Piriformis Syndrome - Causes, Prevention, and Treatment

Cause and Treatment of Piriformis Syndrome

woman doing piriformis stretch outside on grass
Angelita Niedziejko/Moment/Getty Images

Piriformis syndrome is neuromuscular condition that occurs when the muscle of the same name compresses the sciatic nerve.

Everyone has a flat, band-like muscle located in the buttocks near the top of the hip joint. This is the piriformis muscle. It stabilizes the hip joint and lifts and rotates the thigh away from the body when we walk, shift our weight from one foot to another, and helps maintain balance.

Because it is involved in every lower body motion, it is an important muscle. 

The sciatic nerve is a nerve that passes alongside or goes through the piriformis muscle, travels down the back of the leg, and eventually branches off into smaller nerves that end in the feet. 

How Piriformis Syndrome Occurs

Specifically, when the piriformis muscle becomes tight or cramps, pressure can be put on the sciatic nerve. Typically this pain increases when the muscle contracts, when sitting for an extended time, or direct pressure on the muscle. Gluteal (or buttock) pain is common. Pirformis syndrome is also a common cause of sciatica.

Piriformis Syndrome Causes

Shortening of the muscle and compression of the nerve is the most common cause of piriformis syndrome, but overuse of the glutes and other muscles in the hip can also cause muscle spasms of the piriformis. Other factors in this syndrome include poor body mechanics and posture, gait problems.

Pain can also be caused by prolonged external rotation of the hip, something that is common in ballet dancers, so that the piriformis muscle is shortened. If the sciatic nerve is compressed for an long time there may be aching in the leg and pain in the low back.

Stretching and strengthening are the best treatments for piriformis syndrome.

This muscle rarely gets stretched, so a simply stretching routine can often work wonders.

Preventing and Treating Piriformis Syndrome

The easiest way to treat the pain of piriformis syndrome is to avoid positions or activities that cause it, such as prolonged sitting, walking with turned out feet, or walking up stairs. You may be able to alleviate the pain with rest, ice, and heat. Your doctor or physical therapist may recommend stretches which can help reduce the pressure on the sciatic nerve.

One could be the Piriformis Stretch. To do so, lay on your back, bend your knees and cross your right leg over your left so your right ankle rests on your left knee in a figure four position. Bring your left leg towards your chest by bending at the hip. Reach through and grab your left thigh to help pull things towards your chest.

If this doesn’t help relieve the pain go away, osteopathic manipulative treatment is an option as well as anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid or anesthetic.

Other therapies tried by some doctors are iontophoresis, which uses a mild electric current, and botox injections. Using the paralytic properties of the botulinum toxin, botox injections is thought by some to relieve muscle tightness and sciatic nerve compression to minimize pain.

If none of these things work, surgery may be recommended as a last resort.

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