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Piriformis Syndrome

Piriformis syndrome is a condition of spasm of the piriformis muscle and pain in the buttocks. Due to the involvement of the sciatic nerve, it is also associated with pain, numbness, and tingling along the calf and the foot.

Piriformis muscle originates from the sacral vertebrae and is attached to the upper surface of the femur (thigh bone) of the corresponding side. The sciatic nerve runs directly beneath it or in some cases, the nerve can run through the muscle. It is supplied by the nerve to the piriformis. Your piriformis muscle assists you in walking by rotating the hip and external rotation of the leg. There is nothing wrong with saying that this muscle maintains your gait.

People who are involved in vigorous exercises such as athletes and runners are more prone to suffer from piriformis syndrome. This is because athletes use this muscle repeatedly while rotating their hips and legs. Piriformis syndrome is more common in women than men. This higher incidence in females is due to the anatomical variations of this muscle in relation to the sciatic nerve.

In this article, you will get to know about almost every aspect of piriformis syndrome ranging from its causes and risk factors up to treatment and prevention.

What does piriformis syndrome feel like?

If you develop piriformis syndrome, you will feel back pain, difficulty in walking, and sciatica-like pain radiating down the back of the thigh, leg, and foot. Typical symptoms of piriformis syndrome may include:

Patients suffering from piriformis syndrome often complain of dull pain in the lumbar region which extends into the gluteal region. The skin of the buttock is supplied by the nerve originating from the sacral segments of the spinal cord. When there is damage or inflammation of the piriformis muscle, then due to the involvement of the sacral nerves, you will feel chronic pain in the buttock. The buttock pain can radiate into the posterior aspect of your thigh or even the proximal portion of your lower leg.

The sciatic nerve runs in close relation to the piriformis muscle. Any condition affecting the muscle will also involve the sciatic nerve(1). The sciatic nerve supplies the skin of the back of the thigh, hamstring muscles, back of the leg, and some parts of the foot. So you will also feel sciatica-like symptoms if you have piriformis syndrome.

Your leg pain will aggravate due to activity, prolonged sitting, and walking up the stairs, as it increases the tension on your piriformis muscle. You may present with a positive piriformis sign in which your leg is shortened with an outward rotated position when supine. This is due to the spasm of the piriformis muscle.

Causes of piriformis syndrome

The exact causes of piriformis syndrome are unknown. Physical examination is necessary to know the exact cause and to make the final diagnosis of piriformis syndrome. However, suspected causes include:

Muscle spasm in the piriformis muscle is the most common cause. Whenever there is an injury to the muscle, certain reactions take place which cause the muscle to contract and become spastic(2). Spasticity may also be due to irritation in the muscle itself or irritation of the sacroiliac joint or other nearby structures. Spinal stenosis and herniated disc is also potent risk factor for piriformis syndrome. Due to this, any movement at the hip joint will cause pain.

Injury to the muscle also damages the blood vessels supplying it. As a result, there is extravasation of blood in the muscle, leading to swelling of the muscle. This muscular swelling may compress the nearby structures including the sciatic nerve.

Muscle dysfunction due to botulinum toxin is also another cause. If this is your case, you need to undergo a physical exam and electromyography (EMG) to identify the exact condition. If the cause of your buttock pain is an osteopathic disease, you should go for an x-ray or MRI (magnetic resonance imaging).

The sciatic nerve passes through the sciatic notch in front of the sacrum and downwards into the back of the thigh. Sitting for long periods of time, especially with poor posture, can lead to irritation of the sciatic nerve(3). This leads to spasms in the piriformis muscle and creates a feeling of being sore or achy.

Treatment of piriformis syndrome

Immediate treatment includes proper first aid. The first 48 to 72 hours of injury are critical. The R.I.C.E. method is one of the first-line treatments. You can treat mild pain and muscle spasms with this method. This is a simple technique that reduces swelling, relieves pain, and speeds up the healing process.

Pain indicates that some damage is going on in your body. Stop doing any kind of movement for at least 2 days after injury because it can make the damage worse and delay recovery. Apply the ice pack for about 15 to 20 minutes after every 2 to 3 hours for 2 days. This will have a positive effect on reducing pain. 

Compression of the affected area is also effective in reducing swelling. You can use elastic bandages, casts, and splints for this purpose. You must take care of the site of pain because if the compression is tight, it may interrupt the blood flow. The last one includes the elevation in which the affected area is raised above the heart level. This improves blood flow to the affected area and reduces swelling and pain.

Medical treatment includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen for pain relief. These medications also decrease inflammation by reducing the synthesis of prostaglandin that mediate pain by stimulating sensory nerve endings. You can treat muscle spasms by using local anesthetics and botox that have muscle-relaxing effects(4). In addition, your doctor can prescribe you steroids such as corticosteroids. However, overuse of these medications can be harmful to your health.

