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).
Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs — in short, in almost every motion of the hips and legs.
Piriformis Syndrome Exercises
- Resisted hip abduction: Stand sideways near a door with your injured side further from the door. Tie elastic tubing around the ankle on your injured side. Knot the other end of the tubing and close the knot in the door near the floor. Pull the tubing out to the side, keeping your leg straight. Return to the starting position. Do 2 sets of 15. For more resistance, move farther away from the door.
- The plank: Lie on your stomach resting on our forearms. With your legs straight, lift your hips off the floor until they are in line with your shoulders. Support yourself on your forearms and toes. Hold this position for 15 seconds. (If this is too difficult, you can modify it by placing your knees on the floor.) Repeat 3 times. Work up to increasing your hold time to 30 to 60 seconds.
- Side plank: Lie on your side with your legs, hips, and shoulders in a straight line. Prop yourself up onto your forearm with your elbow directly under your shoulder. Lift your hips off the floor and balance on your forearm and the outside of your foot. Try to hold this position for 15 seconds and then slowly lower your hip to the ground. Switch sides and repeat. Work up to holding for 1 minute. This exercise can be made easier by starting with your knees and hips flexed toward your chest.
Prone hip extension with bent leg:
- Lie on your stomach with a pillow under your hips. Bend the knee on your injured side. Draw your belly button in towards your spine and tighten your abdominal muscles. Lift your bent leg off the floor about 6 inches (15 centimeters). Keep your other leg straight. Hold for 5 seconds. Then lower your leg and relax. Do 2 sets of 15.
- Clam exercise: Lie on your uninjured side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your heels touching each other. Hold for 2 seconds and lower slowly. Do 2 sets of 15 repetitions.
Piriformis Syndrome Treatment
While medications, such as pain relievers, muscle relaxants, and anti-inflammatory drugs may be recommended, the mainstay of treatment for piriformis syndrome is physical therapy, exercise, and stretching. Specific treatments may include:
- adjustments in gait
- improved mobility of sacroiliac joints
- stretching to relieve tight piriformis muscles and those surrounding the hip
- strengthening of the hip abductors (muscles that move the hips outward from the body)
- application of heat
If these measures are not effective, more invasive treatment can be considered such as:
- injections of a local anesthetic (similar to Novocain), botulinum toxin, and/or a corticosteroid agent — these injections are generally guided by ultrasound, x-ray, or electromyogram (which detects muscle and nerve activity) to make sure the needle is in the right place.
- surgery — Although an option of last resort, removing a portion of the piriformis muscle or its tendon has been reported to provide relief in refractory cases.
Piriformis Syndrome Icd 10
- G57.00 – Lesion of the sciatic nerve, unspecified lower limb
- G57.01 – Lesion of sciatic nerve, right lower limb
- G57.02 – Lesion of the sciatic nerve, left lower limb
- M62.838 Other muscle spasms
Piriformis Syndrome Test
Unfortunately, there is no definitive test for piriformis syndrome. However, frequently the patient has a history of trauma or overuse activity. During the patient’s physical exam, palpating or moving the patient’s piriformis muscle in certain directions may elicit pain. Because piriformis syndrome is a relatively infrequent cause of sciatica and low back pain (its estimated incidence is about 6%), health care professionals usually perform other tests to rule out other causes of sciatic nerve compression, such as herniated discs, back sprains, lumbosacral spondylolisthesis, spinal stenosis, and many others.
Tests such as X-rays can rule out bone fractures. CT, MRI (magnetic resonance imaging), electromyography (EMG, neurography or electrophysiologic tests), and injection of trigger points in the piriformis muscle with an anesthetic (lidocaine, for example) can help the physician determine whether the symptoms are due to piriformis syndrome or other conditions like a herniated disc.
Piriformis Syndrome Symptoms
Early signs of piriformis syndrome usually occur in the buttocks and may include the following:
- Tingling feeling (like pins and needles pricking the skin)
- Low back pain (sacroiliac and/or sciatic pain)
Later signs of piriformis syndrome may include the following:
- Extension of pain down the length of the sciatic nerve, as far as the foot
- Severe buttock pain and/or leg pain (leg muscle spasm)
The early and late signs and symptoms may be intermittent; however, they may recur, usually triggered by sitting, running, climbing stairs, or even applying pressure over the piriformis muscle.
Piriformis syndrome closely mimics sciatica and low back pain symptoms caused by other mechanisms such as disc nerve entrapment (disc herniation).
Piriformis Syndrome Stretches
- Gluteal stretch: Lie on your back with both knees bent. Rest the ankle on your injured side over the knee of your other leg. Grasp the thigh of the leg on the uninjured side and pull toward your chest. You will feel a stretch along the buttocks on the injured side and possibly along the outside of your hip. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
- Standing hamstring stretch: Put the heel of the leg on your injured side on a stool about 15 inches high. Keep your leg straight. Lean forward, bending at the hips, until you feel a mild stretch in the back of your thigh. Make sure you don’t roll your shoulders or bend at the waist when doing this or you will stretch your lower back instead of your leg. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
How To Heal Piriformis Syndrome Quickly
Since piriformis syndrome is usually caused by sports or movement that repeatedly stresses the piriformis muscle, such as running or lunging, prevention is often related to good form. Avoid running or exercising on hills or uneven surfaces. Warm-up properly before activity and increase the intensity gradually. Use good posture while running, walking, or exercising. If pain occurs, stop the activity and rest until the pain subsides. See a health care provider as needed.
Piriformis Syndrome 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.
Anyone 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).