What is piriformis syndrome?
The piriformis muscle is a pear-shaped muscle in the buttocks that extends from the base of the spine to the top of the thigh. Tightness in this muscle can compress the sciatic nerve. The sciatic nerve is the largest nerve in the body. It extends from the lower spine down to the foot. Piriformis syndrome is a neuromuscular condition which can cause posterior hip pain, deep buttock pain and even shooting pain down the back of the leg. Piriformis Syndrome is commonly misdiagnosed. Boulder, Colorado orthopedic hip and sports medicine specialist, Dr. Austin Chen specializes in numerous hip conditions, including piriformis syndrome.
What are the symptoms of piriformis syndrome?
Inflammation or contracture of the piriformis can compress the nerve causing shooting pain down the leg, numbness and tingling in the lower extremity and deep posterior buttock pain. Some people with piriformis syndrome may think the problem is in the hamstrings. The main sign of piriformis syndrome is not tenderness in the hamstrings but very tender spots on the hips or buttocks. Piriformis syndrome can come on suddenly, usually following an injury, or it can appear gradually over several months.
- Tenderness or pain in the buttocks, usually on one side only
- Pain that radiates down the back of the leg to the hamstrings and sometimes the calves
- Nerve pain radiating from the buttocks down the leg
What are the risk factors for piriformis syndrome?
- An injury, such as a fall, a blow to the area, or a car accident
- Overuse, such as from frequent running, excessive exercise, or over stretching
- A sedentary lifestyle, especially with long periods of sitting
- Changing from a sedentary lifestyle to more frequent exercise
- Buttock muscles wasting away
- Muscle tension and excess weight due to pregnancy
What is the treatment for piriformis syndrome?
Piriformis syndrome can be treated with conservative measures including activity modification, physical therapy, anti-inflammatories and local ultrasound-guided injections.
- Becoming more active. Walking can relieve muscle tension throughout the body and prevent spasms from getting worse.
- Practicing strengthening activities that support the piriformis, buttock muscles, and hips. Hip extension and abduction exercises, which move the hips against resistance, are particularly useful.
- Managing pain with non-steroidal anti-inflammatory drugs (NSAIDs). These drugs should not be used to make hard physical activity less painful.
- Avoiding activities that make the pain worse. This often includes running. Rest can help, particularly in the days following an obvious injury.
It is necessary to make sure the pain is not referred pain from the lumbar spine. Many patients may need to see a spine specialist at some point during management of this condition. In the rare case that a patient’s piriformis syndrome is not improved with conservative measures, surgery to release the piriformis may be indicated.
