Piriformis Syndrome

The piriformis is an external rotator muscle of the hip joint. It originates in the lower portion of the pelvis and connects to the top of the thigh bone in the buttocks region. The sciatic nerve runs perpendicular through this region along its way to the lower legs.

The hallmark of piriformis syndrome is pain in the buttocks that may burn and shoot down the back of the leg into the foot. There may also be numbness or tingling along the sciatic nerve distribution.

Symptoms include:

• Chronic buttock and hip pain
• Inability to sit for prolonged periods
• Pain that worsens with hip movement
• Pain when walking or running
• Pain when climbing stairs

When the piriformis muscle is overused, it swells, spasms and irritates the adjacent sciatic nerve causing symptoms.

Causes include:

• Sports
• Hip or buttocks trauma
• Sitting for prolonged periods
• Poor posture
• Anatomic anomalies – sometimes the sciatic nerve runs through the piriformis muscle.
• Scoliosis

Diagnosis is based on clinical history and comprehensive physical exam. Conditions that must be ruled out include lumbar spinal stenosis, disc degeneration, lumbar muscle strain, hamstring injury, and some pelvic causes. The expert team at LALL Orthopedics+ will order imaging such as X-Ray, MRI or CT scans to evaluate for these conditions. An MRI can also reveal the presence of nerve entrapment when the nerve runs through the muscle. Specialized physical exam maneuvers will be used to pinpoint the cause of your symptoms and guide management options.

Early, correct diagnosis is important to prevent nerve entrapment and scarring, which can lead to long-term pain and discomfort.

First line treatment is conservative management with short term rest, muscle relaxants, anti-inflammatory medications, and physical therapy. Botox, steroid or regenerative medicine injections such as Stem-Cell Therapy and Platelet-Rich Plasma (PRP) injections around the inflamed muscle can help decrease pain. If conservative measures have been tried without success, minimally invasive outpatient surgical options exist to decompress the sciatic nerve.

Athletes can return to play once they have pain-free range of motion and return of muscle strength/endurance. The key to preventing a recurrence is avoiding prolonged sitting, regular exercise and incorporating stretching into daily life.