Piriformis Syndrome
Piriformis syndrome occurs when the piriformis muscle deep within the buttock irritates or places pressure on the sciatic nerve. This can cause pain in the buttock along with burning, tingling, numbness or radiating discomfort that may travel down the back of the leg.
What Is the Piriformis Muscle?
The piriformis is a small muscle located deep in the buttock beneath the gluteal muscles. It extends from the lower pelvis toward the upper femur and helps stabilize the hip while assisting with rotation and outward movement of the leg.
The Piriformis & Sciatic Nerve
The sciatic nerve travels from the lower spine through the buttock and down the leg. In most people, it passes beneath the piriformis muscle. Tightness, swelling or spasm in the muscle may irritate nearby portions of the nerve and produce sciatica-like symptoms.
How Piriformis Syndrome May Feel
Symptoms commonly begin in the buttock and may become worse after sitting for a prolonged period or during activities that repeatedly use the hip muscles.
Common Symptoms May Include:
Why Can the Piriformis Become Painful?
Piriformis syndrome can develop when the muscle becomes irritated, tight, inflamed or repeatedly overloaded.
Injury or Trauma
A fall, direct blow or other injury to the buttock or hip region can cause inflammation or muscle spasm around the piriformis.
Repetitive Activity
Running, climbing, repetitive hip rotation or other activities can overwork the piriformis and surrounding muscles.
Muscle Spasm
Spasm or persistent tightening of the piriformis can increase pressure within the buttock and irritate the nearby sciatic nerve.
Movement & Muscle Imbalance
Weakness, tightness or abnormal movement patterns involving the hips and pelvis can place additional strain on the piriformis muscle.
Similar Symptoms Can Have Different Causes
Piriformis syndrome can resemble lumbar sciatica, which is why a thorough examination is important before treatment begins.
Piriformis Syndrome
With piriformis syndrome, sciatic nerve irritation is believed to occur in the deep buttock region near the piriformis muscle. Buttock pain and symptoms aggravated by prolonged sitting or hip movement are common.
Lumbar Sciatica
Traditional sciatica often originates from nerve-root irritation in the lumbar spine caused by conditions such as a herniated disc or spinal stenosis. Symptoms may be similar, but the source of the nerve irritation is different.
How Piriformis Syndrome Is Diagnosed
There is no single test that definitively confirms piriformis syndrome. Diagnosis often involves examining the hip and buttock and ruling out other causes of sciatic-type pain.
Your provider will review when symptoms began, which activities worsen them and whether there has been an injury or change in activity.
Hip movement, muscle strength, tenderness and specific positions that reproduce symptoms may be evaluated.
Strength, sensation and reflexes may be checked to determine whether symptoms could originate from a spinal nerve root.
MRI, X-ray or other studies may be used primarily to evaluate the lumbar spine, hip or other possible sources of symptoms.
Treating Piriformis Syndrome
Treatment is usually focused on reducing irritation around the piriformis, improving flexibility and correcting factors that may be placing excess stress on the muscle.
Physical Therapy
Stretching of the piriformis and surrounding hip muscles, strengthening and movement retraining can help reduce tension and improve mobility.
Heat & Soft-Tissue Therapy
Heat, massage and other soft-tissue techniques may help reduce muscle tightness and spasm in selected patients.
Medication
Anti-inflammatory or other pain medications may be recommended when appropriate to help control pain and inflammation.
Piriformis Injection
In selected cases, an image-guided injection of local anesthetic and corticosteroid may help reduce pain and inflammation around the piriformis muscle.
It May Feel Like Sciatica — But the Source Matters.
Sciatic-type symptoms can originate from the lumbar spine, the deep gluteal region or other structures along the nerve's pathway. Treating the correct source is essential. A thorough evaluation can help determine whether the piriformis muscle, a spinal nerve or another condition is responsible for the pain.
Experiencing Buttock Pain That Travels Down Your Leg?
Schedule a consultation to identify the source of your symptoms and discuss treatment options for piriformis-related pain.