Piriformis Syndrome

Author: Courney Erickson-Adams, MD

If you are an athlete or someone who sits for long periods, you may be at risk for developing piriformis syndrome. The good news is that with expert guidance, piriformis syndrome can be both treated and prevented to help you remain active with less pain.

What is piriformis syndrome?

Piriformis syndrome is a neuromuscular disorder that occurs when the piriformis muscle puts pressure on the sciatic nerve. Although relatively uncommon, it can be quite painful when it occurs. 

The piriformis is a flat, band-like muscle located near the top of the hip joint. It serves to stabilize the joint and makes it possible for a person to lift and rotate the thigh away from the body. Athletes use the piriformis muscle extensively, since it is involved in almost every motion of the hips and legs.

The long, thick sciatic nerve runs alongside or passes through the piriformis muscle, down the back of the leg, and branches off into smaller nerves into the feet. Since the piriformis muscle and the sciatic nerve are in such close proximity, spasms or inflammation of the piriformis can put pressure on the sciatic nerve and cause pain—resulting in sciatica and piriformis syndrome.  

What are the signs and symptoms of piriformis syndrome?

The early signs and symptoms of piriformis syndrome usually include pain, tingling, or numbness in the buttocks. Pain can also extend down the sciatic nerve, which may cause severe radiating pain down the leg. Pain usually occurs when the sciatic nerve is compressed during various activities, such as sitting for long periods, climbing stairs, or running. 

What are the risk factors for developing piriformis syndrome?

Activities which may cause spasm or inflammation in the piriformis muscle increase the risk of developing piriformis syndrome. These include conditions that are often the result of sports injuries, such as:

  • Inflammation from any cause, such as overuse or sprain.
  • Trauma, such as blunt trauma to the buttocks.
  • Hematoma formation.
  • Scar tissue formation.

Other risk factors include:

  • Sitting for long periods.
  • The formation of growths near the piriformis—such as tumors or cysts.  

How is piriformis syndrome diagnosed and treated?

Although there are no definitive tests to diagnose piriformis syndrome, a patient’s history of trauma or overuse often provides the first clue. If the piriformis muscle is painful when palpated during the exam, piriformis syndrome may also be suspected. Since sciatica can be caused by other conditions, a healthcare provider may order imaging studies or perform other tests to rule out additional sources of sciatic nerve compression. 

The treatment of piriformis syndrome typically depends upon whether a patient is within the acute, recovery, or maintenance phase: 

  • Acute phase treatments include rest, initial physical therapy using various treatment modalities, and medications to reduce inflammation and pain.
  • Recovery phase treatments include enhanced physical therapy for muscle strengthening and optimal pelvic alignment, as well as medications used in the acute phase, as needed.
  • Maintenance phase treatments include a regular exercise program for increasing strength and stability. In this phase, athletes who are resuming training should do so slowly under expert guidance.

Can piriformis syndrome be prevented?

Piriformis syndrome is usually caused by repeated stress to the piriformis muscle, through sports activities, other repetitive movements, or sitting for long periods. In order to prevent piriformis syndrome, athletes should warm up properly, maintain good form, and avoid exercising on uneven surfaces. Individuals who tend to sit for long periods at work or at home should build in regular breaks to get up, move around, and stretch. 

If you want to learn more about how you can prevent or treat piriformis syndrome, our experts can help. Contact us today.