Piriformis Syndrome

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Piriformis Syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats. The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle.

Most commonly, patients describe acute tenderness in the rear and sciatica-like pain down the back of the leg.
Typical symptoms of piriformis syndrome may include:

  • A dull ache in the mid-rear
  • Pain down the back of the leg
  • Pain when walking up stairs or inclines
  • Increased pain after prolonged sitting

  • Symptoms of piriformis syndrome often become worse after prolonged sitting, walking or running, and may feel better after lying down on the back.

    The symptoms of sciatica come from irritation of the sciatic nerve. It's still a mystery why the piriformis muscle sometimes starts to irritate the sciatic nerve. Many doctors think that the condition begins when the piriformis muscle goes into spasm and tightens against the sciatic nerve, squeezing the nerve against the bone of the pelvis.

    In some cases, the muscle may be injured due to a fall onto the buttock. Bleeding in and around the piriformis muscle forms a hematoma. A hematoma describes the blood that has pooled in that area. The piriformis muscle begins to swell and put pressure on the sciatic nerve. Soon the hematoma dissolves, but the muscle goes into spasm.

    The sciatic nerve stays irritated and continues to be a problem. Eventually the muscle heals, but some of the muscle fibers inside the piriformis muscle are replaced by scar tissue. Scar tissue is not nearly as flexible and elastic as normal muscle tissue. The piriformis muscle can tighten up and put constant pressure against the sciatic nerve.

    Unfortunately, the treatment of piriformis syndrome is quite general, and often this is a difficult problem to recover from. Some treatment suggestions are:
    • Physical Therapy - Emphasis on stretching and strengthening the hip rotator muscles
    • Rest - Avoid the activities that cause symptoms for at least a few weeks
    • Anti-Inflammatory Medication - To decrease inflammation around the tendon
    • Deep Massage - Advocated by some physicians

    • On some occasions, when these treatment fail, patients have surgery to release, or loosen, the piriformis muscle tendon. This surgery is not a small procedure, and generally considered the last resort if a lengthy period of conservative treatment does not solve the problem.


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