The piriformis muscle effectively assists in lateral opening of the hip as well as outward rotation. The piriformis muscle can be a source of serious pain, and it can also be very sensitive as the sciatic nerve typically passes under the piriformis muscle and then carries transmission to the leg. Piriformis Syndrome is actually peripheral neuritis of the sciatic nerve caused by an abnormal condition of the piriformis muscle, characterized by pain in the groin and back of the hip. It can also be described as a ‘sciatica’ caused by compression of the sciatic nerve by the piriformis muscle. It is estimated that at least 6% of patients diagnosed with low back pain actually have piriformis syndrome, although this range can vary widely, from 5 to 36% depending on the evaluation criteria (Boyajian-O’Neill et al, 2008).
What are the Symptoms of Piriformis Syndrome?
• Pain while sitting
• Pain along the sacrum, hip area and thigh
• Pain in one leg with movement
• Pain when getting up from sitting or squatting
• Numbness in feet
• Weakness in the leg
• Abdominal, pelvic or groin pain
• Pain with bowel movements
How to Diagnose Piriformis Syndrome?
In most cases, there is a history of trauma to this area, repetitive, vigorous activity such as long-distance running or prolonged sitting. The diagnosis of piriformis syndrome is made by the patient’s complaints and physical examination using various movements to create pain in the piriformis muscle. In some cases, a contracted or tender piriformis muscle may be found on physical examination. Piriformis syndrome may be masked by other potentially more common dysfunctions such as herniated disc, lumbar radiculopathy, sacral dysfunctions, sacroiliitis, sciatic nerve disorders, and trochanteric bursitis. To distinguish such conditions, your doctor may order imaging tests such as X-ray, ultrasound and MRI.
What are the Treatment Options in Piriformis Syndrome?
If the pain is caused by sitting or certain activities, try to avoid positions that trigger pain. Rest, ice, and heat can help relieve symptoms. A doctor or physical therapist may recommend an exercise and stretching program to help reduce sciatic nerve compression. Osteopathic manipulative therapy can be used to help relieve pain and increase range of motion. Your doctor may recommend anti-inflammatory drugs, muscle relaxants, or ultrasound-guided corticosteroid or anesthetic injections. Using the paralytic properties of botulinum toxin, botox injections are thought by some to relieve sciatic nerve compression to minimize muscle tension and pain. If physiotherapy treatment has been ineffective in reducing pain and symptoms and the diagnosis has been confirmed on imaging, an ultrasound-guided injection may be right for you. Surgery may be recommended as a last resort.