What is Piriformis Syndrome and How Can It Be Treated?
What is Piriformis Syndrome?
Piriformis syndrome is a condition that affects the piriformis muscle, a muscle that stretches from the lower spine, through the glutes, and down to the top of the thighs. It’s often referred to as deep buttock pain or deep gluteal syndrome. When the piriformis muscle becomes inflamed, it can cause discomfort that’s not just annoying—it can be a pain in the butt!
When the piriformis muscle spasms or becomes inflamed, it can also compress the sciatic nerve, a long nerve that travels from the spinal cord through the glutes down the back of each leg to the feet. This can lead to additional pain and is often referred to as sciatica.
Are Piriformis Syndrome and Sciatica the Same?
Although sciatica and piriformis syndrome both involve the sciatic nerve, they are not the same condition. Sciatica symptoms occur when the sciatic nerve is compressed and may be caused by various conditions, including a herniated disc, degenerative disc disease, and back injuries.
On the other hand, piriformis syndrome is a condition that involves only the piriformis muscle, which irritates or compresses the sciatic nerve.
Several conditions may also cause sciatic nerve compression. However, according to the International Journal of Surgery Case Reports, piriformis syndrome may cause 0.5% to 17% of cases of sciatica and low back pain1.
What Causes Piriformis Syndrome?
The most common causes of piriformis syndrome include the following:
- Overuse: Repetitive motions, such as climbing stairs, cycling, and running, may lead to muscle spasms, tightness, or inflammation of the piriformis muscle.
- Anatomical abnormalities: Structural abnormalities, like variations in the piriformis muscle's shape or the sciatic nerve's path, can raise the risk of piriformis syndrome.
- Trauma: Injuries from a motor vehicle accident, sports injury, or a fall can injure or irritate the piriformis muscle, leading to spasming and inflammation.
- Prolonged sitting: Sitting for long periods may lead to continuous pressure on the piriformis muscle, causing tightness and inflammation.
Type of Piriformis Syndrome
Piriformis syndrome can be categorized into two types, depending on its cause:
- Primary piriformis syndrome: This type of piriformis syndrome is caused by an anatomical abnormality, such as having a sciatic nerve that takes an abnormal path throughout the body.
- Secondary piriformis syndrome: This condition is caused by outside factors such as bad posture or excessive muscle use.
Whether the condition is primary or secondary, treatment for piriformis syndrome remains the same.
Piriformis Syndrome Symptoms
The main symptom of piriformis syndrome is pain, which usually develops in the glutes, hip, or upper thigh. The quality of the pain may include:
- Aching
- Shooting
- Burning
If the sciatic nerve becomes entrapped, additional symptoms, including weakness, numbness, or tingling that extends down the back of the leg, may develop. Symptoms may worsen during certain activities, such as walking, climbing stairs, or sitting for extended periods.
How Do Doctors Diagnose Piriformis Syndrome?
Doctors diagnose piriformis syndrome through a combination of physical exams and symptom reviews. During your physical exam, the doctor may rotate, stretch, and press your glute muscles, hip, and leg to determine what hurts.
Diagnostic imaging tests can help rule out other conditions that cause sciatic nerve compression, including herniated discs and spinal stenosis. Imaging tests recommended to rule out other conditions include:
- MRIs
- CT scans
- EMGs
Piriformis Syndrome Treatment
Treatment for piriformis syndrome may include a combination of medication, lifestyle modifications, and exercises. In most cases, conservative treatment is recommended as the first option. Further treatment options for piriformis syndrome include those listed below.
Home Treatment
Home treatment may include rest, ice, and over-the-counter non-steroidal anti-inflammatory medications such as ibuprofen. However, rest does not mean being completely sedentary. Prolonged sitting can actually exacerbate piriformis syndrome.
Instead, avoid activities that may have strained the muscle, such as running, jumping, or excessive stair climbing.
Medications
Medication may include muscle relaxants to decrease muscle spasms. Anti-inflammatory medicines can also help reduce inflammation. Over-the-counter pain relievers, such as acetaminophen, may be helpful to ease discomfort. However, doctors typically avoid prescribing opioid pain medications due to the risk of side effects and dependency.
