Piriformis Syndrome - Understanding the Pain

What is Piriformis Syndrome?

Piriformis syndrome is an uncommon neuromuscular disorder that most often results in irritation of the sciatic nerve.

The piriformis muscle is a small muscle situated deep in the upper buttocks that run between the hip joint (femur) and lumbar spine (low back) at a diagonal. This muscle plays an essential role in our mobility because it stabilizes the hip and allows the thigh to rotate externally and out to the side (abduction). Without piriformis weakness or pain, it can become difficult to complete daily weight-bearing tasks and shift weight due to lack of stability. 

When this muscle spasms it can press on the sciatic nerve that runs directly beneath it, causing sciatica, and is known as piriformis syndrome. Pain and numbness are the most common symptoms associated with the condition. If symptoms affect both sides of the buttocks, it’s referred to as bilateral piriformis syndrome (even more uncommon).

Piriformis Syndrome vs. Sciatica

When the piriformis muscle spasms or gets overused, it can press down on the sciatic nerve in some people. This leads to sciatic pain—a type of referred pain that starts in the buttocks and moves down the legs along its neural pathway.

Not everyone is at equal risk of piriformis syndrome, however, because the sciatic nerve doesn’t always pass through the piriformis muscle. In fact, only seventeen percent of the population are built like this. People in this subgroup are at higher risk of piriformis syndrome. Other people can develop the condition if the piriformis muscle and the sciatic nerve are very close together.

On the other hand, sciatica can also be caused by other underlying issues that are causing nerve compression in people that don’t have piriformis syndrome. For example, the spine, caused by bone spurs, spinal stenosis, or a herniated disc, is one of the most common causes of sciatica.

More on Sciatica Pain Here

Piriformis Syndrome Causes and Risk Factors

Piriformis muscle syndrome occurs when this muscle spasms and becomes excessively tight. Because we use this muscle every day—when walking, running, or even rotating the lower body—it can easily get injured with poor biomechanics or repetitive overuse.

You may experience a spasm in the piriformis muscle due to:

• Long periods of inactivity
• Too much exercise resulting in overuse of the muscle
• Lifting heavy items
• Repeatedly climbing stairs or other inclines
• Irritation of local joints, such as the hips or the sacroiliac joint (SI)

Direct trauma or injury to the gluteal muscle can also cause piriformis syndrome due to local swelling or bleeding. You might sustain an injury if you:

• Suddenly twist your hip
• Fall or slip
• Are involved in a car accident
• Receive a penetrating wound that hits the muscle
• Collide with another player or object during contact sports

Symptoms of Piriformis Syndrome from Pregnancy

Back pain and sciatica are common during pregnancy, especially in the second half of gestation (end of the second and third trimester). As the baby and belly grow and weight is gained, it has been found that biological changes can occur within the hip muscles themselves, including the piriformis. The piriformis is under extra strain during pregnancy secondary to elongation and biomechanical changes that put it under further strain. If muscle spasms and sciatica are present, piriformis syndrome may be the cause.

Piriformis Syndrome from Running

The piriformis plays a vital role in strength and stability with running. The muscle is subject to overuse with running (particularly if increasing distance or pace too quickly) and can result in the onset of the syndrome and sciatic nerve pain. Most often, runners will notice the most discomfort with sitting after they are done with their run. Knowing how to recognize this syndrome and treat it can help runners stay active with less risk of further injury.

Piriformis Syndrome Symptoms

Piriformis syndrome by itself doesn’t cause many symptoms. Instead, it irritates the sciatic nerve, which causes several symptoms including:

• Shooting buttock pain, that can also travel down the back of the thigh
• Numbness or tingling in the butt or back of the leg
• Leg pain
• Low back pain
• Tingling
• Tenderness of the piriformis muscle (deep in the glutes)
• Difficulty finding a comfortable way to sit

For people with piriformis syndrome, sitting down for too long makes symptoms worse, but so does too much movement. This can make everyday tasks more challenging, especially for those with severe piriformis syndrome that causes disabling pain.

Piriformis Syndrome Diagnosis

If you have pain or numbness in your legs, buttocks, or back for more than two weeks, see your doctor for an accurate diagnosis.

While there is no definitive piriformis syndrome test, your doctor will be able to make a diagnosis based on your description of your symptoms and an in depth physical examination. They will ask you to move about in a variety of ways and palpate the buttock area to check for pain and tenderness.

They may also order imaging tests, including:

Piriformis Syndrome MRI

An MRI scan shows soft tissue damage in the body. This scan may help your doctor determine whether other conditions, such as arthritis or a herniated disk, are responsible for the pain.

Piriformis Syndrome Ultrasound

An ultrasound uses sound waves to show images on a screen. It may help confirm a diagnosis of piriformis syndrome.

Treating and Preventing Piriformis Syndrome

Treating piriformis syndrome is typically pretty straightforward. Home treatment is often enough with pain medication (anti-inflammatories or even corticosteroid injections), stretches, proper warm up before exercise, and self-massage. Additional remedies might be needed as well such as muscle relaxants or a round of physical therapy that includes biomechanical training, complete physical exam, professional massage, education, and more. 

Being able to differentiate piriformis syndrome from other causes of sciatica is a great first step in finding an effective treatment strategy that gives adequate pain relief. Additionally, understanding the potential causes can help prevent the onset of symptoms in the first place and keep them from becoming more severe or result in the onset of chronic pain. Talk to your sports medicine doctor or physical therapist about concerns you have related to your symptoms.