Piriformis Syndrome and Sciatica

Woman performing piriformis stretch
Woman performing piriformis stretch. Dorling Kindersley / Getty Images

Piriformis Syndrome and Sciatica

Sciatica is a set of symptoms that is characterized by pain down the leg. Contrary to what many people believe, it is usually not caused by piriformis syndrome - although it can be.  Instead, sciatica is quite often related to a herniated disc that, in irritating a spinal nerve root can cause pain, pins and needles, burning or electrical sensations, weakness and/or numbness going down one leg.

 Technically, this type of "sciatica" is called radiculopathy.

What is Piriformis Syndrome?

Piriformis syndrome is a rare type of sciatica caused by irritation to the sciatic nerve by a tight piriformis  muscle.  The piriformis is located in the buttock; the sciatic nerve passes under it in that area.

Symptoms of piriformis syndrome includes leg and buttock pain and tenderness you can feel on the skin in the area between the back hip and the sitting bone.  Leg pain may be accompanied by electrical type sensations such as pins and needles, etc., weakness and/or numbness. Sitting aggravates piriforms syndrome symptoms, as does any movement that contracts the piriformis - for example hill or stair climbing.

Unlike the other types of sciatica, diagnosing piriformis syndrome is a matter of ruling out all possible causes. For this and other reasons, there is controversy around the accuracy of diagnosis.

In fact, controversy exists about whether or not piriformis syndrome is even real.  According to a 2010 review published in the European Spine Journal, this may be related to the fact that some doctors claim it is over diagnosed, while others believe it is under diagnosed.

Piriformis syndrome was first described in medical literature in the 1940s and studies on it continue today.

Related: Are You at Risk for Sciatica?

According to a 2013 "brief review" published in the Canadian Journal of Anesthesiology, if your doctor is not sure if you have piriformis syndrome, electrophysiological testing and/or nerve blocks may help her with the diagnostic procedure.  The authors say  that injections - of local anesthetics, steroids, or botulinum toxin into the piriformis muscle can be used both diagnostically and as treatments.  They also comment that an interdisciplinary diagnostic procedures will likely be the most accurate, possibly leading you to the most optimal form(s) of treatment.

Most of the time, treatment for piriformis syndrome consists of conservative (i.e. non-surgical) care.  This includes physical therapy, which may help break the cycle of spasm and pain with stretching exercises, and other treatments. Surgery for piriformis syndrome is very rare, and is usually only considered after all conservative care techniques have been tried with unsatisfactory results.

Here's an outer hip muscle stretch that may help you relieve pain due to piriformis syndrome: Outer hip stretch.

Sources:

Hopayian., K., et. al. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. Dec 2010. Accessed March 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997212/

Jankovic D., Peng P., van Zundert A. Brief review: piriformis syndrome: etiology, diagnosis, and management.Can J Anaesth. Oct. 2013. Accessed: March 2016. http://www.ncbi.nlm.nih.gov/pubmed/23893704

NINDS Piriformis Syndrome Information Page. NINDS Piriformis Syndrome Information Page . In NINDS Web Site [Web]. Bethesda: National Institute of Neurological Disorders and Stroke. Accessed Feb 2007. http://www.ninds.nih.gov/disorders/piriformis_syndrome/piriformis_syndrome.htm

Papadopoulos, E.C., Kahn, S.N. Piriformis syndrome and low back pain: a new classification and review of the literature.. Orthop Clin North Am. 2004. Accessed: February 14, 2007. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15062719

Rodrique, T., Hardy, R.W. (2001). Diagnosis and treatment of piriformis syndrome. Neurosurg Clin N Am. 2001. Accessed: February 2007. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11525209

Broadhurst, D.A., Simmons, D.N. Bond, M.J. Piriformis syndrome: Correlation of muscle morphology with symptoms and signs.. Arch Phys Med Rehabil. Dec 2004. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15605344

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