Piriformis Syndrome refers to a neuromuscular disorder that affects the Piriformis muscle located in the buttock. This muscle begins at the lower spine and connects it to the femur (thigh bone) with the sciatic nerve running beneath it. The Piriformis muscle enables the rotation of the hip and forward leg movement. The syndrome is a result of stress or irritation caused to the muscle which, in turn, compresses the underlying sciatic nerve. It may lead to pain, spasm or numbness in the buttock radiating downwards to the thigh, lower leg and calf muscles. It is a complex medical condition that needs to be diagnosed and treated at the earliest as it may lead to a host of other pathological problems.
What Is the Piriformis?
A small muscle in the buttocks that runs from the sacral region of the spine, individuals can find the piriformis muscle under the gluteus maximus. The piriformis muscle runs over the sciatic nerve to the top part of the femur called the greater trochanter. The piriformis muscle has a variety of roles. The main roles of the piriformis muscle include stabilizing the pelvis, allowing for lateral rotation of the leg, stabilizing movement, walking and running.
What Is Piriformis Syndrome?
Piriformis Syndrome occurs from an impingement of the sciatic nerve due to compression from a malfunctioning piriformis muscle. Multiple causes of piriformis syndrome exist. Often, the patient overuses the piriformis muscle. With overuse, the piriformis muscle may damage, leading to spasms or freezing of the muscle in a contracted position. The Piriformis muscle when behaving this way can compress the sciatic nerve causing the same Sciatica symptoms that a spine disorder would achieve. The symptom of Sciatica caused due to the Piriformis muscle remains a rare condition called Piriformis Syndrome.
Other causes may include:
- Sitting for long hours may tighten the Piriformis muscle
- Sportspersons who indulge in running, rowing or cycling tend to bend forward most of the time leading to weakening of buttock muscles
- Trauma to the gluteal region or the buttock
What Are the Symptoms of Piriformis Syndrome?
Every individual processes pain differently but the most common symptoms of piriformis syndrome include:
- Inability or difficulty to sit comfortably
- Pain that radiates down the back of the leg
- Numbness and/or tingling in the buttocks area
- Pain in the buttocks area that worsens with exercise, activity or sitting for long periods of time
Other symptoms may include:
- Mild to severe pain in the buttock, leg or thigh
- Discomfort while moving the hip joint
- Tenderness in the buttock muscle
- Pain tends to increase while walking up an incline, climbing stairs or sitting for a long duration
- Discomfort while sitting on the affected buttock
- Pain or discomfort during bowel movement
- Pain generally diminishes once the patient lies on his/her back
- Numbness in feet or difficulty in walking
- Women may experience dyspareunia
- Some patients may experience pain in neck or head
How Do Orthopedic Specialists Diagnose Piriformis Syndrome?
Piriformis syndrome feels exacerbated from overuse of the piriformis muscle. The treating orthopedic physician starts with performing a physical examination of the patient. During a physical exam, the doctor asks the patient about their history and daily activities. The doctor then examines the area and palpates the area to feel the piriformis muscle. If the patient suffers from piriformis syndrome, often the piriformis feels hard and noticeably tight. Next, the doctor most likely orders diagnostic imaging. Diagnostic imaging to diagnose piriformis syndrome may consist of X-ray, MRI or both. These tests can help the physician rule out any other issues including herniated discs or torn ligaments.
Piriformis Syndrome is a complex condition that requires various tests and methods of examination for accurate diagnosis. These may include:
- Review of the patient’s medical history to rule out other causes of pain
- Physical examination of the leg and hip by the doctor X-ray, MRI, CT scan and few other nerve conduction tests
- Reflex, strength and sensory testing of the deep tendon
- Assessment of disparities in length of legs
- Tenderness in the gluteal region
How Do Orthopedic Specialists Treat Piriformis Syndrome?
To treat piriformis syndrome, the treating physician always starts with conservative treatments. Doctors often recommend rest and non-steroidal anti-inflammatory medications. Non-steroidal anti-inflammatory medications can reduce inflammation and muscle irritation, in turn decreasing pain. Orthopedic specialists can prescribe steroid treatments in addition to offering injections that may help clear the patient’s symptoms. The treating doctor may give the patient specific exercises and stretches, or refer the patient to physical therapy. In physical therapy, the physical therapist can teach the patient specific techniques to clear up the sciatica issues from piriformis syndrome. The physical therapist may ask the patient to acquire a dense foam roller for rolling out the piriformis muscle at home to help relieve symptoms. Depending on the physical therapist, some may perform manual massage and potentially even use dry needling to attempt to release the piriformis. In very rare cases where all conservative treatments fail to alleviate the patient’s pain, the doctor may opt for surgical intervention. Opting for surgical intervention may occur when patients have developmental variation that has left them with their sciatic nerve running through the piriformis muscle instead of behind it.
During surgery to treat piriformis syndrome, the surgeon has the patient under general anesthesia. Under general anesthesia, the patient remains asleep for the entirety of the procedure. Depending on the physician and the patient, the physician may use one of two methods to perform the piriformis surgery. For the first method of piriformis surgery, the doctor cuts the area of the piriformis where it attaches to the top portion of the femur. The other most common type of piriformis surgery consists of the surgeon cutting through the piriformis with a goal of releasing pressure. Alleviating pressure allows the sciatic nerve to have more space and therefore decrease the pain. During this procedure, the surgeon may also remove a small portion of the muscle.
Other conservative treatments may include:
- The orthopedic doctor may recommend heat therapy to reduce stress and encourage flow of blood to the affected muscles
- Specific stretching exercises may also help to strengthen the Piriformis muscle, hamstrings, hip flexors and abductor muscles
- Anti-inflammatory drugs and muscle relaxants may be prescribed
- The doctor may ask to avoid activities that lead to stress or pain
- Rest for a prescribed period of two to three weeks
OrthoTexas provides comprehensive diagnosis and treatment for Piriformis Syndrome.
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