Another strategy for the treatment of this condition is physical therapy. For this purpose, you need to consult a physical therapist. This procedure constitutes the mainstay of treatment in musculoskeletal syndromes. This includes some exercises that decrease the stretch on the piriformis.

Prolotherapy:

Many of the structures have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Preventative measures of piriformis syndrome

A famous saying goes like this,

“Prevention is better than cure.”

Warm-up yourself by doing regular exercise. Exercise has positive effects on the muscles(5). It increases their strength, improves their blood supply, and increases muscle bulk. Do perform stretching exercises as this increases flexibility, and range of motion and decreases your chance of getting piriformis syndrome.

You also need to maintain good posture when you’re sitting or driving. Sitting in good posture decreases the strain on your body muscles and lowers the risk of fatigue. It also allows you to work efficiently. Abnormal posture may compress your sciatic nerve and irritates the piriformis muscle.     

Avoid lifting in a bending position. Keep your back straight and hold the object close to your body as it puts less strain on the piriformis. Use your leg muscles while lifting the object. Avoid twisting your body while lifting.

Avoid sitting or lying down for long periods because it can cause the cramp of the piriformis muscle(6). As the sciatic nerve runs below the piriformis, it can cause the compression of the nerve as well, leading to the pain in buttock and legs.

Avoid running uphill or downhill or on uneven surfaces because such movements require increased stability of the hip joint. Your piriformis contracts strongly to maintain the stability of the joint during these movements. You should perform these movements slowly so that the muscle does not get cramps. 

Conclusion

Piriformis syndrome is a musculoskeletal condition and you need proper medical advice from a healthcare professional to get rid of it. Now you are completely aware of the aspects of this condition and you are better able to identify if you or any of your relatives present with this condition. However, proper medical care is essential if your pain is due to injury or any other unknown cause. In that case, you need to seek your doctor’s advice. In addition, you can adopt precautionary measures to prevent this condition.

 

Frequently Asked Questions

Is walking good for piriformis?

Continuous walking exacerbates piriformis syndrome because continuous physical activity stretches piriformis muscle and it can further increase the pain. However, if you walk slowly with an appropriate posture, it will do a great relief to your pain.

How do I know if I have sciatica or piriformis?

The primary method by which you can identify your condition is by moving your hips and legs and feeling where the pain occurs. If you feel pain in the lower back and buttocks only, it may be piriformis syndrome. But If the pain is in the lower extremity, it is likely sciatic pain.

Does sitting irritate piriformis?

If you have piriformis syndrome, sitting can make your symptoms worse. You will feel intense buttock and back pain due to the irritation and pinching of the sciatic nerve by the piriformis muscle. Sitting all day in your office or workplace can aggravate the pain even more.

How do you sleep with piriformis syndrome?

When you are lying down, it’s easy for the sciatic nerve to become compressed which can exacerbate your symptoms. An appropriate sleeping posture maintains proper spinal alignment and also let you rest comfortably. The best one is sleeping on the back.

How long does it take for piriformis to heal?

Mild pain may heal in a few weeks but a severe injury may take 6 weeks or longer. Also, the healing time depends on how much you take care of yourself and your diet. Taking healthy food with adequate hydration along with advised medications is necessary if you want to heal your condition as early as possible. 

Where is piriformis pain located?

You will feel pain, tingling sensation, or numbness in your buttocks. Pain can be severe and extend down the whole of your leg. The pain is due to the piriformis muscle causing sciatic nerve compression, while you are sitting for a long time.

References

  1. Maxwell, T. D. (1978). The piriformis muscle and its relation to the long legged sciatic syndrome. The Journal of the Canadian Chiropractic Association, 22(2), 51–55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2484076/
  2. Wheeler, A. H., & Aaron, G. W. (2001). Muscle pain due to injury. Current Pain and Headache Reports, 5(5), 441–446. https://doi.org/10.1007/s11916-001-0055-5
  3. Byrd, J. W. T. (2005). Piriformis syndrome. Operative Techniques in Sports Medicine, 13(1), 71–79. https://doi.org/10.1053/j.otsm.2004.09.008
  4. Bernstein, E., Carey, T. S., & Garrett, J. M. (2004). The Use of Muscle Relaxant Medications in Acute Low Back Pain. Spine, 29(12), 1346–1351. https://doi.org/10.1097/01.brs.0000128258.49781.74
  5. Cygańska, A., Truszczyńska-Baszak, A., & Tomaszewski, P. (2020). Impact of Exercises and Chair Massage on Musculoskeletal Pain of Young Musicians. International Journal of Environmental Research and Public Health, 17(14), 5128. https://doi.org/10.3390/ijerph17145128
  6. Investigation of trunk muscle co-contraction and its association with low back pain development during prolonged sitting. (2013). Journal of Electromyography and Kinesiology, 23(4), 778–786. https://doi.org/10.1016/j.jelekin.2013.02.001

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