Piriformis Syndrome Causes, Symptoms & Treatment Options

Piriformis syndrome is a rare pain disorder that involves the narrow piriformis muscles located on either side of the upper buttocks. The muscle’s primary purpose is to rotate the hip externally — i.e. turning the hip so the knee points away from the other leg. The sciatic nerve is a large nerve that runs from the lower back down the back of the legs. In most people the sciatic nerve passes behind the piriformis, but in some it goes through the piriformis. If the piriformis presses on the sciatic nerve, the nerve can become compromised, resulting in severe pain.

Every time you move your lower body, the piriformis muscle is involved. This muscle can become irritated and inflamed due to overuse. This can cause the muscle to spasm or swell, putting pressure on the sciatic nerve. A direct trauma to the muscle, for example, due to a fall in sports, can also cause piriformis syndrome and result in muscle spasms and buttock pain.

Piriformis syndrome is most common in these sports:

• Running
• Soccer
• Lacrosse

Piriformis syndrome typically causes pain on one side of the lower back, in the buttocks area. Common symptoms also include:
• Pain that gets worse when walking, running, climbing stairs, or sitting for long periods of time
• Buttock pain that gets worse when walking, running, climbing stairs, or sitting for long periods
• Tingling or numbness in the legs and calves
• Difficulty sitting

Athletes with symptoms of piriformis syndrome should see their doctor if their symptoms persist for several weeks. At your visit, you will be asked to describe your symptoms and physical activity. A physical examination will include evaluating the range of motion in your hip and back. Your physician will perform other physical examination tests to rule out other conditions.

Diagnosing piriformis syndrome can be challenging. Doctors frequently use imaging tests, such as X-rays and MRI scans, to rule out other causes of symptoms. These tests may be ordered to rule out sciatica (sciatic nerve pain) or problems with your hip, like hip pain, tendonitis, arthritis, or stress fractures.

Treatment of piriformis syndrome usually involves avoiding activity that aggravates pain. This may involve resting from sporting activities or avoiding sitting for long periods of time. Conservative treatments may also include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, to relieve pain
• Muscle relaxants to relieve pain and muscle spasms
• Applications of moist heat
• Physical therapy exercises and piriformis syndrome stretches can help you to strengthen muscles and improve flexibility.

In some cases, an ultrasound-guided corticosteroid injection may be helpful for relieving pain. For cases of severe pain, your doctor may recommend electrical stimulation of the muscles to block pain.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Piriformis Syndrome

In rare cases, when conservative treatments are not effective, your doctor may recommend surgery to release the piriformis muscle.

Your doctor may advise limited activity during your recovery period. Oftentimes, piriformis syndrome may take many weeks to resolve. Your doctor and physical therapist will work with you to develop an exercise and piriformis syndrome stretch program to help get you ready for a full return to play while reducing the recurrence of sciatic nerve pain, hip pain, and buttock pain.