Quick Summary
Piriformis syndrome is commonly understood as pain caused by irritation of the sciatic nerve near the piriformis muscle. However, a Daradia-associated study published in the Journal on Musculoskeletal Ultrasound and Pain Medicine suggests that many cases are not purely primary muscle problems.
The study reviewed 578 patients with hip and buttock pain. Among them, 99 patients (17.13%) were diagnosed with piriformis syndrome, and the majority had secondary piriformis syndrome, meaning the piriformis-related pain was associated with another underlying condition such as lumbo-sacral pathology, spondyloarthropathy, degenerative arthropathy, or sacroiliac joint involvement.
The study was approved by the Daradia Ethics Committee and registered with the Clinical Trial Registry of India.
CTRI Number: CTRI/2022/07/044438
Understanding Piriformis Syndrome
Piriformis syndrome is a painful condition in which the sciatic nerve is irritated or compressed near the piriformis muscle, a deep muscle located in the buttock region.
Patients with piriformis syndrome may experience:
- Deep buttock pain
- Pain radiating to the thigh or leg
- Sciatica-like symptoms
- Pain while sitting for long periods
- Pain aggravated by hip movement
- Local tenderness around the sciatic notch
Because these symptoms can resemble lumbar disc prolapse, sciatica, sacroiliac joint pain, or spinal stenosis, piriformis syndrome can be difficult to diagnose accurately.
This is why a patient with buttock pain should not be labeled as having a simple muscle spasm without proper clinical evaluation.
Primary and Secondary Piriformis Syndrome
Piriformis syndrome may be broadly divided into two types.
Primary Piriformis Syndrome
Primary piriformis syndrome is usually due to local anatomical factors, such as variations in the piriformis muscle or the sciatic nerve. It is relatively uncommon.
Secondary Piriformis Syndrome
Secondary piriformis syndrome occurs when another underlying condition contributes to piriformis-related pain. These associated conditions may include:
- Lumbo-sacral pathology
- Lumbar disc prolapse
- L5–S1 or L4–L5 PIVD
- Sacroiliac joint arthropathy
- Spondyloarthropathy
- Lumbar canal stenosis
- Degenerative arthropathy
- Fibromyalgia or widespread pain syndromes
This distinction is very important because treating only the piriformis muscle may not be enough if the real pain generator lies elsewhere.
About the Study Conducted at Daradia: The Pain Clinic
The study titled “Unmasking Secondary Piriformis Syndrome: A Retrospective Analysis of 578 Patients with Hip and Buttock Pain” was published in the Journal on Musculoskeletal Ultrasound and Pain Medicine in 2026.
It reviewed electronic medical records of patients presenting with hip and buttock pain. Patients were evaluated using clinical findings such as tenderness and provocative tests, along with lumbo-sacral MRI findings.
The study followed an ethical and structured research pathway. It was:
- Approved by the Daradia Ethics Committee
- Registered with the Clinical Trial Registry of India
- Registered as CTRI/2022/07/044438
For Daradia, this is an important example of how daily pain practice can generate meaningful clinical research when observations are properly documented, ethically reviewed, and scientifically published.
Key Findings of the Study
Out of 578 patients with hip and buttock pain:
| Finding | Result |
|---|---|
| Total patients screened | 578 |
| Patients diagnosed with piriformis syndrome | 99 |
| Primary piriformis syndrome | 5 |
| Secondary piriformis syndrome | 94 |
| Prevalence of primary piriformis syndrome | 0.87% |
| Prevalence of secondary piriformis syndrome | 16.26% |
The main message is clear: secondary piriformis syndrome was much more common than primary piriformis syndrome.
Common Conditions Associated With Secondary Piriformis Syndrome
Among patients with secondary piriformis syndrome, the common associated causes were:
| Associated Condition | Frequency |
|---|---|
| Lumbo-sacral pathology | 37.23% |
| Spondyloarthropathy | 27.66% |
| Degenerative arthropathy | 14.89% |
| Fibromyalgia | 11.7% |
| Others | 8.51% |
Among lumbo-sacral pathologies, the common findings were:
| Lumbo-sacral Finding | Frequency |
|---|---|
| L5–S1 PIVD | 40.00% |
| L4–L5 PIVD | 28.57% |
| Lumbar canal stenosis | 22.86% |
| Internal disc disruption | 8.57% |
This means that in many patients, piriformis syndrome may be part of a broader lumbo-sacral or musculoskeletal disorder rather than an isolated muscle problem.
Why This Study Matters for Patients
Many patients with buttock pain are told that they have piriformis spasm, sciatica, or disc pain. But symptoms often overlap.
