Piriformis Syndrome Causes, Symptoms and Treatment

Piriformis Syndrome Causes, Symptoms and Treatment



The piriformis muscle is situated in the buttocks at the top of the hip joint. By rotating the thigh away from the body and stabilizing the hip joint, it enables you to walk, keep your balance and shift your weight.The sciatic nerve runs alongside and then through the piriformis muscle, traveling down the back of the leg, and finally branching into some smaller nerves that terminate in the feet.Piriformis syndrome is an unusual neuromuscular condition that occurs when the piriformis muscle presses against and compresses the sciatic nerve, for example during muscle spasms.

Causes and Symptoms of Piriformis Syndrome
Piriformis syndrome can arise from many everyday activities, including walking, running, climbing stairs, and sitting for a long time. The condition may also result from a traumatic injury, such as a fall ora car accident.

The most frequent symptom of piriformis syndrome is a painful, numbing or tingling sensation traveling from the buttock area down the back of the leg – this is known as Sciatica. The feeling may begin as a fierce burning pain deep in the buttocks.

When to See a Doctor
If you experience any of the following, you will need to see your doctor:

• The pain arises following a traumatic injury.


• The pain continues for more than a few weeks.


• There is a sudden intense pain in your lower back, or weakness, numbness or severe pain in your leg.


• You have difficulty with bladder or bowel control.

Treatment for Piriformis Syndrome
Piriformis syndrome usually improves with the appropriate medication and lifestyle changes. However, if the condition is not treated, it may cause irreversible nerve damage, so it is important to see your doctor and follow his/her advice. Here are some treatment options and self-care tips:

1. Avoid Certain Activities
Take a temporary break from any activities that exacerbate the pain, for example running or riding a bike.

2. Take a Walk
Make sure that you avoid prolonged periods of sitting by taking regular short walks and stretching.

3. Use Cold Packs and Warm Packs
In the early stages of the condition, place a cold pack on the affected region for about 15 minutes several times a day. After a couple of days, swap the cold pack for a warm pack or heating pad. If the pain continues, switch between the warm and cold treatments.

4. Medications
Non-steroidal anti-inflammatory drugs, such as ibuprofen (Motrin,Advil), aspirin andacetaminophen (Tylenol), as well as naproxen (Aleve) can be used to alleviate the pain.

5. Massage
Try massaging the affected region. Gentle massage can also be combined with ice treatment. Lie down on your stomach and ask someone to carefully massage the painful area using a large ice cube or cold pack. If you are using ice cubes, make sure that you restrict the massage to 8-10 minutes, so that you don’t get any ice burns. Ice massages are particularly useful immediately after specific activities that increase the pain.

6. Piriformis Injections
If self-treatment hasn’t alleviated the pain, your doctor can give you a steroid injection in the area between the sciatic nerve and piriformis muscle for pain relief.

7. Surgery
In severe cases, surgery may be required to ease the pressure on the sciatic nerve.

8. Stretching Exercises
Sciatic pain can be relieved by stretching the piriformis muscle. There are several exercises stretching the piriformis, hamstring, and hip extensor muscles that can help alleviate pain along the sciatic nerve and increase your range of motion.

• Lie on your back with your legs flat. Place the foot of your affected leg on the outside of the opposite leg’s knee. Gently push the knee of the bent leg towards the other leg until you feel the stretch and hold this position for 30 seconds before slowly going back to the starting position. Don’t force the stretch or try to pull your knee to the floor. Try to repeat this exercise 3 times.


• Lie down with your knees bent and feet on the floor. Take your affected leg and cross it over the other leg at the knee. Link your hands behind the unaffected leg just below the knee, and taking the foot off the floor, pull the leg gently up towards the shoulder on the same side until you feel a stretch. Hold this for 30 seconds, then gently lower yourself back into the starting position. Try to complete a set of 3 stretches.

Watch the video below to learn Top 3 Exercises for Piriformis Syndrome:

Prevention
To prevent piriformis syndrome developing or recurring once your symptoms improve, follow these tips:

• Ensure you maintain correct posture when sitting and standing.


• Take regular exercise.


• Don’t sit or lie down for prolonged periods with too much weight and pressure over the buttocks.


• Practice the correct lifting technique. Make sure you bend your knees and squat to pick up objects; keep a straight back, holding the object close to your torso. Avoid bending over or twisting your body.

10 Effective Piriformis Syndrome Exercises

10 Effective Piriformis Syndrome Exercises

The piriformis muscle is located in your buttocks region above your hip joint. Sometimes, strain or overuse causes it to tighten and compress the sciatic nerve that passes along it. This leads to numbness in your buttocks and a tingling pain that can extend to your thighs, calf or foot. As the soreness originates from the piriformis muscle, Piriformis syndrome is also referred to as "Deep Buttock" syndrome.

Piriformis Syndrome exercises For You
Exercises, especially stretches, are very beneficial for strengthening your piriformis muscle. However, ease off, if you experience any tenderness while doing the following exercises.

