Piriformis syndrome

Piriformis syndrome

What is Piriformis syndrome?

Piriformis syndrome refers to irritation of the sciatic nerve as it passes through the Piriformis muscle located deep in the buttock. Inflammation of the sciatic nerve, called sciatica, causes pain in the back of the hip that can often travel down into the leg.

What is the piriformis muscle?

The piriformis is a muscle that travels behind the hip joint. The piriformis muscle is small compared to other muscles around the hip and thigh, and it aids in external rotation (turning out) of the hip joint. The muscle and its tendon have an intimate relationship to the sciatic nerve–the largest nerve in the body–which supplies the lower extremities with motor and sensory function. The piriformis tendon and sciatic nerve cross each other behind the hip joint, in the deep buttock. Both structures are about one centimeter in diameter.

How does it occur?

The Piriformis muscle is located deep in the buttock and pelvis and allows the thigh to rotate outward. The sciatic nerve travels from the back into the leg by passing through the Piriformis muscle. If it is unusually tight or goes into spasm, the sciatic nerve can become inflamed or irritated. Piriformis syndrome may also be related to intense downhill running.

What are the symptoms?

You have pain deep in your buttock that may feel like a burning pain. The pain usually travels down across your lower thigh. Your pain may increase when you move your thigh outward, such as when you are sitting cross-legged.

How is it diagnosed?

Your doctor will talk to you about when your symptoms began. Since your sciatic nerve begins in the back, it can be irritated from a back injury, such as a herniated disk. Your doctor will ask if you have had any injuries to your back or hip. He or she will examine your back to see if the sciatic nerve is irritated there. He or she will examine your hip and legs and move them to see if movement causes increased pain.  Your doctor may order     x-rays, a computed tomography (CT) scan, or a magnetic resonance image (MRI) of your back to see if there is a back injury. There are no x-ray tests that can detect if the nerve is being irritated at the Piriformis muscle.

How is it treated?

  • Massaging of the muscle frequently throughout the day.
  • Sitting on a tennis ball and rolling it under the buttock and hip where “trigger points” have formed will help release built up toxins and facilitate relaxation of the muscle. If this procedure is sore and painful, you are stimulating the right areas. Use this method on each trigger point area for 15-20 seconds each.
  • Applying iced on the affected area for 15-20 minutes frequently throughout the day.
  • Stretching once the acute pain is gone. Stretch gently by using a crossed-legged stretch while pulling up on the knee.
  • Corticosteroids and a local anesthetic can be injected into the muscle to help reduce pain and inflammation, enabling a patient to participate in stretching exercises.

How can I prevent Piriformis syndrome?

Piriformis syndrome is best prevented by stretching muscles that rotate your thigh inward and outward. It is important to have a good warm-up before starting and a good cool down after ending your sport or activity.