Piriformis Syndrome - Causes, Symptoms, Diagnosis, and Treatment

What Is Piriformis Syndrome?

Piriformis syndrome is a neuromuscular disorder caused by the compression or irritation of the sciatic nerve around the piriformis muscle. Piriformis muscle is present in the pelvic region of the human body. The sciatic nerve is a thick nerve formed at the lumbar spine and enters the pelvis by passing below the piriformis muscle. It is the main nerve supply to most of the muscles of the lower limbs. Hence, compression at the piriformis muscle may cause pain in the buttock and hip area, extending to the lower leg and sometimes associated with numbness and tingling. As this condition causes symptoms similar to sciatica (compression at the lumbar spine), it is often misdiagnosed. It is the diagnosis of exclusion. In sciatica, the problem originates in the spine, but here, it is not in the spine itself.

The piriformis extends from the sacrum, the triangle-shaped bone in the pelvis, to the top of the femur and moves across the sciatic nerve. This muscle helps the side-to-side movement of the thigh. Spasm in this muscle compresses the sciatic nerve, which results in this condition. The symptoms of this condition were described first in 1928 by Yeoman, and in 1947 the term piriformis syndrome was coined by Robinson. It is difficult to diagnose this, as the symptoms are not specific, and there is no routine test.

What Are the Symptoms of Piriformis Syndrome?

The symptoms may occur intermittently or be present chronically. The common signs and symptoms of piriformis syndrome are:

1. Sciatica (pain that radiates from the lower back to the calf and foot).

2. Numbness and tingling in the hips and back of the leg.

3. The muscles in the buttock area are tender.

4. Problems sitting comfortably.

5. Pain gets worse when sitting for an extended period.

6. Pain in the hips region worsens with activity.

7. In severe cases, the pain can be disabling.

8. Difficulty performing everyday tasks, such as sitting and working on a computer, going for long drives, climbing stairs, etc.

9. Pain during a bowel movement.

10. Painful intercourse in women.

For some patients, a "sausage-shaped" mass is palpable in the buttock due to the piriformis muscle's contraction or spasm.

What Causes Piriformis Syndrome?

The compression of the sciatic nerve due to the contraction or spasm of the piriformis muscle results in piriformis syndrome. The sciatic nerve is one of the longest nerves in the body, which runs from the lower spine, hips, and lower leg and branches out in the foot. The piriformis muscle is located in the hip area and helps rotate the hip, leg, and feet outward. The piriformis muscle is used while walking, turning hips, shifting weight from one leg to another, etc. The sciatic nerve is present below the piriformis muscle. The common causes of piriformis syndrome are:

1. Muscle overuse due to excessive exercise.

2. Running or performing other repetitive activities.

3. Sitting for a long time.

4. Climbing stairs extensively.

5. Injuries to the muscle:

   • Fall.

   • Sports injury.

   • Road traffic accident.

   • Penetration wound.

What Are the Risk Factors for Developing Piriformis Syndrome?

The following are some factors that can increase the risk of this syndrome:

• Females are six times more prone to get affected than men.

• Variation in the positioning of the sciatic nerve in relation to the piriformis muscle.

• Direct injury to the hip region, resulting in swelling, hematoma, and scarring.

• People who sit on the wallet over a hard surface. So it is also called "fat wallet syndrome" or "wallet sciatica."

• Long-distance running, cycling or walking.

How Is Piriformis Syndrome Diagnosed?

There is no definitive test to diagnose this syndrome. The condition is diagnosed based on the history of trauma or overuse. If a person is experiencing symptoms that might suggest piriformis syndrome, the doctor will perform physical examination, which include palpating or moving the piriformis muscle in specific directions. These movements will result in pain if the sciatic nerve is affected. The doctor will then suggest getting the following tests to rule out other disorders, such as herniated discs, sprains, spondylolisthesis, and spinal stenosis, which can compress the sciatic nerve:

1. X-Rays - It is done to rule out fractures.

2. CT (Computed Tomography) Scan or MRI (Magnetic Resonance Imaging) - These imaging tests are done to rule out other possible causes.

3. Electromyography (EMG) - Records the electrical activity of muscles.

4. Anesthetic Injection -Lidocaine to the piriformis muscle helps determine if the symptoms are due to spasms of the piriformis muscle or not (this is both diagnostic and therapeutic).

Pain can last for several weeks to months, so consult a doctor immediately if the symptoms last more than a few days.

What Are the Treatment Options for Piriformis Syndrome?

The treatment is done in three phases:

1. Acute Phase -

• It includes rest and physical therapy. The therapist will teach some exercises to stretch the piriformis muscle. The physical therapist will also perform soft-tissue massages and electrical stimulation and apply cold packs.

• In rare cases, the pressure on the sciatic nerve is relieved surgically.

• Transrectal massage, ultrasound treatment, and manual manipulation can also help.

• The medications prescribed are local injections of anesthetics, oral NSAIDs (nonsteroidal anti-inflammatory drugs), Opiates, muscle relaxants, and Corticosteroids.

2. Recovery Phase -

• To strengthen the piriformis muscles, physical therapy is focused more during this phase.

• Medications might also be needed.

3. Maintenance Phase -

• The patient continues the exercise program to increase strength and stability.

• Athletes can slowly resume normal activities.

Home Remedies:

• Lay flat on the bed and roll from side to side with the knees flexed and then extended.

• Rotating from side to side while standing.

• Lay flat on the bed and move the legs in a cycling motion.

• Warm baths.

• Apply cold packs.

• Gentle massage.

• Yoga.

How to Prevent Piriformis Syndrome?

To prevent piriformis syndrome or injury to the piriformis muscle:

• Warm up and stretch properly before doing strenuous exercises.

• Maintain proper posture and balance while working out.

• If one experiences pain while performing some exercise, then avoid doing it.

• To prevent injury to the buttock area, wear proper protective gear during sports.

• Do not sit with a fat wallet in the back pocket.

Conclusion:

The prognosis depends on how soon the condition gets diagnosed. But as it is often misdiagnosed or overlooked, diagnosis usually takes time. If one gets diagnosed early, he will respond to conservative treatment. But in patients with long-standing piriformis syndrome, the prognosis is bad. Make sure to stay active and exercise regularly. Always stretch before lifting weights.

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