Piriformis Syndrome - Information and Specialists

Piriformis syndrome occurs when the sciatic nerve is compressed by the piriformis muscle. This can result in pain—sometimes severe—that radiates down into the legs. Tingling and numbness may also occur.

Piriformis syndrome is a neuromuscular condition that some people confuse with other conditions such as sciatica or a herniated disc.

Possible triggers for compression of the sciatic nerve include:

• Physical activity (unfamiliar or overly intense strength training, cycling, jogging)
• Prolonged pressure (e.g., from sitting too long on a hard surface)
• A fall onto the buttocks, or
• Long-term changes in muscle tension combined with misalignment of the sacrum (e.g., due to dysfunction of the sacroiliac joint)

The exact triggers cannot always be determined. Piriformis syndrome is usually caused by compression in the buttock area. This is because the piriformis muscle emerges from the pelvic bone at that point and covers the sciatic nerve.

This is why pain occurs along the entire distribution of the sciatic nerve.

People with piriformis syndrome often experience pain, numbness, and tingling in the buttocks. In many cases, the pain and abnormal sensations radiate into the thigh, calf, or foot.

The pain often occurs while sitting. However, it can also occur when climbing stairs, jogging, or cycling. Any posture or movement can trigger the symptoms if it causes sustained pressure over the piriformis muscle.

Movements or postures involving bent legs are often to blame. As a result, some people also experience symptoms while sleeping. Side sleepers who bend their legs sharply are particularly affected.

If those affected bend their legs less or keep them stretched out for long periods, the symptoms usually subside.

Pain associated with piriformis syndrome usually occurs on one side of the buttocks and lower back, as well as in the leg @ Microgen /AdobeStock

First, the doctor conducts a medical history interview with the patient and asks about their symptoms. This is followed by a physical examination. In some cases, the doctor may be able to palpate significant tension in the piriformis muscle. Patients often also report tenderness.

There is currently no test to confirm piriformis syndrome. Therefore, it is a diagnosis of exclusion. In this process, the doctor must ensure that the symptoms are not caused by another condition.

Possible alternative conditions include:

• Irritation of the sciatic nerve due to a herniated disc in the lower lumbar spine or due to nerve root irritation syndromes,
• hip joint disorders
• Disorders of the sacroiliac joint, such as sacroiliac joint syndrome
• Degenerative joint disease in the lumbar spine and sacrum
• Tumors in the pelvis

To rule out these conditions, the doctor will perform further imaging tests.

• The diagnostic options are:
• Ultrasound,
• X-ray, and
• MRI

Although imaging techniques cannot directly confirm piriformis syndrome, they can rule out other conditions.

The first step is to avoid postures and movements that trigger or exacerbate pain and abnormal sensations.

If pain occurs while sitting or during certain movements and activities, changing your posture is recommended.

For sports activities that cause discomfort, a temporary break is advisable. Relaxation exercises as well as heat or cold therapy can help relieve symptoms.

Patients who sit a lot should stand up every 20 minutes to stretch the muscles in the buttocks.

Sometimes, the doctor will prescribe anti-inflammatory medications to relieve the pain. Muscle relaxants may also be considered.

Depending on the severity of the symptoms, the doctor may recommend a painkiller injection or an injection of anti-inflammatory glucocorticoids.

In addition, physical therapy may be used to reduce the symptoms. The physical therapist stretches and works on the surrounding muscles or the trigger point in the gluteal muscles.

Patients also learn proper posture during physical therapy. They learn exercises and stretches specifically designed for the piriformis muscle. Patients should also perform these exercises at home. 

Physical Therapy for Piriformis Syndrome @ New Africa /AdobeStock

Using heat to loosen the muscles before stretching is helpful. To avoid further irritating the nerve, you should only perform gentle stretches.

Ultrasound treatments can also help reduce symptoms. In severe cases, surgery may be an option, during which the doctor cuts through the piriformis muscle.

The course of piriformis syndrome depends on the underlying cause. However, patience is usually required, as it often takes some time for improvement to occur.

Long-term treatment success can be expected when the doctor identifies and treats not only the symptoms but also the underlying cause. In most cases, misalignments are the trigger and lead to muscular imbalances. In such cases, correction of the misalignment is necessary. Posture training or stability exercises can positively influence the success of treatment.

Piriformis syndrome is usually a result of sports and movements that place strain on the piriformis muscle. 

If you want to prevent piriformis syndrome, you would have to avoid those specific sports. However, since this isn’t a viable solution, there are a few things you should keep in mind when exercising. 

The following tips can therefore help as a preventive measure:

• Be sure to warm up thoroughly before exercising
• Increase your intensity slowly whenever possible
• When jogging, avoid hills and uneven ground
• Maintain good posture while jogging
• The same applies to strength exercises, which you should perform correctly

If you experience pain, take a break until the pain subsides.