What's to know about piriformis syndrome?
This irritation can cause pain, numbness, tingling, and shooting sensations in the buttocks and hip, and sometimes in the thighs and legs. Piriformis syndrome can be a chronic condition, a one-time injury, or a recurring source of pain.
What is piriformis syndrome?
When the piriformis muscle causes irritation to the sciatic nerve, it may cause pain in the hip and buttocks.
The piriformis muscle is a pear-shaped muscle in the buttocks that extends from the base of the spine to the top of the thigh. Tightness in this muscle can compress the sciatic nerve.
The sciatic nerve is the largest nerve in the body. It extends from the lower spine down to the foot.
Compression of the sciatic nerve can cause shooting, tingling, or numbness anywhere from the hip to the lower leg or foot.
The most common symptoms of piriformis syndrome are:
- tenderness or pain in the buttocks, usually on one side only
- pain that radiates down the back of the leg to the hamstrings and sometimes the calves
- nerve pain radiating from the buttocks down the leg
A person can experience tingling, numbness, shooting, or electrical sensations that spread from the buttocks down the leg.
Some people with piriformis syndrome think the problem is in the hamstrings. The main sign of piriformis syndrome is not tenderness in the hamstrings but very tender spots on the hips or buttocks.
Piriformis syndrome can come on suddenly, usually following an injury, or it can appear gradually over several months.
Piriformis syndrome may cause pain down the back of one leg, from the buttocks downward.
Tension and tightness in the piriformis muscle can cause the muscle to spasm. Like muscle tension in other areas of the body, the causes vary.
- an injury, such as a fall, a blow to the area, or a car accident
- overuse, such as from frequent running, excessive exercise, or over-stretching
- a sedentary lifestyle, especially with long periods of sitting
- changing from a sedentary lifestyle to more frequent exercise
- buttock muscles wasting away
- muscle tension and excess weight due to pregnancy
Piriformis syndrome is a somewhat controversial diagnosis. Doctors have argued that it is both under- and over-diagnosed. The controversy is mainly due to a lack of scientifically validated tests.
Many doctors diagnose piriformis syndrome based on symptoms alone. Only two tests that are available can boast significant evidence to support their use. These tests are:
- Magnetic resonance neurography: This form of magnetic resonance imaging (MRI) test looks for inflammation in the nerves.
- FAIR Test: The flexion, adduction, and internal rotation test flexes the hip to stretch the piriformis and compress the sciatic nerve. It measures delays in sciatic nerve signals due to its compression under the piriformis.
Stretches and exercises
A number of stretches and exercises can strengthen the piriformis muscle. Doing these exercises and stretches may help reduce the severity of muscle spasms and relieve muscle tightness.
People with piriformis syndrome may wish to try one or more of the following:
- Lie on the back with the legs extended out. Lift the painful leg toward the chest by holding the knee and ankle. Pull the knee toward the ankle on the other side of the body until a stretch occurs.
- Lie on the back with legs flat and extended. Lift the painful leg and put the foot on the floor on the outside of the opposite knee. Pull the leg across the body with the assistance of a hand, exercise band, or towel.
- With the affected leg crossed over the opposite knee and both legs bent, lie on the back. Pull the lower knee toward the shoulder until a stretch occurs.
Each stretch should be held for 30 seconds and repeated three to five times.
No one should ever force a stretch or perform one that is painful.
Stretching and gentle exercise can help to ease the symptoms of piriformis syndrome. As the condition improves, more challenging exercises such as jogging can be pursued.
In addition to gentle stretching, it is often possible to manage and treat piriformis syndrome with self-care.
Alternating hot and cold packs can improve blood flow to the area and speed the healing. Some people find that either heat or ice works better, so it is fine to use only the pack that is most effective at relieving pain.
For alternating heat and cold, try 20 minutes on, 20 minutes off, followed by another 20 minutes on with a fresh pack.
Other treatment options include the following:
- Becoming more active. Walking can relieve muscle tension throughout the body and prevent spasms from getting worse.
- Practicing strengthening activities that support the piriformis, buttock muscles, and hips. Hip extension and abduction exercises, which move the hips against resistance, are particularly useful.
- Managing pain with non-steroidal anti-inflammatory drugs (NSAIDs). These drugs should not be used to make hard physical activity less painful.
- Avoiding activities that make the pain worse. This often includes running. Rest can help, particularly in the days following an obvious injury.
Massaging the painful area, as well as surrounding muscles, may help. Tension in one muscle can sometimes cause the tension in another, so massaging the entire hip and buttock area may be helpful. Some people with piriformis syndrome find that massaging with ice or heat packs also helps.
If the pain is intense, gets worse over several days, or is still around after a week of home management, it is time to see a doctor. A number of treatments may help the condition.
Clinical treatment options include:
- Botox injections that can reduce muscle spasms and relieve pain.
- Prescription pain medications or muscle relaxants. A person should discuss the risks and benefits of pain medication with their doctor, as these drugs can be addictive.
- Corticosteroid or anesthetic injections.
- Alternative treatments, such as acupuncture, chiropractic manipulation, and trigger point therapy.
- Physical therapy to regain use of the piriformis, and to prevent wasting related to disuse and dysfunction in surrounding muscles.
As a last resort, surgery is an option. One option is to cut the piriformis tendon where it attaches to the hip. The other is to cut into the piriformis to relieve pressure on the sciatic nerve.
The same stretches that help with piriformis pain can also reduce the risk of developing piriformis pain.
Many people develop piriformis syndrome due to repetitive movements. Developing good technique can prevent these repetitive motions from damaging the piriformis.
Investing in comfortable, well-fitting running shoes is important. Shoes should ensure that a person moves properly and should not pinch or hurt in other ways. Ill-fitting shoes can undermine posture and form.
Other strategies for prevention include:
- warming up before each workout
- avoiding exercise that causes pain
- treating any injuries promptly
- avoiding exercise using injured muscles until they have healed
- practicing good posture