Piriformis syndrome is a musculoskeletal condition caused by the dysfunction of the Piriformis muscle (located in the buttock). It occurs when the piriformis muscle compresses the sciatic nerve, which runs down the back of the leg. This can result in symptoms around the buttocks and also extending down the leg.
The piriformis muscle originates on the sacrum and runs across horizontally attaching onto the greater trochanter of the femur.
Piriformis’ function is to abduct and laterally rotate the thigh.
Piriformis also crosses over the sciatic nerve (largest nerve in the body), and in some people the sciatic nerve can actually run through the muscle.
Causes of Piriformis Syndrome
Piriformis syndrome is most often caused by trauma to the buttocks, leading to an inflammation of the soft tissues, muscular spasms, or both. This can also result in compression of the sciatic nerve.
It can also be caused by piriformis overworking. This is usually due to an underlying weakness of the other gluteal muscles (gluteus medius/minimis) causing piriformis to work extra hard.
We also find that individuals that overpronate their feet (i.e. flat feet) tend to be more predisposed to this condition. This is due to also placing extra load through piriformis while performing activities.
- Persistent and radiating low back pain.
- Pain/Discomfort in buttock.
- Numbness/Tingling down the back of the thigh.
- Difficulty with walking.
- Pain/Discomfort with prolonged sitting, standing and squatting.
- Pain may go away with lying down or walking.
Piriformis Syndrome is determined through a thorough clinical examination by your Physiotherapist. Your Physiotherapist will perform specific tests that will try to aggravate and stretch the Piriformis muscle, when pain is positive on these tests – then piriformis syndrome is indicated.
The use of CT, MRI and ultrasound aren’t commonly used to diagnose this condition however if your Physiotherapist is concerned then they may send you to your GP for further investigations.
- Specific exercises prescribed by your Physiotherapist – if the muscle is tight and in spasm you will be given specific stretches to help lengthen the muscle. However, if it’s being overworked, you will be given strengthening exercises to try and offload the piriformis and promote activation of other muscles.
- Education/Advice: specific solutions to avoid aggravating movements.
- Massage – reduce tension and spasm in associated muscles to promote better movement.
- Dry Needling/Acupuncture – is a safe way to release tight muscles and decrease pain levels.
- Heat/Ice – can be effective treatment modality that can be used to ease discomfort at home or at work.
- Foot orthotics – if you’re Physiotherapist recognises that your feet may be contributing to your pain, they may prescribe orthotics for you.
Physiotherapy has great outcomes with managing Piriformis syndrome.
If treatment is sought early, pain and discomfort can be reversed within a matter of days to a week.
However more chronic cases may take a few weeks to address the underlying biomechanical changes that have occurred over time.