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Piriformis Syndrome

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Recover from Piriformis Syndrome (buttock pain) with the latest conservative treatment options, such as anti-inflammatory drugs, physical therapy, corticosteroid injections, and electrical nerve stimulation. Downtown Pain Physicians are experts in piriformis muscle spasms and can pinpoint the source of your pain and prescribe a personalized, time-tested treatment plan that works. Visit our pain management center and meet our NYC local physicians to get the pain relief you need in the safe, reassuring hands of the best doctors in New York.

Piriformis Syndrome


Piriformis Syndrome

Piriformis syndrome is a condition that leads to sciatica, which might be more known. Sciatica is a pain that begins in the buttocks and runs down either one or both legs. Typically, it is caused by pressure or irritation that affects the nerves of the lower back. This type of pressure on the nerves can be caused by a condition known as piriformis syndrome.

The piriformis is a muscle, which extends from the front of the sacrum; that triangle-shaped bone between the two hipbones in the pelvis. The piriformis muscle extends across the sciatic nerve and to the top of the femur, the large bone located in the upper leg. The piriformis muscle has the function of helping our thighs to move side to side.

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When the piriformis muscle suffers from a spasm, the pressure might be put on the sciatic nerve, which can lead to symptoms. One result thereof is piriformis syndrome.

What are the symptoms of piriformis syndrome?

The main symptom of piriformis syndrome is sciatica. However, some people might also suffer from discomfort in other parts of the body, such as the back of the leg. This type of pain is referred to as referred pain.

Some common signs of piriformis syndrome also include:

  • difficulty with finding a comfortable position to the seat
  • tenderness on the muscles of the buttocks
  • pain when sitting, which worsens the longer that you sit
  • pain in the legs and buttocks which worsens with activity
  • numbness or tingling in the buttocks, which might extend down the back of the leg

In severe cases of piriformis syndrome, the pain in the buttocks and the pain in the legs can be so severe, that it can lead to disability. Patients might not be able to go on with everyday tasks, such as:

  • driving
  • sitting at a computer
  • doing household chores

What causes piriformis syndrome?

Our piriformis muscle is used daily. We need it when we walk or whenever we move our lower body. The piriformis is used simply when we shift our weight from one side to the other. It is a muscle that can get injured or irritated if we exercise too much or whenever we are inactive for a long time.

Some of the most common causes of piriformis syndrome include:

  • extensive stair climbing
  • lifting heavy objects
  • sitting for a long time
  • overuse after excessive exercise or running
  • doing other repetitive activities, which involve the legs

An injury can also lead to damage of this piriformis syndrome, which can lead to it pressing down on the sciatic nerve. A typical piriformis injury cause could include:

  • vehicle accident
  • bad fall
  • direct hit during sports
  • sudden twist of the hip
  • penetration so deep, that it reaches the muscle

What are the risk factors for piriformis syndrome?

People who sit for a long time, such as those who spend the day working at a desk, or those who spend a lot of time in front of the TV, are at a higher risk of suffering from piriformis syndrome. At the same time, people who do a lot of rigorous workouts that include the lower-body might injure their piriformis muscle, leading to piriformis syndrome.

How is piriformis syndrome diagnosed?

To diagnose piriformis syndrome, your doctor will ask you about the symptoms that you have been experiencing. If you suffer from pain or numbness in the legs or buttocks which won’t go away even after a couple of weeks, it is very important to speak to a professional. Sciatica can last for more than a couple of weeks, depending on what causes it. If your symptoms come and go frequently, talk to your doctor about it as well.

Your doctor will also want to know about your medical history and possible causes of your pain. If you recently had a fall or have strained a muscle during sports, you must share that with your doctor. Your doctor will also perform a physical exam, during which you will be put through different movements that can help the doctor to find out which positions cause pain.

In some cases, imaging tests might be necessary, as they can help to rule out other possible causes of your pain. To determine whether a ruptured disk or arthritis is the cause behind the pain, your doctor can order imaging tests such as:

  • MRI scan
  • EMG/NCV Nerve Test
  • CT scan

In cases where piriformis syndrome is the cause of your pain, an additional ultrasound of the muscle might help your doctor for a final diagnosis of the piriformis syndrome.

How is piriformis syndrome treated?

In often cases, no treatment for piriformis syndrome is necessary. It can be sufficient to rest and to avoid activities that might trigger the symptoms. Some might also feel better with the use of ice and heat treatment. For this treatment for piriformis syndrome, it is sufficient to wrap an ice pack in a thin towel and place it on the affected area for 15 minutes a couple of times a day. A heating pad on a low setting for just as long can also help relieve the pain. Some patients profit from over-the-counter painkillers, such as naproxen or ibuprofen.

Physical therapy. Pain and numbness that is connected to the piriformis syndrome can go away without any other treatment, however, it can be very beneficial to go through physical therapy. During physical therapy sessions, you will be taught how to do various stretches and exercises, which can help to improve the flexibility of the piriformis and its strength.

Injections. Piriformis syndrome can also be treated with injections of corticosteroids. Such steroid injections can be a helpful treatment for piriformis syndrome, as they can help to provide relief from pain and the inflammation of the muscle.

TENS treatment. Other possible piriformis syndrome options include transcutaneous electrical nerve stimulator or other referred to as the TENS treatment. During this treatment, a TENS device is used to send small electrical charges through the skin and to the nerves underneath it.

Patients who don’t experience relief even after trying different non-invasive options might need surgery, during which the piriformis muscle is cut to ease the pressure that is put on the sciatic nerve. This is however rarely the case.

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What is the outlook for piriformis syndrome?

Piriformis syndrome is a condition that is difficult to diagnose and not as common. In most cases, it can be treated with the use of conservative treatment options, such as resting, physical therapy, and corticosteroid injections.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997212/
https://pubmed.ncbi.nlm.nih.gov/28846222/
https://jaoa.org/article.aspx?articleid=2093614
https://www.researchgate.net/publication/11476322_Piriformis_syndrome_Diagnosis_treatment_and_outcome-A_10-year_study

Do you have any questions about Piriformis Syndrome? Would you like to schedule an appointment with the top pain management doctors in Downtown, Brooklyn, and Lower Manhattan? Please call our office for a consultation and indicate which location you want to visit.

This page was published on Mar 15, 2021, modified on Apr 5, 2021 by Dr. Raj Raval, MD (Pain Management Doctor)
DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way does any of the information provided reflect definitive treatment advice. It is essential to consult a best-in-class pain management specialist in New York regarding ANY questions or issues. A thorough evaluation should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call your pain doctor to schedule a consultation.

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  • Dr. Raj Raval, M.D.

    1. Board Certified
    2. Interventional Pain & Musculoskeletal Medicine Specialist
  • Education & training

    1. SUNY Downstate PMR Residency
    2. Rutgers University Fellowship
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