Piriformis Syndrome

Overview

Piriformis syndrome is a neuromuscular disorder that can develop when the piriformis muscle compresses the underlying sciatic nerve causing ongoing pain and numbness in the buttocks and leg.

The piriformis muscle is a wide, flat band attached from the interior of the hip to the femur and facilitates lateral movement, rotation and stability of the hip joint. When the muscle becomes strained, inflamed, traumatized or spasms it can lead to the development of piriformis syndrome.

Piriformis syndrome causes

Piriformis syndrome develops when the piriformis muscle compresses the underlying sciatic nerve. Sciatic nerve compression by the piriformis can be caused by:

• Microtrauma to muscles of the buttocks that results in inflammation or muscle spasms from frequent and repetitive motions such as walking, running, dancing, over-stretching or other exercises
• Sudden injury to the muscle by accidents such as a falls and other blunt forces to the area
• Sedentary lifestyles with long periods of sitting
• Beginning an exercise program for the first time
• Buttock muscle atrophy
• Tension on the piriformis muscle from excess weight

Piriformis syndrome risk factors

There are many factors that can increase your risk of developing piriformis, such as:

• Performing repetitive motions during exercise over a period
• Sudden injury to the muscle by accidents
• Regularly sitting for long periods of time
• Starting a new exercise regimen
• Buttock muscle atrophy
• Tension on the piriformis muscle from excess weight, such as during pregnancy
• Having legs of different lengths
• Having scoliosis or abnormal spine alignment

Piriformis syndrome symptoms

Symptoms of piriformis may include:

• Tenderness, pain, or a dull ache in only one side of buttocks
• Radiating pain from the buttocks down the hamstring
• A feeling of numbness or tingling down the back of the thigh, sometimes to the calf and foot
• Pain walking up hills or stairs
• Increased pain after sitting for long stretches of time
• Reduction hip joint range of motion

Piriformis syndrome complications

Undiagnosed and untreated piriformis syndrome can lead to complications such as:

• Continued pain that becomes chronic
• Increased likelihood of an unnecessary lower back surgical solution
• Inadvertent corticosteroid injection of the sciatic nerve leading to temporary mononeuropathy
• Inability to continue training or keep up an exercise routine

Piriformis syndrome prevention

To lower your risk of developing piriformis:

• Take time off from activities that cause pain
• Practice stretching and strengthening exercises for hip and gluteal muscles
• Warm up before exercise
• Assess daily routines to allow for periods of movement
• Avoid sitting routinely for prolonged periods of time on hard surfaces

Piriformis syndrome diagnosis

Diagnosis of piriformis syndrome includes a physical exam and providing your doctor with a history of symptoms. Certain diagnostics such as a CT scan, MRI or ultrasound may be recommended to exclude other conditions.

Piriformis syndrome treatment

The main treatment for piriformis syndrome includes:

• Avoiding activities that cause pain
• Physical therapy
• Stretching
• Anti-inflammatory drugs

Surgery is rarely advised but may be recommended in cases where conservative treatments have had no effect on pain.

It is important to carefully follow your doctor’s recommendations for physical therapy and activity reduction or modification, in order for treatment to be successful.

When to seek care

Call your doctor if your pain doesn’t go away or gets worse after several weeks of rest and activity reduction.

Next Steps

Your doctor will work with you to set up the best treatment plan for piriformis.