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Piriformis Syndrome

There’s a muscle deep in each of your buttocks called the piriformis muscle. It’s one of the muscles that helps your hip rotate and keeps it stable. It also helps you walk, run and keep your balance. In fact, it’s used just about any time you move your hip or leg.

The piriformis muscle can get irritated and press on the sciatic nerve. The sciatic nerve passes from your spine through your buttock and down your leg. When this happens, it may cause piriformis syndrome. This usually happens on one side of your body, but it can affect both sides.

Piriformis syndrome symptoms include:

  • Pain and tenderness in your buttock.
  • Pain that spreads down the back of the leg (sciatica).
  • Pain when you walk up stairs or hills.
  • Numbness or tingling in your leg.
  • Pain when you sit for long periods of time. 
  • Less range of motion in your hip than normal.
  • Symptoms that get worse when you walk, run or sit for a long time.

With these symptoms, you may think you have sciatica, but piriformis syndrome is different. Most of the time, something else causes sciatica – not piriformis syndrome.

Causes and risk factors for piriformis syndrome

There are several reasons you might be more likely to get piriformis syndrome:

  • Muscle imbalances: Weak, tight or unbalanced muscles in your hip or buttock can irritate the piriformis muscle and lead to piriformis syndrome. 
  • Overuse or repetitive activities: Using your hip joint repetitively or sitting for a long time can increase your risk. Long-distance running (especially on hard surfaces), cycling, ice skating and rowing can cause overuse.
  • Trauma or injury: Falling on or injuring your buttock area in an accident can irritate the piriformis muscle. 
  • Lifting items incorrectly: When you don’t lift things properly, you can damage the piriformis muscle.
  • Variations in body structure: Some people have a shorter or narrower pathway for the sciatic nerve. So the nerve can get more pressure and irritation when it passes through or under the piriformis muscle. 
  • Poor posture: Sitting or standing with poor alignment can stress the piriformis muscle.
  • Age: People of any age can have piriformis syndrome, but it’s most common in people aged 40 to 60.
  • Gender: Women are more likely to have piriformis syndrome than men. 
  • Other conditions: Certain spine conditions, such as lumbar disc herniation, sacroiliac joint dysfunction or spinal stenosis, change your hip and pelvis in ways that may irritate the piriformis muscle.

How is piriformis syndrome diagnosed?

If you have pain lasting longer than a few weeks, you should contact your health care provider. You should also seek medical care if:

  • Your pain is severe or sudden.
  • You have trouble controlling your bowels or bladder.
  • You have sudden weakness or numbness in your back or leg.
  • You fall because of pain or numbness.
  • You can’t easily pick your foot up from the floor.
  • Your pain started after an injury.

Diagnosing piriformis syndrome can be difficult because other conditions have similar symptoms. No test can tell for sure whether you have piriformis syndrome. Your health care provider, a neurologist (brain and nervous system doctor) or an orthopedist (muscle and skeleton doctor) can help you get an accurate diagnosis and a treatment plan that works for you.

Your provider will consider factors like these to see if you have piriformis syndrome:

  • Medical history: Your provider will ask about your history and symptoms. They will want to know where you notice symptoms, how long they last and what makes them better or worse. Also, be sure to tell them about any injuries or activities that might be causing your symptoms.
  • Physical examination: Your provider may check the range of motion in your hip, pelvis and lower back for issues. They may also test the strength and flexibility in your hip and nearby muscles and press on specific areas to see if you feel tenderness or pain. 
  • Other conditions: Piriformis syndrome is somewhat rare, so your provider will want to rule out other conditions related to the back, buttocks or legs. Those include lower back arthritis, hip bursitis, herniated lumbar disc, sacroiliac joint dysfunction and spinal stenosis. 
  • Imaging tests: Magnetic resonance imaging (MRI), computed tomography (CT) scans or ultrasound can show your provider what’s going on with your spine, pelvis and hip joint. Your provider might use these images to rule out other conditions or see if piriformis syndrome is a likely diagnosis.
  • Response to treatment: If physical therapy or exercises targeting the piriformis muscle help, it’s likely that you have piriformis syndrome. 

How is piriformis syndrome treated?

Patients with piriformis syndrome can work with their health care provider to come up with a treatment plan. Most of the time, the condition clears up with simple treatments. 

Here are some piriformis syndrome treatment options your provider may want you to consider:

  • Rest and activity modification: You can avoid or modify activities that make your symptoms worse.   
  • Physical therapy: Working with a physical therapist, you can stretch and strengthen the piriformis muscle and other muscles. You can also improve your posture and how your body moves. 
  • Myofascial release: You can relieve tightness in the muscle by rolling it with a tennis ball or foam roller.
  • Pain management: Your provider may prescribe pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, to help manage your pain and reduce muscle spasms. Medication can help with the pain, but there aren’t medicines that treat the condition itself.
  • Heat and cold therapy: Applying hot or cold treatments to the affected area may reduce pain and help your muscles relax.
  • Massage: Massage can help relax your piriformis muscle.
  • Injections: In some cases, corticosteroid and/or Botox injections into the muscle may help your symptoms. 
  • Transcutaneous electrical nerve stimulation (TENS): This treatment uses a mild electrical current to help relieve pain. 

How to prevent piriformis syndrome

You can take these steps to prevent piriformis syndrome or keep it from returning:

  • Use proper posture when you’re sitting: Sit upright without slumping. Keep your feet flat on the floor and your thighs parallel to the ground. 
  • Take breaks from sitting: Walk around for a few minutes if you’ve been sitting for a while, such as when you’re working at a desk or driving for a long time. Use cruise control on long drives.
  • Support your body when you’re sitting: Use an ergonomic chair or ergonomic supports.
  • Stretch your piriformis muscle: Lie on your back with your legs straight, bend one knee and gently pull it toward your shoulder with your opposite hand. Hold for 30 seconds and repeat on the other side. 
  • Strengthen your piriformis muscle and nearby muscles: Bridges, straight and side leg raises and clamshells can help. Your provider or a physical therapist can show you how to do these exercises.
  • Exercise regularly: Be sure to warm up before you exercise and stretch afterward.
  • Lift items properly: Squat to lift, keeping your back straight. Don’t twist and lift at the same time.
  • Keep your body in line when you’re physically active: Keep your back straight and avoid tipping your pelvis to the front.
  • Don’t keep your wallet in your back pocket: Sitting on your wallet can put pressure on your piriformis muscle.

Piriformis syndrome key points

Piriformis syndrome is a condition where the piriformis muscle gets irritated or inflamed, causing pain in your buttocks. It’s often caused by sitting for too long or by overuse. 

Your health care provider can diagnose it by checking your symptoms and ruling out other conditions. In most cases, piriformis syndrome clears up with simple treatments and you can take steps to keep it from coming back.