Piriformis syndrome is a chronic condition arising from the piriformis muscle. This muscle causes pain locally in the buttock. However, given its closeness to the sciatic nerve, we think it also causes irritation of the nerve. So, what is piriformis syndrome and how can you treat it?

What is the piriformis muscle?

This muscle is located at the back of the hip joint. Its primary function is to rotate the hip to the outside (external rotation). Importantly, the large sciatic nerve that supplies the lower leg leaves the buttock by passing under the muscle. So, we think part of the piriformis syndrome is related to irritation of the nerve as it passes under the piriformis muscle.

Possible causes 

Although somewhat controversial, we think that tightness of the piriformis muscle can lead to problems. Some people have an anatomical variation where the muscle and nerve are close together or tethered to each other. So, we suspect that in these people, the nerve can be irritated by the muscle.

Symptoms of piriformis syndrome

piriformis syndrome

Common symptoms of piriformis syndrome include:

  • pain in the buttocks
  • pins and needles and/or numbness in the lower leg
  • tenderness on pressing of the muscle and reproduction of pain with pressure

Overall, it is important to see a doctor to confirm the cause of buttock pain.

In general, there are many causes of buttock pain in sportspeople. Piriformis syndrome is a diagnosis of exclusion when other conditions are ruled out. Some examples of pathology that can mimic piriformis syndrome include hip arthritis, nerve pinching from the lumbar spine, and hamstring tendonitis.

Often, we use MRI scan to see the soft tissue in the buttock and rule out nerve pinching from the spine. Also, nerve studies may be helpful to confirm irritation of the sciatic nerve from the piriformis muscle.

Sometimes, in difficult cases, we use an injection into the piriformis muscle to help with the diagnosis. If we inject the muscle and the pain disappears, then we can be certain that the pain is coming from the piriformis. In general, we do this injection with ultrasound to increase accuracy.

Piriformis vs sacroiliac joint pain 

Often, it is difficult to know whether buttock pain is coming from the piriformis or the sacroiliac joint. These two structures sit close together. Sometimes, both structures can be causing buttock pain.

Generally, sacroiliac joint pain is tender at the joint – which is more to the centre than the piriformis muscle. Also, certain tests (such as Ober or posterior draw test) can bring on the pain. Frequently, MRI scans can point to degenerative changes in the sacroiliac joint such as swelling or spur formation.

Sometimes, we treat both structures if we think both is coming from both.

Treatment of piriformis syndrome

piriformis syndrome stretch

Generally, piriformis syndrome is a difficult condition to treat. It is important to individualise treatment based on what works for each person.

Firstly, exercise therapy to strengthen the muscle behind the hip is important. Secondly, stretching exercises to relieve muscle tightness can also be effective. Examples of Yoga stretching exercises include the pigeon, thread the needle, and butterfly. You must stop if you feel severe pain with these stretches. Thirdly, we use soft tissue therapy and acupuncture to reduce muscle tightness. Finally, a cortisone injection into the piriformis muscle can help with the therapy.

In rare cases, surgery to release the sciatic nerve from the piriformis muscle is done. However, surgery should only be considered when other simple treatments fail.

More about piriformis injection

Generally, the aim of a piriformis injection is to reduce pain from the piriformis muscle. Injecting the muscle helps to reduce pain and help with rehab. Usually, we inject a combination of local anesthetic and low-dose cortisone. Also, injections should be done under ultrasound guidance to make them more accurate and more effective.

Injections are done after the consultation and only take 15-20 minutes.

Final word form Sportdoctorlondon

Overall, we need to be cautious about making a diagnosis of piriformis syndrome. This condition is a diagnosis of exclusion only. We recommend you see your doctor to rule out other causes. Finally, most treatments aim at improving stability around the hip and flexibility of the hip muscles.

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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