A patient may have pain in the buttock region, but the actual source may be:
- Lumbar disc disease
- L5–S1 nerve root irritation
- Sacroiliac joint pathology
- Spondyloarthropathy
- Lumbar canal stenosis
- Degenerative joint disease
- Piriformis muscle involvement
This study highlights that buttock pain needs a complete evaluation. The pain may be felt around the piriformis muscle, but the underlying cause may be elsewhere.
Why This Study Matters for Physicians
For physicians, this study reinforces a crucial principle in pain medicine:
The site of pain is not always the source of pain.
A patient may have piriformis tenderness, positive FAIR test, or sciatica-like symptoms, but that does not always mean the piriformis muscle is the only pathology.
In suspected piriformis syndrome, physicians should also consider:
- Lumbar radiculopathy
- Lumbar disc prolapse
- L5–S1 and L4–L5 PIVD
- Sacroiliac joint pain
- Facet arthropathy
- Spondyloarthropathy
- Spinal canal stenosis
- Fibromyalgia
A narrow diagnosis may lead to partial treatment. A broader clinical approach can help identify the true driver of pain and improve outcomes.
Importance of CTRI Registration
The study was registered with the Clinical Trial Registry of India as:
CTRI/2022/07/044438
This is an important research quality marker.
CTRI registration reflects transparency, accountability, and structured research documentation. For a clinical pain study, this adds credibility and shows that the study was not merely an informal observation, but part of a systematic academic process.
At Daradia, this is especially meaningful because it represents a larger vision: converting real-world clinical experience into ethical, publishable, India-based pain medicine evidence.
Daradia’s Clinical Message
Piriformis syndrome should not be treated as a routine muscle spasm in every patient.
When a patient presents with buttock pain or sciatica-like symptoms, the evaluation should include the piriformis muscle, but it should not stop there.
A good pain physician must ask:
- Is this primary piriformis syndrome?
- Is it secondary piriformis syndrome?
- Is there L5–S1 or L4–L5 disc pathology?
- Is the sacroiliac joint involved?
- Is there spondyloarthropathy?
- Is there lumbar canal stenosis?
- Is the pain part of a wider musculoskeletal or nociplastic pain condition?
This approach can prevent misdiagnosis and help guide more precise treatment.
When Should You See a Pain Physician?
You should consider consulting a pain physician if you have:
- Persistent buttock pain
- Sciatica-like pain going down the leg
- Pain while sitting
- Pain not improving with routine medicines
- Pain returning after physiotherapy
- Low back pain with buttock radiation
- Suspected piriformis syndrome
- Suspected sacroiliac joint or lumbar disc pain
At Daradia: The Pain Clinic, Kolkata, patients with buttock pain, sciatica, piriformis syndrome, and spine-related pain are evaluated with a structured clinical approach to identify the actual source of pain.
Final Takeaway
Piriformis syndrome is not always a primary piriformis muscle disorder.
Daradia’s CTRI-registered study shows that secondary piriformis syndrome is much more common than primary piriformis syndrome. The most frequent association was lumbo-sacral pathology, especially L5–S1 PIVD.
For patients, this means persistent buttock pain deserves proper diagnosis.
For physicians, this means piriformis syndrome should be evaluated as part of a broader spine, sacroiliac, and musculoskeletal pain framework.
Frequently Asked Questions
What is piriformis syndrome?
Piriformis syndrome is a condition where the sciatic nerve is irritated or compressed near the piriformis muscle in the buttock region. It can cause buttock pain and sciatica-like pain radiating to the thigh or leg.
What is secondary piriformis syndrome?
Secondary piriformis syndrome occurs when piriformis-related pain is associated with another underlying condition, such as lumbar disc disease, sacroiliac joint arthropathy, spondyloarthropathy, or spinal canal stenosis.
Is piriformis syndrome the same as sciatica?
No. Sciatica is a symptom pattern involving pain along the sciatic nerve. Piriformis syndrome can mimic sciatica, but sciatica can also occur due to lumbar disc prolapse, spinal stenosis, or nerve root compression.
Can L5–S1 disc prolapse cause piriformis-like pain?
Yes. In the Daradia-associated study, L5–S1 PIVD was the most common lumbo-sacral pathology associated with secondary piriformis syndrome.
Why is CTRI registration important?
CTRI registration means the study was registered with the Clinical Trial Registry of India. The CTRI number for this study is CTRI/2022/07/044438. It reflects transparency and strengthens the credibility of the research process.
Where can I consult for piriformis syndrome in Kolkata?
Patients with persistent buttock pain, sciatica-like symptoms, or suspected piriformis syndrome can consult Daradia: The Pain Clinic in Kolkata for evaluation by experienced pain physicians.
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