In the simplest terms, piriformis syndrome results from the compression (entrapment) of the sciatic nerve by the piriformis muscle. The piriformis is a slender, band-like muscle that is located in the buttocks near the top of the hip joint. This muscle is important to the functioning of the leg because it stabilizes the hip joint and rotates the thigh away from the body when it contracts.
The sciatic nerve is a long, thick nerve that passes beside or through the piriformis muscle. As it passes down the back of the leg, it divides into smaller nerves that travel into the foot.
There are two variations of entrapment. The first variation takes place below to the piriformis muscle and above the gemellus muscle. Entrapment in this area is likely due to a myospasm or contracture (tightening or shortening) of either of these two muscles. The second variation is when the sciatic nerve pierces the piriformis muscle. In this case, myospasm and/or contraction of the piriformis muscle can lead to pain along the back of the thigh to the knee, loss of sensation, or numbness and tingling into the foot.
Piriformis syndrome usually begins with some combination of pain, tingling, or numbness in the buttocks, but symptoms can be severe and may extend down the entire length of the leg. This particular syndrome can often mimic its more notorious counterpart, sciatica syndrome. The main difference between sciatica syndrome and piriformis syndrome is the cause. Sciatica is directly due to a lumbar disc pressing on the sciatic nerve, not the piriformis muscle.
What both of these syndromes have in common is that they both affect the sciatic nerve and can produce pain, numbness, and tingling below the knee and into the foot. Some of the common symptoms include:
- Pain that is often aggravated by sitting, squatting, or walking
- Affected leg is externally rotated (toes point out) when relaxed
- Low back pain
- Deep aching in the buttock and thigh on the involved side
Unfortunately, there is no specific test for piriformis syndrome. As a result, diagnosis is usually made on the basis of clinical history. Patients usually describe an injury to the local area, a habit of sitting for long periods as a result of work or lengthy travel, or recreational running. Diagnosis can be further confirmed by finding a tender or contracted piriformis muscle during physical examination.
Clinical history and physical examination are usually sufficient to diagnose piriformis syndrome, but further tests like MRI scans are often conducted to exclude other causes of sciatic nerve compression.
In the first instance, patients who suffer from piriformis syndrome are advised to avoid any activities that have caused or worsened the condition. If recreational running has been a factor, then doctors generally suggest alternate physical activities. If lengthy periods of sitting are implicated, establishing regular breaks for standing and stretching is likely to be helpful.
In addition to resting the area, ice and/or heat may offer relief or reduction in symptoms for some patients. Furthermore, a physical therapist or other healthcare professional may be able to suggest a regime of exercises and stretches that minimize the compression of the sciatic nerve. Some patients report positive results from osteopathic manipulation, but evidence is mixed and many doctors are skeptical of the value of these treatments.
For those who wish to pursue pharmaceutical options, a health care provider will be able to recommend a range of medications that may help, including anti-inflammatory drugs and muscle relaxants. Some practitioners may suggest injecting a corticosteroid or anesthetic into the local area, which will offer anti-inflammatory and pain-killing effects, respectively.
In cases of piriformis syndrome that do not respond to typical treatments, some clinics and private medical practices are able to offer alternative options that can include iontophoresis treatment with a mild electrical current or local injection of a paralyzing botulinum toxin. More severe cases of piriformis syndrome may only respond to surgical interventions, ischiofemoral impingement (IFS) decompression using endoscopic or open technique.
Your trusted health care professional will be in the best position to suggest the most appropriate treatment in your particular circumstances.
Recovery from piriformis syndrome is variable. Uncomplicated cases can resolve without medical intervention in a matter of days, while more serious cases may take weeks or months to improve and may require surgery.
How to heal piriformis syndrome quickly
Many cases of piriformis syndrome resolve quickly without treatment — it’s often sufficient to rest and avoid any activities that trigger your symptoms. Heat and cold on the buttocks and legs can also provide relief; simply alternate 20 minutes of an ice pack with a heating pad for the same period of time.
Over-the-counter medications like ibuprofen and naproxen can provide considerable relief in as little as 30 minutes. It’s important to remember, though, that the injury is still present — only the pain is gone. Pain relief shouldn’t mean that you begin to engage in the activities that caused piriformis syndrome to begin with.
Given that piriformis syndrome typically results from particular movements or posture, there are a number of practices that can be adapted to prevent the condition from developing in the first place. It’s important to warm up sufficiently before exercise, as well as to make gradual increases in the intensity of a training regimen — particularly in the early stages. Good posture is imperative during all physical activity, whether walking, running, or otherwise. Try to avoid exercising on hilly or uneven surfaces.
Be alert to pain or discomfort anywhere in your body, particularly when exercising. If necessary, seek the advice of a doctor or other health care professional.
If rest and over-the-counter treatments do not resolve your symptoms, you may benefit from exercising the region. A physical therapist will be able to advise you about exercises that assist in the treatment of piriformis syndrome, but here are two options that may be helpful:
- Knee rolling. Lie on your back with your hips and knees flexed and your feet flat on the floor. While in this position, gently roll your knees clockwise and then counter-clockwise for 15 seconds each.
- Knees to chest. Remain in the same position as knee rolling above and simply flex your hips until your knees are at your chest. Hold this position for 15 seconds before releasing. Repeat 3–5 times.
The following two piriformis muscle stretches can help to stretch and mobilize the muscle:
- Sitting stretch. Sit up straight on a chair and place a rolled towel directly under your gluteal muscles. Arch your back by sticking your buttocks out and moving your chest forwards. In this position, lift your right leg and place the ankle on the opposite knee. Hold for 15 seconds and then repeat on the other side.
- Lying stretch. Pull your knee up and across your body (towards the opposite shoulder). Feel a stretch deep in the hip/buttock. Hold for 30 seconds. Repeat 3 reps, twice a day.