Piriformis Syndrome Causes, Symptoms & Treatment Options

Overview

Piriformis syndrome is an uncommon neuromuscular disorder involving the piriformis muscles, which are located deep within the upper buttocks. These muscles primarily rotate the hip, turning the leg outward externally. 

The sciatic nerve, which runs from the lower back down the posterior legs, may become compressed if it passes through or beneath a tight or hypertrophied piriformis muscle, leading to significant pain and discomfort.

What causes Piriformis Syndrome?

The piriformis muscle engages with nearly every lower-body movement and can become irritated or inflamed from repetitive use. Overuse, trauma, or prolonged compression may lead to muscle spasm or swelling, exerting pressure on the sciatic nerve and producing characteristic referred leg pain.

• How the Injury Occurs: Piriformis syndrome typically develops when the muscle becomes tight or inflamed from repetitive motion, prolonged sitting, or direct trauma such as a fall. The resulting tension compresses the sciatic nerve, leading to radiating pain and functional discomfort.
• Common Everyday Causes: Piriformis syndrome may also affect individuals with sedentary lifestyles or occupations requiring long hours of sitting, such as drivers or office workers. It can occur after improper lifting, extended travel, or repetitive lower-body movements in daily routines.

Piriformis syndrome is most common in these activities:

• Running: Continuous hip rotation and stride repetition can overload the piriformis, especially on uneven terrain.
• Soccer: Frequent kicking and sudden direction changes strain the hip rotators, increasing muscle tension.
• Lacrosse: Rapid sprinting and twisting during play heighten the risk of overuse of the piriformis.

Symptoms

Piriformis syndrome generally presents with pain on one side of the hip, lower back, or buttocks. Common clinical manifestations include:

• Pain that intensifies during activities such as walking, running, stair climbing, or prolonged sitting
• Deep aching discomfort in the buttocks that may radiate down the leg
• Tingling or numbness extending into the legs or calves
• Difficulty maintaining a seated position for extended periods

Non-operative treatment

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

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are used 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 strengthen muscles and improve flexibility.

In some cases, an ultrasound-guided corticosteroid injection may help relieve 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

Surgical Treatment

In rare and persistent cases where conservative measures such as physical therapy, medication, and activity modification fail to provide relief, surgical intervention may be considered. Surgery aims to release or decompress the piriformis muscle, thereby reducing pressure on the sciatic nerve.

This procedure is typically reserved for patients with chronic, debilitating pain that significantly affects mobility and daily function despite exhaustive non-surgical management.