Piriformis Syndrome: That You Need To Know

What is Piriformis Syndrome?

Piriformis syndrome occurs when there is compression of the sciatic nerve or one of its branches by the contracted piriformis muscle. Piriformis is a muscle located deep in the buttock near the top of the hip joint. Here piriformis and the sciatic nerve run adjacent to one another. As a result, sometimes, the irritated or injured piriformis compresses the nerve and causes pain in the buttocks and hip. It affects women six times more than men. About five percent of all sciatic nerve cases are caused by piriformis syndrome.

What are the causes of Piriformis Syndrome?

Piriformis syndrome has identifiable and non-identifiable causes. Identifiable causes include:

• Injury
• Anatomical problems like abnormal development or location of piriformis
• Too much stair climbing
• Heavyweight lifting
• Prolonged sitting with a wallet directly below the piriformis
• Excessive muscle use due to vigorous exercise
• Leg-length discrepancies (anisomelia)
• Muscle tension due to excess weight during pregnancy

The muscle may also get injured during accidents such as:

• Automobile accident
• A bad fall
• A direct hit in the sports
• Sudden hip twisting
• A penetrating wound

What are the signs and symptoms of Piriformis Syndrome?

The signs and symptoms of piriformis syndrome are identical to that of sciatica or slipped disc. That’s why another name of this condition is pseudo sciatica. In reality, the person with the disease complains of sharp radiating pain from the buttocks down into the legs and foot. There will be lower back or buttock pain also. Common symptoms are as follows:

• Dull, aching pain which starts from the lower back or buttocks and extends downward
• Tenderness in the buttocks
• Tingling or numbness that radiates from the buttocks down into the legs and feet
• Difficulty sitting comfortably or walking for a longer duration
• Pain that worsens (becomes sharp) with activity

Usually, the pain of piriformis syndrome affects only one side of the body.

How to make a diagnosis of Piriformis Syndrome?

The diagnosis of piriformis syndrome is based on:

• Signs and symptoms such as pain, numbness, or tingling
• Medical history of a recent injury or fall
• Physical examination to check for tenderness on the buttocksas, ability to cross legs or sit comfortably. One important physical examination is the FAIR test. It stands for flexion, adduction, and internal rotation. These are movements in which the piriformis muscle plays an important role. If these movements cause pain in the buttocks, the test is positive for piriformis syndrome.
• An MRI or a CT scan helps detect nerve inflammation or rule out other conditions such as arthritis or disc slip.

How is the prognosis of Piriformis Syndrome?

People with piriformis syndrome get better by following doctors’ recommendations. The treatment options work well for most people. Since it is soft tissue damage, the condition may become chronic and the nerve damage permanent. Hence, early diagnosis is crucial for a better prognosis and to prevent recurrences of the syndrome.

What are the treatments of Piriformis Syndrome?

Although medications have roles, the first-line treatment is physical therapy, exercise, and stretching. Following are medications to relieve pain:

• OTC-pain relievers like ibuprofen
• Prescription pain relievers or muscle relaxants

Usually, rest and avoiding pain-triggering activities are necessary.

Alternating between ice and heat on the buttocks and legs may also prove effective. Applying ice for 15 to 20 minutes every couple of hours, followed by heat, can help relieve pain.

Exercise and other therapies include:

• Stretching exercises to relieve tight piriformis
• Strengthening exercises to help piriformis regain its function.
• Avoiding activities that worsen pain like running
• Maintaining a good posture
• Massaging may also prove effective

What are interventional managements?

When the symptoms persist, interventional pain management is needed. Trigger point injection is the treatment of choice. Ultrasonography of fluoroscopy is needed to increase the accuracy for best results. At times, corticosteroids are added in resistant cases.

Sometimes, few patients need Botulinum toxin of BOTOX injection, which is another very good treatment option. But, it is preferred when there is a recurrence of symptoms even after trigger point injections.

Is there any role of surgery in Piriformis Syndrome?

Lastly, if all the above options don’t work for you, surgery is needed to dissect the piriformis to release the sciatic nerve is the last resort.