Piriformis Syndrome

Piriformis syndrome is a neuromuscular disorder that occurs when the piriformis muscle, a narrow muscle that works to rotate the leg outwards located deep within the buttocks, puts pressure on or irritates the sciatic nerve, the largest nerve in the body and located just beneath the piriformis muscle. While this syndrome is considered to be relatively rare, it is most often thought to be a sports related injury.


Symptoms of Piriformis Syndrome


Symptoms of piriformis syndrome include a burning, tingling or numbness in the back of the thigh to the knee and sometimes in the bottom of the foot. There could be pain or tenderness in the buttock, or discomfort in the hip, back of the thigh or the mid-buttock area.


Heaviness or fatigue in the leg is not unusual. The pain may worsen with strenuous or sportive activities such as jumping, running, walking upstairs or in hilly terrain or taking long walks. The pain may worsen with long bouts of sitting, which is sometimes relieved by raising the affected buttock, or climbing stairs, running or walking.


Causes of Piriformis Syndrome


The obvious cause of the pain is the pressure from the piriformis muscle on the sciative nerve, but the cause of the strain on the piriformis muscle can be difficult to diagnose. It is thought that the shortening and or tightening of the piriformis muscle is caused by muscle imbalances in the hip or rotator muscles, while another common cause is having tight adductor muscles, which are located at the inside of the thigh. This forces the abductor muscles at the outside of the thigh to not work properly, which puts further strain on the piriformis muscle.


Diagnosis of Piriformis Syndrome


Piriformis syndrome is relatively difficult to diagnosis, thanks to the fact that the muscle is located so deeply inside the buttock, and has been described as a “diagnosis of exclusion,” as it is often diagnosed after ruling out other problems in the area.


While sciatica, or the pain that is associated with problems stemming from the sciatic nerve, is most often caused by a pinching of the sciatic nerve at the root near the spinal cord, piriformis syndrome does not usually include lower back pain as a symptom, so this can help rule out common problems such as a slipped disc or spinal stenosis.


There are several stretches that can be performed that activate the piriformis muscle which can help pinpoint the cause of the problem.


Treatment of Piriformis Syndrome


In most cases, piriformis syndrome can be treated with rest, stretching exercises and massage of the affected area. For those patients that do not find relief from these conservative treatments, anti-inflammatory medications or a corticosteroid injection near where the muscle and nerve meet may be prescribed to give temporary relief while the muscle heals.


If the damage is considered to be severe, surgery may be required to loosen or release the tension of the muscle. In all cases, the prognosis is good and the patient should eventually return to normal activities.