1. Hip Rotator Stretch

• Lie on your back, with your knees bent and feet lying flat on the floor.


• Place the ankle of the injured leg on the thigh or knee of the opposite leg.


• Grip your thigh and gently try to pull in towards your chest, till you feel a stretch in your buttock.


• Hold the position for 30-40 seconds and repeat it 3 times.

2. Abdominal Strengthening

• Lie on your back, with knees bent and feet lying flat on the floor. Tighten your belly muscles.


• Lift one knee and bring it towards your chest. Your knee should be straight above your hip joint, with your leg bent at a 90° angle.


• Lift the other knee in the similar position. Lower your first leg to the floor. Alternate between legs for 8-10 times.

3. Hip Stretches

This is one of the easiest Piriformis syndrome exercises out there.

• Lie on your back and bend the knee of the injured leg, while stretch the opposite leg straight.


• If you have hurt your left knee, grip it with your right hand and pull it over your right foot towards the right side.


• You will feel a pull in your left leg. Hold it for 30 seconds and repeat it for 3-4 times.

4. Stretch for the Long Adductor Muscles

The long adductors attach to your knee and need to be stretched for increasing muscle strength.

• Sit on the floor with your back straight.


• Spread your feet wide apart as far as you can stretch with your knees straightened.


• Bend slightly forward from your hips without bending your back.


• Hold position for 30 seconds. Repeat 3-5 times.

5. Stretch for the Short Adductors

These muscles are attached above your knee near your thigh.

• To stretch them, sit on the floor and place the soles of your feet together.


• Hold the ankles of your feet and gently push your knees downwards with the help of your elbows. You would feel a stretch along your muscles of the inner thigh.


• Hold the position for 30 seconds. Repeat 5 times.

6. Hip Extension Stretch

Among all Piriformis syndrome exercises, this will definitely relieve your discomforts.

• Position yourself on your all fours. Slightly reduce pressure on the injured leg.


• Keep your knee bent and lift the injured leg off the floor, moving it skywards.


• Keep the position for 30 seconds and then come back to starting position.


• Initially, repeat the exercise 10-15 times and then slowly increase the number.

7. Rolling of Your Glutes

• Place a foam roller on the back of your thigh below your glutes.


• Cross your left leg over the right thigh and bend your knee.


• Place your hands flat behind on the floor for added support.


• Roll your body in the forward direction, so that the roller is placed under your lower back. Roll back and forth on it.


• Repeat the exercise on your right glutes.

8. Jump Squats

• Place your hands behind your head and straighten your elbows, so that they are in line with your shoulders.


• Squat down in such a way that your thighs lie parallel to the floor. Jump up as high as possible.


• As soon as you come back on the floor, squat and jump again. You can make the exercise more challenging by using dumbbells at your sides.

9. Resistance Band Stretch

• Take a band and tie it around your ankle with the other end tied to some fixed object near the floor.


• Move your leg away from the body in the outward direction as far as possible.


• Keep your knees straight and hold the position for 10-20 seconds.


• Slowly release the leg and return it to the former position.


• Repeat the exercise 10-15 times.

10. Clam Exercise

• Lie on your side with your back straight and feet lying one on top of the other. Your hips should be in line with your back.


• Bend your knees without bending your spine. Lift the top knee away from the bottom knee without lifting your ankles. The movements should arise only from your hips and not your back or pelvis.


• Repeat it 15 times.

Other Methods of Dealing With Piriformis Syndrome
Sometimes, due to extreme pain and discomfort, you are not able to perform the Piriformis syndrome exercises. In this case, you can reduce your muscular aches by the following methods:

1. Heat
Heat therapy can help to relax your muscles, reduce muscle spasms and tightness and allow better blood flow. However, do not use this method in case of injuries or inflammation, as it can worsen the bleeding and cause swelling. Heat therapy performed before the exercises would help you perform the stretches in a better manner.

2. Massage
You can also use a good rub-down to increase blood flow and reduce the tension in the piriformis muscle. A therapist may encourage you to relax and contract the tissue, while rotating your femur bone in an inwards direction.

3. Electrotherapy
You can also use ultrasound, interferential and laser treatments for relieving pain and reducing tightness in your sinews. In ultrasound, your tendons are exposed to a very high frequency of sound waves. In the interferential technique, electric current passing by helps to relax muscles and eliminate the tenderness and aches in your body.

Piriformis Syndrome

Piriformis Syndrome






Piriformis syndrome also called as Sciatica is a neuromuscular disorder that occurs when the muscles of piriformis exerts pressure on the sciatic nerve. Piriformis muscle is a bundle of flat muscle found in the buttocks which manages the muscular movement of the lower body. It is the muscles that are responsible for walking with balanced movement. This disorder occurs in one side of the body causing inflammation and numbness on the affected leg. Conservative treatment is enough for controlling mild to moderate pain and surgery is done only for severe case of the syndrome.