Physical Therapy
Physical therapy is also useful for treating piriformis syndrome and preventing its recurrence. PT may include strengthening and stretching exercises to reduce muscle spasms and tension and promote sciatic nerve mobilization.
Therapists may use additional modalities such as ultrasound, electrical muscle stimulation, and heat and cold therapy.
Physical therapy treatment plans are individualized for each patient based on the severity of their symptoms and overall health and may last several weeks.
Trigger Point Injections
Continued muscle spasms can lead to the development of pinpoint trigger areas of tense contracted muscle fiber. These trigger points can irritate the sciatic nerve.
Trigger point injections deactivate a muscle spasm and relieve the pain associated with piriformis syndrome. A trigger point injection is generally a quick procedure and may offer pain relief for up to a month or longer 2.
Using fluoroscopic guidance, the physician inserts a needle into the trigger point of the piriformis muscle and injects a steroid to reduce inflammation, muscle tightness, and pain.
Botox Injections
Botox is a neurotoxin that inhibits signals from the nerves to the muscles. It temporarily relaxes muscles and is used therapeutically to treat various conditions, including piriformis syndrome. The Botox is injected directly into the piriformis muscle, relaxing tension and decreasing pressure on the sciatic nerve to reduce pain.
Surgery
Typically, doctors do not recommend surgery for piriformis syndrome unless all other types of treatments fail. Surgery may include a procedure to release the pressure on the nerve and remove scar tissue.
How Long Does it Take to Recover from Piriformis Syndrome?
The time it takes to recover from piriformis syndrome may vary depending on the extent of inflammation. Typically, mild piriformis syndrome decreases with rest in about 1 to 2 days 3. However, in moderate cases, symptoms could take a few weeks to resolve.
Can You Prevent Future Episodes of Piriformis Syndrome?
Although you may not be able to prevent all instances of piriformis syndrome, you can take steps to decrease your risk and prevent future occurrences.
Consider some of the following suggestions:
- Get regular exercise: Regular exercise can strengthen the piriformis muscle and surrounding hip muscles. Regular hip and piriformis muscle stretching can also help reduce the risk of injury. Always perform a proper warm-up before engaging in exercise to reduce the risk of muscle strain.
- Maintain good posture: This includes practicing good posture while sitting, standing, and walking. For example, when walking, stand up straight, engage the core, and keep the head level.
- Lift properly: To lift properly and safely, bend the knees, keep the back straight, and keep the object close to the body.
- Avoid prolonged sitting: Those with sedentary jobs should take frequent breaks to walk around and stretch. This relieves pressure on the piriformis muscle and may reduce the risk of an overuse injury.
If you develop piriformis syndrome repeatedly, physical therapists and physical medicine specialists can play an important role in preventing and treating piriformis syndrome.
Conclusion
Piriformis syndrome is a condition caused by inflammation of the piriformis muscle, which compresses the sciatic nerve. It causes pain, numbness, and weakness in the glute, hip, and leg.
Treatment generally includes lifestyle changes, physical therapy, exercise, and possible injections.
If you have symptoms of piriformis syndrome, call or text (480) 573-0130 or reach out online to schedule a consultation and discuss treatment options.
References
- Fahmi A, Rahmadhan MA, Aprianto DR, Subianto H, Turchan A. Complete resolution of recurrent piriformis syndrome after piriformis resection with 3 years' follow up: A case report. Int J Surg Case Rep. 2020;77:576-579. doi: 10.1016/j.ijscr.2020.11.099. Epub 2020 Nov 20. PMID: 33395849; PMCID: PMC7708764. https://pmc.ncbi.nlm.nih.gov/articles/PMC7708764/
- How Long Does Piriformis Syndrome Last? (2022). Spine health. https://www.spine-health.com/blog/how-long-does-piriformis-syndrome-pain-last
- Trigger Point Injections. (2022).Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/17582-trigger-point-injection