Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle compresses the sciatic nerve by hypertrophy or contracture. It causes a set of signs and symptoms in the area of innervation of the sciatic nerve. The syndrome is often confused with the known sciatica, so prevalent among the population.
What are the causes of piriformis syndrome?
The most common cause is repetitive trauma, overuse, muscle spasms or soft tissue inflammation that cause nerve compression. The causes of microtraumatisms include sitting on hard surfaces, or sports and professions such as walking long distances, professional drivers, runners, tennis players or cyclists, among others.
Functional causes include shortening of the posterior muscle chain that causes biomechanical alterations of the pelvis and lower back that would cause irritation of the sciatic nerve.
What are the symptoms of piriformis syndrome?
It usually begins with pain in the buttock or in the retrotrochanteric area, tingling, paraesthesia or numbness in the buttocks; but it can extend to the groin, perineum, hip, back of the thigh, leg and foot. The pain is due to the pyramidal muscle that compresses the sciatic nerve, for example while sitting or running. Many patients cannot sit comfortably for more than 20-30 minutes. The pain can be chronic and worsens when the piriformis is pressed firmly against the sciatic nerve. For instance, after prolonged sitting due to internal rotation, flexion and adduction of the hip or when we explore the patient by pressing the muscle. In addition, patients have difficulty walking or crossing the homolateral leg over the other.
Diagnosis
It is usually based on the patient’s symptoms and the physical examination. It will seek to cause pain in the pyramidal muscle of the pelvis and the exclusion of other causes of sciatic pain.
Imaging tests (such as x-rays, MRIs, and nerve conduction tests) may be done to exclude other conditions that may cause symptoms similar to those of piriformis syndrome.
Magnetic Resonance with Neurography allows to see the signal alterations of the muscle and the nerve and the changes in it after treatments, such as botulinum toxin injection.
High resolution ultrasound also facilitates diagnostic and therapeutic tests or infiltrations, being a technique that is easier to access in consultation. Patients respond to perineural anesthetic infiltrations, associated or not with corticosteroids.
Treatment
The approach must be multidisciplinary. It should include the modification of activities and physiotherapy in its different forms, treating not only the pyramidal area but all the muscles that are around.
Rest and local application of cold and heat can help relieve symptoms. Specialists recommend an exercise and stretching program to help reduce sciatic nerve compression. Also, osteopathic manipulation therapy helps to relieve pain and increase range of motion.
In some cases, electrotherapy is an option. Transcutaneous nerve electrostimulation (TENS) can help block pain and reduce muscle spasm associated with piriformis syndrome.
Pyramidal or piriformis syndrome surgery is considered a last resort in those limiting cases that do not improve with the treatments described. It will consist of the muscle section and the release of the sciatic nerve.
At the London Spine Unit, we have some of the best specialists to diagnose and treat Piriformis syndrome. Book an appointment to get a checkup.
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What are the causes of piriformis syndrome?
The most common cause is repetitive trauma, overuse, muscle spasms or soft tissue inflammation that cause nerve compression. The causes of microtraumatisms include sitting on hard surfaces, or sports and professions such as walking long distances, professional drivers, runners, tennis players or cyclists, among others.
What are the symptoms of piriformis syndrome?
t usually begins with pain in the buttock or in the retrotrochanteric area, tingling, paraesthesia or numbness in the buttocks; but it can extend to the groin, perineum, hip, back of the thigh, leg and foot.
Diagnosis
It is usually based on the patient's symptoms and the physical examination. It will seek to cause pain in the pyramidal muscle of the pelvis and the exclusion of other causes of sciatic pain. Imaging tests (such as x-rays, MRIs, and nerve conduction tests) may be done to exclude other conditions that may cause symptoms similar to those of piriformis syndrome.
Treatment
The approach must be multidisciplinary. It should include the modification of activities and physiotherapy in its different forms. So we treat not only the pyramidal area but all the muscles that are around. Rest and local application of cold and heat can help relieve symptoms. Specialists recommend an exercise and stretching program to help reduce sciatic nerve compression. Also, osteopathic manipulation therapy helps to relieve pain and increase range of motion.
