Piriformis Syndrome - Symptoms, Causes and Treatments

What is Piriformis syndrome?

Piriformis syndrome is a neuromuscular disorder caused by compression or irritation of sciatic nerve by piriformis muscle leading to pain, numbness and tingling in the buttocks and alongside the sciatic nerve. This disorder is mainly caused by overstress or strain of the nerves and the resulting condition does not provide a definitive way to diagnose the syndrome as these symptoms are also associated with other conditions.

What are the causes of Piriformis syndrome:

1. As mentioned above, overstress and strain on the sciatic nerve by piriformis muscle is the main cause of this syndrome.
2. Trauma, any type of injury or stress in the area surrounding piriformis muscles or disorders related to nerves and muscles, which cause overstress/strain on the piriformis muscles can lead to development of this syndrome.
3. Inactivation of gluteal muscles that play an important role in helping and supporting hip extension and piriformis muscles in external rotation of the femur caused by overstressed and overactive hip flexors; is also considered to lead to onset of this syndrome.
4. People involved in exercise, sports (race, cycling etc.) and activities that need to use forward postures/movements of body are prone to develop piriformis syndrome as a result of the stress and strain on the piriformis muscles. In order to compensate the stress and strain caused by the forward movement, one should use stretching and some other exercises so that piriformis muscles can be relaxed and strengthened.
5. A combination of weaker abductors and relatively stronger adductors can also cause piriformis syndrome.
6. Problems related to sacroiliac joints such as stiffness, overstress etc. can also lead to this condition as the stress/stiffness is taken care by surrounding gluteal and piriformis muscles.
7. A rotational movement of foot occurs at the subtalar and talocalcaneonavicular joints, which is known as pronation. If this movement is overdone, it can cause the knee to turn medially more than the natural degree of rotation, this is prevented with the help of piriformis muscles. As the piriformis muscles are not made to bear such a high stress/pressure, it can lead to development of piriformis syndrome.

What are the symptoms of Piriformis syndrome?

Initially, the patient experiences chronic pain, tingling and numbness in the buttocks and surrounding area. The pain, tingling and numbness can spread to the surrounding area such as lower back, back of the calf and thigh and worsen when the patient is performing any activity such as running, resting on a narrow ended chair, stretching the thighs etc. The pain increases as the sciatic nerve is pressed against piriformis muscle in activities such as sitting, while rotating the leg internally as against static/still thigh etc. Pain involved with bowel movement and at the time when the patient is getting up/standing. Male patients may experience pain in the scrotum and female patients may experience pain in labia majora. The pain and irritation makes it intolerable for the patient to sit for longer hours.

How is Piriformis syndrome diagnosed?

Physical examination, a patient’s social and personal history, habits etc. can help in diagnosis of piriformis syndrome. The following methods also can be used to diagnose the syndrome:

Beatty Method (also known as Beatty’s Maneuver): In this method selective contraction of piriformis muscles is carried out. The patient lies on the table on the unaffected side and rotates/moves the thighs in the upward direction.

Pace Test: In this method, the sciatic muscle pain is reproduced with the help of external rotation of the piriformis muscles.

Freiberg Test: This method is used to reproduce pain with the help of forced internal rotation of the extended thigh.

Magnetic Resonance Neurography: This is an imaging technique used to show problems related to sciatic nerve.

Reproduction of pain by pressing the point where sciatic nerve crosses piriformis muscles also can help in diagnosis of the syndrome.

Treatment:

In almost all the cases, the doctor’s first advice to the patient suffering from piriformis syndrome is to take as much rest as possible, and stop all the activities which cause stress and strain on the piriformis muscles. Medication, exercise, change in posture, injection of corticosteroid in the affected area, massage etc. are used to ease the pain. Surgery is also a rarely used option, as it does not guarantee total solution.