Piriformis Syndrome

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).

What are the causes?

The exact causes of piriformis syndrome are unknown. Suspected causes include:

  • Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip
  • Tightening of the muscle, in response to injury or spasm
  • Swelling of the piriformis muscle, due to injury or spasm
  • Bleeding in the area of the piriformis muscle.

Any one or combination of the above problems can affect the piriformis muscle (causing buttock pain) and may affect the adjacent sciatic nerve (causing pain, tingling, or numbness in the back of the thigh, calf, or foot).

What are the symptoms?

Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:

  • A dull ache in the buttock
  • Pain down the back of the thigh, calf and foot (sciatica)
  • Pain when walking up stairs or inclines
  • Increased pain after prolonged sitting
  • Reduced range of motion of the hip joint

Symptoms of piriformis syndrome often become worse after prolonged sitting, walking or running, and may feel better after lying down on the back.

What are the treatments?

Depending on the severity of the patient’s sciatica-type pain and other symptoms, a number of treatment options may be recommended by a health care professional.

A comprehensive approach to managing piriformis syndrome may include a combination of the following nonsurgical treatments:

Ice and Heat Therapy for Piriformis Syndrome

  • Ice Packs and Ice Massage
  • At the onset of pain, lie in a comfortable position on the stomach and place an ice pack on the painful area for approximately 20 minutes. Repeat as needed every 2 to 4 hours.

It may be more helpful to combine a gentle massage with the ice. Lie on the stomach and have someone gently massage the painful area with a large ice cube. If ice is applied directly to the skin (instead of a cold pack), limit it to 8 to 10 minutes to avoid an ice burn.

If specific activities are usually followed by increased pain, it may be a good idea to apply ice immediately following the activity.

Heat Therapy

Some people find it helpful to alternate cold with heat. If using a heating pad, lie on the stomach and place the heating pad on the painful area for up to 20 minutes. Be sure to avoid falling asleep on a heating pad, as this may lead to skin burns.

Medications for Sciatica Pain

Since most episodes of pain include some type of inflammation, non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, may help decrease inflammation in the affected area.

Piriformis Injections

For severe sciatica pain from piriformis syndrome, an injection may be part of the treatment.

Piriformis injection

A local anesthetic and corticosteroid may be injected directly into the piriformis muscle to help decrease the spasm and pain. The purpose of an injection is usually to decrease acute pain to enable progress in physical therapy.

Botox injection

For persistent piriformis spasm that is resistant to treatment with anesthetic/corticosteroid injections, an injection of botulinum toxin (e.g. Botox®), a muscle-weakening agent, may be useful. The goal of the injection is to help the muscle relax and help reduce pressure on the sciatic nerve.
The goal with both injections is to help the patient progress with stretching and physical therapy, so that when the effect of the injection is over the muscle will be remain stretched and relaxed.

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