Back Pain

Piriformis syndrome is a condition in which the piriformis muscle compresses or irritates the sciatic nerve, causing pain along the nerve in the buttocks, back of the leg and lower back.  The piriformis muscle runs from the sacrum in the pelvis to the outer hip bone and is used in the rotation of the leg and hip.



What is Piriformis Syndrome?

Piriformis syndrome is a condition in which the piriformis muscle compresses or irritates the sciatic nerve, causing pain along the nerve in the buttocks, back of the leg and lower back.  The piriformis muscle runs from the sacrum in the pelvis to the outer hip bone and is used in the rotation of the leg and hip.


What causes Piriformis Syndrome?

Piriformis syndrome may be due to an overuse injury of the piriformis muscle or from a trauma to the muscle.  The piriformis muscle compresses the sciatic nerve, causing pain to radiate through the buttocks and legs.  Overuse of the piriformis muscle is most likely to occur in athletes such as bicyclists, rowers, and runners, as well as any athlete that repetitively engages in forward moving activities.    The condition can often be avoided by performing proper lateral strengthening and stretching exercises.


What are the symptoms of Piriformis Syndrome?

Piriformis syndrome causes pain along the sciatic nerve, along with tingling and numbness.  Pain radiates into the buttocks, thigh and down the leg and may increase when engaging in activity, walking or sitting for long periods of time.  There may also be tenderness in the area of the sciatic nerve.  Pain may occur on only one side of the buttocks and leg or both.


How is Piriformis Syndrome diagnosed?

It is difficult to diagnose piriformis syndrome and the diagnosis is usually one of exclusion.  Symptoms are the same as those in sciatica, except that there is no compression of the spinal nerves.  A medical professional will take a full medical history and perform a physical examination, including manual maneuvers to see if the movement of the piriformis muscle causes sciatic pain.  Questions will be asked about activity levels, what increases and decreases the pain, where the pain is located and other questions that may indicate the source of the pain.  An x-ray, CT scan, MRI, ultrasound or EMG may be used in order to rule out other causes of pain.  The best tool to diagnose the condition involves an x-ray guided injection of an anesthetic directly into the piriformis muscle.  If the pain disappears following the injection, then a diagnosis of piriformis syndrome can confidently be made.


When should I seek care for Piriformis Syndrome?

If you experience sciatic nerve pain, it is best to consult with a medical professional to determine the source of the pain.  If the pain is severe, or you experience weakness or loss of strength in the legs, you should seek immediate medical advice.


What will the treatment for Piriformis Syndrome consist of?

Treatment for piriformis syndrome may include rest, a reduction in the activity or exercise that caused the injury, heat and cold therapy, nonsteroidal anti-inflammatory medication, physical therapy, stretching exercises, core strengthening exercises, massage therapy, or ultrasound.  Gait correction and orthotics may help the piriformis muscle to relax and heal.  If non-invasive treatments are unsuccessful, injections of anesthetics, steroids or anti-inflammatory medications may be helpful.  Surgery is rarely utilized in the treatment of piriformis syndrome.


Which muscle groups/joints are commonly affected by Piriformis Syndrome?

The piriformis muscle is located within the pelvis and connects to the sacrum.  It also connects on the other side to the top side of the hip.  The muscle is an external rotator of the hip and leg.  Pain is caused by compression of the sciatic nerve located underneath the piriformis muscle and may be felt in the buttocks, lower back, and the back of the leg.


What type of results should I expect from the treatment of Piriformis Syndrome?

Treatment is generally successful for piriformis syndrome.  It is important to strengthen and stretch the muscle to keep it from compressing the sciatic nerve in order to prevent the injury from recurring.  Surgery is rarely performed for this condition, but is usually successful in diminishing pain when performed.

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