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What is Piriformis Syndrome?

There is a physical ailment that is an actual pain in the butt. “Piriformis syndrome is a neuromuscular disorder where pressure from the piriformis muscle, located in the buttocks, causes compression of the sciatic nerve as it passes behind the hip joint,” said Marc Rosen, MD, an orthopedic surgeon with Banner Health Clinic in Glendale, Arizona.

The piriformis muscle is one of the muscles responsible for external rotation of your hip and aids in such simple movements as walking and maintaining your balance. “A healthy sciatic nerve passes under the piriformis muscle,” said Dr. Rosen, “but in some cases, the sciatic nerve penetrates and passes through the piriformis muscle.” According to Dr. Rosen, this ailment, commonly seen in runners and ice skaters, can occur during general exercise or with sedentary activity levels.

Is your “pain in the butt” piriformis syndrome?

If you’re experiencing pain in your buttocks or down the back of your leg, you may be wondering if the cause is piriformis syndrome or sciatica. “A patient with piriformis syndrome often thinks they have sciatica, but sciatic pain is a symptom of piriformis syndrome,” said Dr. Rosen.

Symptoms of piriformis syndrome include pain in the buttocks that often worsens after prolonged sitting. “An orthopedic doctor or orthopedic surgeon can diagnose your piriformis syndrome by recreating your pain with manual rotation of your hip or by direct palpation over your piriformis muscle,” said Dr. Rosen. Because it is such a rare disorder, diagnosis of piriformis syndrome usually only happens after excluding all other conditions originating from the back, buttocks or legs.

Best treatment options for piriformis syndrome

The first line of treatment for this painful ailment is physical therapy and regular stretching. Stretching and doing the appropriate physical therapy exercises can both strengthen and relax the piriformis muscle. “Medications are seldom helpful in treating piriformis syndrome as it is a mechanical – not metabolic or illness-oriented – condition,” explained Dr. Rosen.

Your orthopedic specialist may recommend corticosteroid injections as an option for temporary pain relief, but because the injection must be done near where the piriformis muscle and the sciatic nerve meet, “these types of injections can be tricky and require ultrasonic or radiographic control,” according to Dr. Rosen. Surgery is often a last resort after more conventional treatment methods have failed.

Taking preventive steps to avoid piriformis syndrome is your best bet in avoiding serious pain. Because the syndrome can be caused by being sedentary (when you sit for long periods of time) or excessive exercise, it’s important to be mindful of avoiding both extremes. “Incorporating an active stretching regimen into your daily routine can help you avoid piriformis syndrome,” said Dr. Rosen.

If you’re living with lower back or buttock pain, an orthopedic doctor or surgeon can do a physical exam to get to the root of what’s causing your pain and set you up on a treatment plan. To find a Banner Health orthopedic care provider, visit BannerHealth.com.

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Orthopedics Pain Management

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