Piriformis Syndrome

The piriformis muscle can get irritated and compress the sciatic nerve running from your spine through your buttock and down your leg. The sciatic nerve passes from your spine through your buttock and down your leg. When this happens, it may cause piriformis syndrome. This usually happens on one side of your body, but it can affect both sides.

What causes piriformis syndrome?

There are several reasons you might be more likely to get piriformis syndrome:

• Muscle imbalances: Weak, tight or unbalanced muscles in your hip or buttock can irritate the piriformis muscle and lead to piriformis syndrome. 
• Overuse or repetitive activities: Using your hip joint repetitively or sitting for a long time can increase your risk. Long-distance running (especially on hard surfaces), cycling, ice skating and rowing can cause overuse.
• Trauma or injury: Falling on or injuring your buttock area in an accident can irritate the piriformis muscle. 
• Lifting items incorrectly: When you don’t lift things properly, you can damage the piriformis muscle.
• Variations in body structure: Some people have a shorter or narrower pathway for the sciatic nerve. So the nerve can get more pressure and irritation when it passes through or under the piriformis muscle. 
• Poor posture: Sitting or standing with poor alignment can stress the piriformis muscle.
• Age: People of any age can have piriformis syndrome, but it’s most common in people aged 40 to 60.
• Gender: Women are more likely to have piriformis syndrome than men. 
• Other conditions: Certain spine conditions, such as lumbar disk herniation, sacroiliac joint dysfunction or spinal stenosis, change your hip and pelvis in ways that may irritate the piriformis muscle.

It may be time to talk with an orthopedic specialist if you’re experiencing:

• Ongoing hip or groin pain during activity or rest
• Difficulty walking, climbing stairs or standing for long periods
• Limited range of motion or hip stiffness
• Pain that hasn’t improved with medication, physical therapy or injections

A consultation with a Banner orthopedic expert can help determine if hip replacement is the right step for you.

If you have pain lasting longer than a few weeks, you should contact your health care provider. You should also seek medical care if:

• Your pain is severe or sudden.
• You have trouble controlling your bowels or bladder.
• You have sudden weakness or numbness in your back or leg.
• You fall because of pain or numbness.
• You can’t easily pick your foot up from the floor.
• Your pain started after an injury.

Diagnosing piriformis syndrome can be difficult because other conditions have similar symptoms. No test can tell for sure whether you have piriformis syndrome. Your health care provider, a neurologist (brain and nervous system doctor) or an orthopedist (muscle and skeleton doctor) can help you get an accurate diagnosis and a treatment plan that works for you.

Your provider will consider factors like these to see if you have piriformis syndrome:

• Medical history: Your provider will ask about your history and symptoms. They will want to know where you notice symptoms, how long they last and what makes them better or worse. Also, be sure to tell them about any injuries or activities that might be causing your symptoms.
• Physical examination: Your provider may check the range of motion in your hip, pelvis and lower back for issues. They may also test the strength and flexibility in your hip and nearby muscles and press on specific areas to see if you feel tenderness or pain. 
• Other conditions: Piriformis syndrome is somewhat rare, so your provider will want to rule out other conditions related to the back, buttocks or legs. Those include lower back arthritis, hip bursitis, herniated lumbar disk, sacroiliac joint dysfunction and spinal stenosis. 
• Imaging tests: Magnetic resonance imaging (MRI), computed tomography (CT) scans or ultrasound can show your provider what’s going on with your spine, pelvis and hip joint. Your provider might use these images to rule out other conditions or see if piriformis syndrome is a likely diagnosis.
• Response to treatment: If physical therapy or exercises targeting the piriformis muscle help, it’s likely that you have piriformis syndrome. 

Most cases of piriformis syndrome can be managed without surgery. Your provider may recommend:

• Rest and activity modification: You can avoid or modify activities that make your symptoms worse.   
• Physical therapy: Working with a physical therapist, you can stretch and strengthen the piriformis muscle and other muscles. You can also improve your posture and how your body moves. 
• Myofascial release: You can relieve tightness in the muscle by rolling it with a tennis ball or foam roller.
• Pain management: Your provider may prescribe pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, to help manage your pain and reduce muscle spasms. Medication can help with the pain, but there aren’t medicines that treat the condition itself.
• Heat and cold therapy: Applying hot or cold treatments to the affected area may reduce pain and help your muscles relax.
• Massage: Massage can help relax your piriformis muscle.
• Injections: In some cases, corticosteroid and/or Botox injections into the muscle may help your symptoms. 
• Transcutaneous electrical nerve stimulation (TENS): This treatment uses a mild electrical current to help relieve pain. 

You can take these steps to prevent piriformis syndrome or keep it from returning:

• Use proper posture when you’re sitting: Sit upright without slumping. Keep your feet flat on the floor and your thighs parallel to the ground. 
• Take breaks from sitting: Walk around for a few minutes if you’ve been sitting for a while, such as when you’re working at a desk or driving for a long time. Use cruise control on long drives.
• Support your body when you’re sitting: Use an ergonomic chair or ergonomic supports.
• Perform stretching exercises: Lie on your back with your legs straight, bend one knee and gently pull it toward your shoulder with your opposite hand. Hold for 30 seconds and repeat on the other side. 
• Strengthen your piriformis muscle and nearby muscles: Bridges, straight and side leg raises and clamshells can help. Your provider or a physical therapist can show you how to do these exercises.
• Exercise regularly: Be sure to warm up before you exercise and stretch afterward.
• Lift items properly: Squat to lift, keeping your back straight. Don’t twist and lift at the same time.
• Keep your body in line when you’re physically active: Keep your back straight and avoid tipping your pelvis to the front.
• Don’t keep your wallet in your back pocket: Sitting on your wallet can put pressure on your piriformis muscle.

Piriformis syndrome happens when the piriformis muscle becomes irritated or inflamed, often from overuse or long periods of sitting. This can cause pain, tingling or numbness in the buttocks or down the leg.

If you’re having symptoms, it’s important to get the right diagnosis to rule out other possible causes like a herniated disk or spinal issue. Fortunately, piriformis syndrome can usually be treated without surgery using simple therapies and lifestyle changes.

At Banner Health, we’re here to help you feel better and prevent future flare-ups. When you choose Banner, you get:

• A team of experts in neurology, orthopedics and pain management
• A personalized care plan based on your symptoms and goals
• Access to physical therapy, imaging and noninvasive treatments
• Education and support to help you stay active and pain-free