Piriformis Syndrome - Understanding Causes & Treatment

Information about diagnosis and treatment of piriformis syndrome

The piriformis muscle behind the hip joint. SCIEPRO / Getty Images

The piriformis is a muscle that is behind the hip joint in the buttocks. The piriformis muscle is small compared to other muscles around the hip and thigh, and it aids in external rotation (turning out) of the hip joint. The piriformis muscle and its tendon have a close relationship to the sciatic nerve--the largest nerve in the body--which supplies the lower extremities with motor and sensory function. The piriformis tendon and sciatic nerve cross each other behind the hip joint, in the deep buttock. Both structures are about one centimeter in diameter.

Piriformis Syndrome

When people are diagnosed with piriformis syndrome, it is thought that the piriformis tendon may be tethering the sciatic nerve, and causing an irritation to the nerve. While it has not be proven, the theory supported by many physicians is that when the piriformis muscle and its tendon are too tight, the sciatic nerve is pinched. This may decrease the blood flow to the nerve and irritate the nerve because of pressure.

Common signs and symptoms experienced by people who have been diagnosed with piriformis syndrome include:

  • Pain behind the hip in the buttocks
  • Electric shock pains traveling down the back of the lower extremity
  • Numbness in the lower extremity
  • Tenderness with pressure on the piriformis muscle (often causing pain with sitting on hard chairs)

There are no specific tests that can accurately diagnose piriformis syndrome. Many doctors will obtain studies including MRIs and nerve conduction studies, but these are often normal. Because piriformis syndrome is difficult to diagnose, there are likely many cases of misdiagnosis. This means that some people with the condition don't have piriformis considered as a diagnosis. In addition, some people with vague hip pain may receive this diagnosis even if they don't have the condition.

Sometimes referred to as "deep buttock pain," other causes of this type of pain include spine problems (including herniated discs and spinal stenosis), sciatica, and hip bursitis. The diagnosis of piriformis syndrome is often given when all of these diagnoses are eliminated as possible causes of pain.

Treatment of Piriformis Syndrome

Unfortunately, the treatment of piriformis syndrome is quite general, and often this is a difficult problem to recover from. Some treatment suggestions are:

  • Rest: Avoid the activities that cause symptoms for at least a few weeks
  • Physical Therapy: Emphasis on stretching and strengthening the hip rotator muscles
  • Anti-Inflammatory Medication: To decrease inflammation around the tendon
  • Deep Massage: Advocated by some physicians
  • Cortisone Injections: Injections in the area of the piriformis tendon may decrease inflammation and swelling

In rare circumstances, surgery can be performed to loosen the piriformis tendon, called a piriformis release. This surgical procedure should only be considered when simple treatments have been tried for a minimum of 6 months, and when other common causes of pain have been evaluated. While the surgery is straightforward, it is invasive, and recovery takes several months.

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