Piriformis syndrome occurs when the piriformis muscle spasms and causes pain in the buttocks. A spasm of the piriformis muscle can also compresses the sciatic nerve, causing pain, tingling or numbness in the buttocks, leg and foot.
The piriformis muscle is a small flat muscle deep in the buttocks near the top of the hip. It is a very important muscle that stabilizes the hip, allows the thigh to lift and rotate away from the body, and is used in almost every motion of the hips and legs including walking, shifting your weight from foot to foot, and maintaining balance.
The sciatic nerves run from the spinal cord, down each leg to the feet. In most people it passes directly behind the piriformis muscle, while in some cases it runs right through the piriformis muscle. Any kind of inflammation or spasm of the piriformis muscle can compress the sciatic nerve, causing pain and numbness in the buttocks and leg. This pain is known as sciatic pain.
Though piriformis syndrome commonly leads to sciatic pain, most cases of sciatic pain are not due to piriformis syndrome. Piriformis syndrome is not a common cause of sciatic pain, and is actually not common in general.
FAQ About Piriformis Syndrome
What does Piriformis Syndrome feel like?
The first sign of Piriformis syndrome is usually pain or tingling in the buttocks. The pain can quickly become severe and spread down the entire leg. This pain is strongest when walking, running, or sitting for long durations of time. Other common symptoms include pain when walking up stairs or inclines, limited range of motion of the hip,
What causes Piriformis Syndrome?
While many factors can contribute to the development of piriformis syndrome the exact causes remain unknown. Possible contributing factors include muscle spasms, tightening, swelling or bleeding of the piriformis muscle due to irritation or traumatic injury to the piriformis muscle or hip. Any of these conditions can lead to piriformis syndrome.
How is Piriformis Syndrome diagnosed?
There is no definitive test for piriformis syndrome and diagnosis must be made by ruling out other possible causes of sciatic pain. Diagnosis begins by taking a medical history and going through a physical exam.
Your doctor will review your medical history and may ask you about details of the duration and nature of your pain. By considering your medical history your doctor can determine if arthritis or other injuries are possible causes of your pain.
Your doctor will also examine your hip and legs to see exactly what kind of movement causes your pain. Your doctor may test your muscle strength and check for tenderness in your lower back and hip.
X-rays and other imaging tests may be required to rule out other possible causes of your pain like herniated discs.
How to prevent Piriformis Syndrome
Good posture and proper form during physical activities is crucial to preventing piriformis syndrome. Make sure to always warm up before any physical activity and increase your intensity slowly. Try not to spend too much time running or exercising on hills or uneven ground. If you feel any pain, stop what you are doing and rest until the pain goes away.
7 Ways to Treat Piriformis Syndrome
Ice Pack or Ice Massage
Once you begin feeling sciatic pain or pain in your buttocks, take some time to ice the area. If certain activities exacerbate your pain, apply ice immediately after the activity.
Lie down on your stomach in a comfortable position. Place an ice pack on the area where you feel pain for 20 minutes. Repeat as every 2 to 4 hours as necessary.
If possible, an ice massage can be very helpful as well. Lie on your stomach and have someone gently massage the area with a large ice cube. Limit the massage to 10 minutes to avoid getting an ice burn.
For some people, pain can be alleviated by alternating heat with cold. Lie on your stomach and place a heating pad on the area for up to 20 minutes. Do not fall asleep on a heating pad or you might burn yourself.
Over-the-counter anti-inflammatory medications like ibuprofen can reduce swelling and decrease pain.
In some cases, your doctor may give an injection directly into the piriformis muscle. A local anesthetic and corticosteroid can help to decrease the spasm and pain. In some severe cases your doctor may recommend botox injections to relax the muscle and reduce pressure on the sciatic nerve.
The goal of either injection is to relieve your pain enough for you to stretch piriformis muscle and undergo physical therapy, so that when the injection wears off the muscle remains stretched and relaxed.
Electrical stimulation with a transcutaneous electrical nerve stimulation unit or interferential current stimulator can be useful to stop pain and alleviate the piriformis muscle spasm.
Stretching and Physical Therapy
The most important treatment for piriformis syndrome is progressive stretching of the muscle. Your doctor may show you some basic stretching exercises that relax the piriformis, hamstring and hip muscles, increases flexibility, restores range of motion, and allows the muscles to heal. In addition, a comprehensive physical therapy program that includes range of motion exercises and deep massages can reduce the muscle spasm and increase blood flow to the area, allowing for further healing.
In rare cases, your doctor may recommend surgery as a last resort to cut the piriformis in order to relieve your pain symptoms.
If you have sciatic pain or pain in your buttocks, we can help you by starting with a comprehensive diagnosis. Based in Burbank, CA, we at Comprehensive Spine & Pain Physicians believe in a multi-faceted approach to pain management using evidence-based medicine to maximize conservative treatment before considering more invasive modalities. This includes physical and occupational therapy, complementary medicine, prescription medications and spinal procedures when appropriate. Call us at 818-325-2088 or schedule a consultation online. Our award-winning doctors will be by your side on the road to recovery.