What is Piriformis Syndrome?

Piriformis syndrome explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Piriformis Syndrome MRIPiriformis syndrome is a pain condition involving the piriformis muscle, as well as the sciatic nerve. This muscle begins deep within the buttocks and is attached at both the lower back and the top of the femur. The function of this muscle is to rotate the hip, and turn the leg and foot outward. The piriformis muscle is also involved in balance and stabilization during ambulation or walking around. The sciatic nerve runs along this same area and transmits pain information from the legs, buttocks, and lower back to the brain.

Piriformis syndrome is somewhat uncommon. In general, it is estimated that approximately 40-70% of adults experience lower back pain at some point during their lifetime. Of these, it has been suggested that between 5% and 36% of these individuals experience pain that is attributable to piriformis syndrome. Indeed, many believe that these estimates are skewed such that many cases of piriformis syndrome go undiagnosed.

Piriformis syndrome is associated with a significant degree of discomfort and pain, but these symptoms can vary widely. The most common symptom attributed to piriformis syndrome is back pain following long periods of sitting. This causes compression of the sciatic nerve, along with swelling of the surrounding tissue, which leads to discomfort. The pain is typically experienced in the area of the piriformis muscle where the muscle joins the femur and the base of the spine.

Symptom clusters associated with piriformis syndrome can also be widely varied. Many patients will report experiencing sharp, stabbing pain, while others may describe that the pain is more dull and achy. Generally, symptoms vary in conjunction with the specific underlying cause. Below is a list of commonly reported symptoms of piriformis pain.

  • Numbness in feet
  • Painful bowel movements
  • Headache
  • Abdominal, pelvic, or groin pain
  • Difficulty walking
  • Lower extremity weakness
  • Muscle spasms
  • Radiating pain
  • Neck pain
  • Painful intercourse in women 

Causes of Piriformis Syndrome

Piriformis MuscleIt is not known what specifically causes piriformis syndrome. In fact, only about half of all cases of piriformis syndrome can be directly attributed to a history of injury or trauma. In general, however, it is believed that when the piriformis muscle becomes overloaded, tissue inflammation places pressure on the sciatic nerve causing significant pain and discomfort.

A detailed assessment with an expert physician is generally required to achieve an accurate diagnosis for treatment planning. In general, individuals undergo a thorough physical examination that includes an assessment of the patient’s discomfort, pain, and degree of swelling. Your physician will also gather a detailed history of the current episode of sciatic pain and any other relevant symptoms. Your physician will also manipulate a number of your joints in order to assess for any associated pain. This can aid in the diagnostic process.

Piriformis syndrome, though relatively uncommon, can occur more frequently among individuals involved in running, lunging, or jumping. Moreover, piriformis syndrome can occur more frequently among women than men.

Treatments for Piriformis Syndrome

Patients are encouraged to speak with their physician regarding their condition, as a number of treatment options are available. Should the patient not be experiencing severe and debilitating pain associated with their condition, it is recommended that they first attempt conservative, at-home treatment for managing their pain.

NSAIDsOver-the-counter pain relievers with anti-inflammatory qualities (NSAIDs, such as ibuprofen or naproxen) can be very beneficial for patients with piriformis syndrome. These medications are believed to be effective because of their anti-inflammatory characteristics. Some anti-depressants have been shown to have effectiveness in relieving the pain associated with piriformis syndrome. Other medications, such as oral corticosteroids like prednisone and cortisone, may be recommended in instances where the patient’s pain was not significantly reduced using an over-the-counter pain reliever.

Piriformis syndrome can also be associated with chronic or severe pain. Patients with these more significant symptoms may wish to try more aggressive forms of pain management that are available. For instance, a highly effective and almost immediate option for managing neuropathic pain associated with irritation to the sciatic nerve can be corticosteroid injections. This procedure involves the injection of an anaesthetic medication into the area near the nerve that is primarily responsible for transmitting pain signals to the brain. Trigger point injections are one available option for the treatment of piriformis syndrome pain.

BiofeedbackTherapyAnother option is the sciatic nerve block. This procedure is non-surgical and acts to anesthetize the sciatic nerve, whose job it is to transfer pain information from the legs, buttocks, and lower back to the brain. Other methods, including the use of spinal cord stimulation, which sends a very mild electrical impulse to the affected area, has been shown to be highly effective in relieving pain associated with piriformis syndrome.

Alternative and complementary pain management techniques are also available. These can include biofeedback training, relaxation training, and acupuncture. These methods have received some support in terms of their effectiveness in helping patients manage the pain of piriformis syndrome, particularly when used in conjunction with other therapies.

Conclusion

Piriformis syndrome is an uncommon condition that affects both the piriformis muscle and the sciatic nerve, which runs along the lower back and the buttocks. The condition itself can arise from injury or weakness to the area. Individuals who sit for long periods of time are at risk for experiencing sciatic pain associated with piriformis syndrome. As a result of injury or trauma, tissue inflammation places pressure on the sciatic nerve and the surrounding area. This is what leads to the symptoms of pain and discomfort.

There are several treatment options available for assisting patients with managing their pain associated with piriformis syndrome. In general, it is recommended that patients attempt more conservative pain management options before attempting the more interventional strategies. Specifically, corticosteroid injections have been shown to be very effective in managing the pain associated with piriformis syndrome. Indeed, patients should speak with their doctor about their specific condition to learn about the treatment options available for managing their pain.

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References

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