or overuse of the lower extremity.

Certain conditions of the spine such as spinal stenosis (narrowing of the spinal canal) are also related to piriformis syndrome and can affect both sides of the body. Inherent abnormalities of the sciatic nerve are another cause.

Symptoms and signs

Patients who suffer from piriformis syndrome typically complain of deep pain and tenderness in the buttocks. Other symptoms include tingling, numbness, or burning in the back of the thigh to the knee and occasionally to the bottom of the foot. Additionally, patients often have complaints of heaviness or fatigue in the leg. Pain is made worse by prolonged sitting, walking, or climbing stairs.

When examined, patients who suffer from piriformis syndrome will typically have pain on certain movements of the hip. Patient’s may also have tenderness to touch of the piriformis muscle on examination

Piriformis syndrome pain

Piriformis Syndrome Diagnosis

Piriformis syndrome can be diagnosed through clinical history and physical examination, however because symptoms may be similar in other conditions, radiologic tests such as MRI’s may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.  MRI scans of the hip and leg can demonstrate the presence of swelling and irritation of the sciatic nerve where the nerve passes under the piriformis muscle.

In some cases, patients may need to undergo studies that look at the electrical conduction of impulses along the muscle fibres. This is known as an electromyogram and is a useful test in confirming the diagnosis.

Treatment of Piriformis Syndrome

The treatment of piriformis syndrome typically involves rest and rehabilitation. Symptomaic relief of muscle and nerve pain can often be obtained by non-steroidal anti-inflammatory drugs and/or muscle relaxants. Opioids tend to be ineffective in managing patients with piriformis syndrome. Conservative treatment usually begins with Physical therapy, heat, massage, ultrasound therapy and different forms of exercises such as piriformis and hip abductor muscle stretching and strengthening.

In the early stages, simple stretching exercises and massage of the piriformis muscle is usually sufficient. If conservative measures fail to relieve or improve symptoms of piriformis syndrome, certain interventional procedures can be performed by your Pain Management specialist. Trigger Point Injections directly into the piriformis muscle under ultrasound guidance can help with pain and inflammation. They and can also be diagnostic, ruling out true sciatica symptoms.

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Piriformis syndrome physical therapy
Trigger point injection

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