Facts Behind Piriformis Syndrome

Symptoms and diagnosis for Piriformis Syndrome

By Neurosurgery Singapore

Piriformis syndrome info

What is Piriformis Syndrome?

Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

Sciatic nerve compression by the piriformis can be caused by:

  • Microtrauma to muscles of the buttocks that results in inflammation or muscle spasms from frequent and repetitive motions such as walking, running, dancing, over-stretching or other exercises
  • Sudden injury to the muscle by accidents such as a falls and other blunt forces to the area
  • Sedentary lifestyles with long periods of sitting
  • Beginning an exercise program for the first time
  • Buttock muscle atrophy
  • Tension on the piriformis muscle from excess weight

What are some symptoms of Piriformis Syndrome?

Sciatica is the main symptom of piriformis syndrome. Often the discomfort is felt in another part of the body, such as the back of the leg. This is known as referred pain.

Some other common signs of piriformis syndrome include:

  • numbness and tingling in the buttocks that may extend down the back of the leg
  • tenderness of the muscles in the buttocks
  • difficulty sitting comfortably
  • pain while sitting that gets worse the longer you sit
  • pain in the buttocks and legs that worsens with activity

In serious cases of piriformis syndrome, the pain in your buttocks and legs can be so severe it becomes disabling. You may become unable to complete basic, everyday tasks, such as sitting at a computer, driving for any length of time, or performing household chores.

“Anyone who sits for long periods of time, such as people who sit at a desk all day or in front of a television for extended periods of time, are at a higher risk for piriformis syndrome.”

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What types of diagnosis?

Our Spine Specialist will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain.  

Piriformis syndrome is often a diagnosis made through a process of ruling out other possible conditions that may be causing the patient’s symptoms, such as a lumbar disc herniation or sacroiliac joint dysfunction.

Physical exam

The physical exam will include an examination of the hip and legs to see if movement causes increased low back pain or lower extremity pain (sciatica pain).

Typically, motion of the hip will recreate the pain. The exam will also identify or rule out other possible causes of the sciatica pain, such as testing for local tenderness and muscle strength.

Medical history

A medical history includes an in-depth review of the patient’s symptoms, such as what positions or activities make the symptoms better or worse, how long the symptoms have been present, if they started gradually or after an injury, and what treatments have been tried.

It will also include a review of conditions that may be in the patient’s family, such as arthritis.

Diagnostic tests

X-rays and other spinal imaging studies cannot detect if the sciatic nerve is being irritated at the piriformis muscle. However, diagnostic tests (such as X-rays, MRI and nerve conduction tests) may be conducted to exclude other conditions that can cause similar symptoms to piriformis syndrome.

An injection of anesthetic with or without steroids may help to confirm if the piriformis muscle is the source of the symptoms.

Possible treatment methods?

The treatment of Piriformis syndrome depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment. These may include:

  • Rest from those activities that exacerbate the symptoms
  • Anti-inflammatory drugs, muscle relaxants
  • Physical therapy to strengthen the piriformis and other gluteal muscles
  • Ultrasound, electrical stimulation, heat, and ice
  • Piriformis injection whereby medication is injected directly into the piriformis muscle to help decrease the spasm and pain

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