What is Piriformis Syndrome?

Piriformis syndrome is comparable to sciatica. Similarly, people with this condition will commonly report pain, numbness and/or pins and needles radiating down the leg. However, the main feature of piriformis syndrome is that symptoms originate from the buttocks muscles rather than the lumbar spine. It can be challenging to diagnose piriformis syndrome due to its similarities to sciatica and lack of definitive diagnostic testing. Anywhere between 6-36% of people experiencing sciatica symptoms are related to this condition [1]. However, there are medical treatments and strategies available to help reduce symptoms.
 

Piriformis Syndrome Symptoms

Like sciatica, piriformis syndrome causes discomfort and/or disability that impact any of the body regions that the sciatic nerve impacts. Areas, where symptoms can be felt include:

• Bottom, hips and glutes
• Back of the thigh (especially the hamstring and groin)
• Leg and calf
• Foot

Symptoms that can be experienced in these areas include:

• Tingling, numbness and/or pins & needles
• Burning sensations
• Weakness and poor movement
• Dull aches and pains

What does piriformis syndrome feels like?

While symptoms can vary person-to-person, there are standard features of this condition that patients will report. Below are some of the most typical Google entries from people experiencing these symptoms.

• "Buttock pain when sitting"
• "Hip pain radiating down the legs to feet"
• "Pain in buttock cheek"
• "Pain in buttock when walking"
• "Pain down back of leg"

 

What Causes Piriformis Syndrome?

The Sciatic Nerve

Similar to sciatica, changes to the sciatic nerve are responsible for the symptoms felt down the leg. You can review the sciatic nerve's function and location by reading our sciatica article here. To summarise, any pressure or impact on a nerve can cause symptoms anywhere it travels through (e.g. buttocks, thigh, calf, etc.).

Piriformis Muscle

In the case of piriformis syndrome, compression on the sciatic nerve is usually not due to spinal abnormalities or conditions. Instead, changes in the piriformis muscle are the leading cause. The unique characteristic of this muscle is that the sciatic nerve travels near it [2]. As a result, any inflammation or spasming of the piriformis can cause direct pressure onto the nerve. This leads to symptoms down the sciatic nerve route, including the thigh, leg, and foot.

Common Causes

Behaviours, habits and events that lead to compression of the sciatic nerve are the most common causes of this condition. Additionally, some people are genetically more predisposed to this condition due to the unique location of their sciatic nerve in the buttocks [1]. Examples of behaviours associated with piriformis syndrome include:

• Sitting for long periods (e.g. office workers, couriers, truck drivers, etc.)
• Trauma or impact to the buttock and/or hip region (e.g. sports injuries, falling on the bottom, surgical procedures etc.)
• Overuse of the hip muscles (e.g. long-distance running, weightlifting, etc.)
• Sitting on hard surfaces (e.g. wooden chairs, having a wallet in your back pocket, etc.)

 

Piriformis Syndrome Tests and Diagnosis

Piriformis syndrome is usually diagnosed clinically rather than through any specific diagnostic testing. GPs will ask you relevant questions about the condition, such as your day-to-day habits and medical history. Below are a few tests that your GP may recommend to assist with a diagnosis.

Physical Examination

A physical examination of the affected areas, such as the hip, buttock and lower back, can be used to determine a diagnosis. An assessment of your movement and special tests can be performed to see whether the piriformis could be the source of your symptoms.

Imaging Investigations

Usual imaging investigations, such as MRIs and CT scans, will not diagnose piriformis syndrome definitively. However, these techniques can be used to determine whether other conditions could be causing symptoms instead (e.g. disc herniation, spinal stenosis, etc.) [3].
 

Piriformis Syndrome Treatment

Physiotherapy

Your GP may refer you to see a physiotherapist. These are health professionals who specialise in these types of physical conditions. They will also be able to perform a thorough physical assessment to confirm your diagnosis. Treatments can be performed to help ease symptoms and discomfort, including soft tissue release, massage, dry needling, cupping and electrotherapy. Additionally, specific piriformis syndrome exercises and stretches can be provided to help with recovery. Several sessions may be required to achieve the desired outcome.

Pain Medication and Injections

Medications, such as NSAIDs and muscle relaxants, can be prescribed by your GP to help reduce pain and discomfort [3]. Those with more severe or persistent symptoms may be recommended injections with corticosteroid or botox. Although these injections help reduce inflammation and muscle tightness, relief is often short-lived.

Lifestyle Changes

Changing your daily habits, which could be aggravating your symptoms, should also be a priority. Examples include:

• Reduce your time spent sitting
• Take regular breaks in between sitting
• Regular stretching throughout the day
• Avoid sitting on hard or firm surfaces (e.g. padding your seat with cushions)
• Avoid trauma to the buttock region

Surgery

Surgery may be an option for people with persistent symptoms and who fail other treatments [3]. During the procedure, the piriformis muscle can be released to decrease the pressure over the sciatic nerve. However, outcomes after surgery are mixed.
 

Recovery

Most people with piriformis syndrome will recover with daily stretching and modifying daily habits. Rarely will there be any additional treatment required.

How to sleep with piriformis syndrome?

An essential component of recovery is getting enough sleep. However, it can be difficult falling asleep with these symptoms. Below are some recommendations that may assist you during bedtime.

• Choosing or changing to a softer mattress
• Placing a pillow underneath the knees if you sleep on your back. Taking pressure off the buttock can help reduce stress onto the sciatic nerve.
• If you're a side sleeper, also consider placing a pillow between the knees. Creating neutral alignment of the body can also ease pressure away from the nerve.
• Stretching before you go to sleep.

 

Complications

Although most people with this condition make a full recovery, complications can occur if not appropriately managed. Examples include:

• Chronic leg pain and weakness
• Receiving unnecessary treatment which could be more harmful (e.g. surgery, injections, etc.)
• Inability to perform recreational or even everyday tasks

 

Receiving quality care from highly experienced doctors is essential for a prompt diagnosis and receiving the correct medical treatment. With 24-7 MedCare, you can experience telemedicine from the convenience of your own home. Our friendly online doctors will be available 24/7 for a consultation, anytime and anywhere in Australia.

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  References

1. Siddiq M. (2018). Piriformis Syndrome and Wallet Neuritis: Are They the Same?. Cureus, 10(5), e2606. https://doi.org/10.7759/cureus.2606
2. Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S., Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles, ligaments and tendons journal, 6(3), 384–396. https://doi.org/10.11138/mltj/2016.6.3.384
3. Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/