Piriformis Syndrome

Overview

What is piriformis syndrome?

Your piriformis (say: "peer-ee-form-us") muscle runs from your lower spine to the top of your thigh bone. Piriformis syndrome occurs when this muscle presses on your sciatic nerve (the nerve that goes from your spinal cord to your buttocks and down the back of each leg). This can cause pain and numbness in your lower body.

Symptoms

What are the symptoms of piriformis syndrome?

The most common symptom of piriformis syndrome is sciatica. This term describes pain, tingling or numbness that starts in your buttocks and runs down the back of your leg. Sciatica may start as an intense, burning pain deep in the buttocks. The pain gets worse during activities that cause the piriformis muscle to press against the sciatic nerve, such as sitting, walking up stairs or running.

When should I call my doctor?

Talk to your doctor if any of the following are true:

  • Your pain lasts longer than a few weeks.

  • You have sudden, severe pain in your low back or your leg, and you have muscle weakness or numbness in your leg.

  • Your pain starts after you have been injured in a traumatic event.

  • You have problems controlling your bowels or bladder.

Causes & Risk Factors

What causes piriformis syndrome?

You can develop piriformis syndrome from everyday activities, such as sitting for long periods of time, climbing stairs, walking or running. You can also develop it after a traumatic event, such as a car accident or a fall.

Diagnosis & Tests

How is piriformis syndrome diagnosed?

Your doctor will perform a physical exam. He or she will move the affected leg into several different positions to check your pain level.

If your doctor thinks something other than piriformis syndrome is causing your sciatica, he or she may order additional tests. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans cannot diagnose piriformis syndrome, but they may show your doctor if something else is pressing on your sciatic nerve.

Treatment

How is piriformis syndrome treated?

Most people who have piriformis syndrome get better with treatment and lifestyle changes. Failure to treat this condition can lead to permanent nerve damage, so be sure to follow your doctor’s instructions.

Self-care tips for piriformis syndrome include the following:

If your pain doesn’t get better with self-treatment, your doctor may inject a steroid medicine where the piriformis muscle and the sciatic nerve meet. This may help reduce your pain.

If you have severe piriformis syndrome, you may need surgery to relieve the pressure on your sciatic nerve.

  • Temporarily stop doing activities that cause pain, such as running or bicycling.

  • If you have to sit for a long period of time, take regular breaks to walk around and stretch.

  • Use cold packs and warm packs. Start by using a cold pack on the affected area several times a day for about 15 minutes at a time. After using a cold pack for a couple of days, switch to a warm pack or heating pad. If you continue to have pain, alternate between a cold pack and a warm pack.

  • Take a nonsteroidal anti-inflammatory drug (also called an NSAID), such as ibuprofen (two brand names: Advil, Motrin), aspirin or naproxen (one brand name: Aleve), to help relieve your pain. You can also take acetaminophen (brand name: Tylenol) for pain relief.

  • Do exercises to stretch the piriformis muscle. Your doctor can give you information about what stretches will help.

  • Massage the affected area.

Prevention

What can I do to prevent piriformis syndrome?

Once your symptoms improve, you may need to change your activities to avoid developing piriformis syndrome again. The following are some tips to help prevent piriformis syndrome:

  • Exercise regularly.

  • Maintain good posture when you are sitting, driving or standing.

  • Don’t lift by bending over. Lift an object by bending your knees and squatting to pick up the object. Keep your back straight and hold the object close to your body. Avoid twisting your body while lifting.

  • Avoid sitting or lying down for long periods of time in a position that puts too much pressure on your buttocks.

Questions to Ask Your Doctor

  • What is the likely cause of my pain?

  • Do I need any tests to confirm piriformis syndrome?

  • Is it safe for me to exercise? What kind of exercise should I do?

  • Will alternative therapies such as yoga or massage help relieve my pain? Do I need to take any medicine?

  • What should I do if my pain doesn’t go away?