Piriformis Syndrome

Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs in short, in almost every motion of the hips and legs.

The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.

Sciatica is the main symptom of piriformis syndrome. Sciatica is a pain that starts in the buttocks and runs down one or both legs. Sciatica is usually caused by pressure or irritation of nerves in the lower back. Often the discomfort is felt in another part of the body, such as the back of the leg. Some other common signs of piriformis syndrome include:

• Numbness and tingling in the buttocks that may extend down the back of the leg
• Tenderness of the muscles in the buttocks
• Difficulty sitting comfortably
• Pain while sitting that gets worse the longer you sit
• Pain in the buttocks and legs that worsens with activity

In serious cases of piriformis syndrome, the pain in buttocks and legs can be so severe it becomes disabling. Patients may become unable to complete basic, everyday tasks, such as sitting at a computer, driving for any length of time, or performing household chores.

The piriformis gets a workout every day. We use this when we walk or turn our lower body. We also use it just from shifting our weight from one side to the other. The muscle can become injured or irritated from long periods of inactivity or too much exercise.

Some common causes of piriformis syndrome include:

• Overuse from excessive exercise
• Running and other repetitive activities involving the legs
• Sitting for extended periods
• Lifting heavy objects
• Extensive stair climbing

Injuries can also damage the muscle and cause it to press down on the sciatic nerve. Typical piriformis injury causes include:

• A sudden twist of the hip
• A bad fall
• A direct hit during sports
• A vehicle accident
• A  penetration wound that reaches the muscle

Your doctor will do a physical exam which would include a review of your medical history, your symptoms, and any possible causes of your pain. Patients need to discuss the symptoms in detail. If you had a recent fall or recall straining a muscle during sports, be sure to share that information with your doctor. You will be put through a range of movements in order to tell what positions cause pain. Some imaging tests may also be necessary to help rule out other causes of your pain. An MRI scan or a CT scan may help your doctor determine whether arthritis or a ruptured disk is causing your pain. If it appears that piriformis syndrome is causing your symptoms, an ultrasound of the muscle may be helpful in diagnosing the condition.

Rest and avoiding activities that trigger your symptoms are usually the first approaches to take. Over-the-counter painkillers may also help you feel better. In serious cases of piriformis syndrome, people suffering may need injections of corticosteroids(duly prescribed by the medical practitioners) to help relieve inflammation of the muscle. The pain and numbness associated with piriformis syndrome may go away without any further treatment. If it doesn’t, the patient may benefit from physical therapy. The patient will learn various stretches and exercises to improve the strength and flexibility of the piriformis.

Physical Therapy

Physiotherapy interventions include Ultrasound Therapy, Soft Tissue Mobilization, Piriformis Stretching, hot packs or cold spray and various lumbar spine treatments. It focuses on functional exercises for the hip, that aims at strengthening the hip extensors, abductors and external rotators, as well as correction of faulty movement patterns. Hence, to achieve a 60 – 70% improvement, the patient usually follows 2-3 treatments weekly for 2-3 months.

A patient may also find relief after Transcutaneous Electrical Nerve Stimulator (TENS) treatment. The TENS device is a handheld unit that sends small electrical charges through the skin to the nerves underneath. The electrical energy stimulates the nerves and interferes with pain signals to the brain. In some cases, patients may need surgery to cut the piriformis muscle to ease pressure on the sciatic nerve. However, this is rarely needed.