Symptoms :

The initial symptoms of piriformis syndrome are pain and tingling feeling in the buttocks. Sometimes the pain can become serious to extend all through the length of sciatic nerve. For some people there can be numbness for short period on the buttocks area. Pain is felt during actions of sitting, running and climbing staircase. Pain usually begins from the lower spine and proceeds till the buttock and goes beyond till the end of your legs. There will be low back pain in the buttocks and back side of the thigh muscle most of the time.

Pain will range from mild type to sharp burning pain causing great discomfort. For some people it can be felt as an electric shock. The pain increases when you sneeze or cough. Lumbar spine has two nerve roots in it called L4 and L5 and set of three nerve endings (S1-S3) which bind together to constitute sciatic nerve. When the L4 nerve root ending gets affected it causes pain on the thigh and jerk in the knee. If the L5 nerve root gets affected it causes intense pain or numbness on the top surface of the foot, and also on the region between the big toe and second toe.

When to Consult a Doctor?

You can wait for some days to verify if the mild pain subsides on its own. You need to consult your GP if you have sudden sharp pain on the lower back and legs area with numbness or tingling sensation. For some people controlling bowel movements become a problem very often during this condition.

Causes :

Piriformis syndrome occurs due to the pressure exerted by the piriformis muscle on the sciatic nerve. Sometimes the sciatic nerve gets pinched because of development of tumor or due to chronic diabetes. There are six back problems that frequently cause this syndrome.

• Lumbar herniated disc develops when the soft tissue of the inner disc protrudes out to irritate the nerve root.


• Degenerative Disc Disease occurs due to old age. It is the condition when the nerve root extends to cause irritation of the sciatic nerve.


• It can also be caused due to isthmic spondylolisthesis which occurs due to Stress Fracture that pinches the sciatica nerve endings.


• Lumbar Spinal Stenosis is a condition occurs due to aging process when the spinal canal gets narrowed.


• Piriformis syndrome also develops if the piriformis muscle pinches the nerve root of the sciatic nerve.


• Finally when the sacroiliac joint gets irritated for some reasons, it can affect the L5 nerve causing leg pain.


• Sciatic pain can occur due to muscle strain, scar tissue and spinal tumor and also due to serious infection on the lower back.

Who are at risk?

Aging and obesity are the main factors that increase the risk of developing periformis syndrome. People whose job involves constant twisting of back portion like driving vehicle can also develop this disorder. Sitting for extended periods and chronic disease like diabetes is likely to cause periformis syndrome. In rare cases, complications like weakness and lack of feeling on the lower legs develops due to this disorder.

Tests :

No concrete tests are available for detecting piriformis syndrome. The symptoms are common for other diseases and so your doctor will request for imaging tests like magnetic resonance, computerized topography test, and X-ray of the affected leg for detecting how far sciatic nerves are affected.

Treatment :

For milder forms of pain caused by prolonged sitting hours, you can change position frequently. Apply ice pack on the buttocks or thighs to reduce pain. You can also practice stretching exercises to reduce the compression of sciatic nerve.

Medications like muscle relaxants, anti-inflammatory drugs, narcotics and anti seizure medicines are prescribed. But the medications have to be combined with physical therapy for fast recovery. Steroid injections are given on the affected nerve root to reduce inflammation and pain but the pain may come back after few weeks.

Surgical Methods :

Surgery is done only for severe case of pain with problems like Bowel Incontinence. Microdiscectomy is a procedure done when the sciatic pain is caused due to lumbar disc herniation. In this process the protruding part of the herniated disc that pinches the sciatic nerve is removed surgically. Very often there will be complete relief from symptoms after surgery.

Lumbar laminectomy is another process where the root cause for piriformis syndrome is Lumbar Spinal Stenosis. Here small region of the bone or disc that puts pressure on the nerve is removed surgically. Surgery is considered as the last option for this problem and it depends on the patient’s decision. The doctor would consider surgery only if there is severe leg pain for extended weeks and the patient does not respond to non surgical methods.

Lifestyle Changes :

Mild to moderate types of leg pain can be managed by making small changes and applying home remedies. Apply cold packs on the affected area for several times a day to get instant relief from pain and inflammation. Alternatively you can also apply hot packs on the legs for decreasing the pain. Both hot and cold packs can be altered for managing pain considerably.

Stretching exercises can offer relief from nerve compression on the sciatic nerves. Active exercise is vital for managing acute pain caused by piriformis syndrome. Movement of legs and thigh muscles help exchange of fluids and nutrients to keep them healthy. It is possible for the person to recover quickly from flare-ups of sciatica by active stretching exercises. In case you still have pain you can use over the counter medicines like ibuprofen or Motrin.

Alternative Treatment :

Some experts believe that acupuncture is highly useful for relieving the symptoms and managing back pain. Similarly you can approach chiropractors for effective body massage and making spinal adjustments.

Prevention :

You cannot prevent piriformis syndrome but you can manage from the symptoms by doing exercise regularly and sitting in proper posture. Give firm support to your back portion using a pillow or rolled towel to maintain the curved position of the spine. When lifting heavy objects always hold it close to your body and use your lower extremities for this work. Do not lift anything in awkward position.