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Piriformis syndrome

Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle also can irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

The piriformis muscle:

  • Starts at the lower spine and connects to the upper surface of each femur (thighbone)
  • Functions to assist in rotating the hip and turning the leg and foot outward
  • Runs diagonally, with the sciatic nerve running vertically directly beneath it (although in some people the nerve can run through the muscle).




Most patients describe symptoms of acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:

  • A dull ache in the buttock
  • Pain down the back of the thigh, calf and foot (sciatica)
  • Pain when walking up stairs or inclines
  • Increased pain after prolonged sitting
  • Reduced range of motion of the hip joint

These symptoms often become worse after prolonged sitting, walking or running, and may feel better after lying down on the back.

Causes and Risk Factors

The exact causes of piriformis syndrome are unknown. Suspected causes include:

  • Muscle spasm in the piriformis muscle, either because of irritation in the muscle itself or irritation of a nearby structure such as the sacroiliac joint or hip
  • Tightening of the muscle, in response to injury or spasm
  • Swelling of the piriformis muscle, due to injury or spasm
  • Bleeding in the area of the piriformis muscle

Any of the above problems, or a combination of them, can affect the muscle, causing buttock pain, and may affect the adjacent sciatic nerve (causing pain, tingling or numbness in the back of the thigh, calf or foot).


Diagnosis of piriformis syndrome is based on a review of the patient’s medical history, a physical examination and possibly diagnostic tests (such as X-rays, MRI or nerve conduction tests).

Piriformis syndrome is often diagnosed through a process of ruling out other possible conditions that may be causing the patient’s symptoms, such as a lumbar disc herniation or sacroiliac joint dysfunction.


Almost every treatment for piriformis syndrome will include a focus on carefully and progressively stretching the muscle.

Other treatment modalities include:

Alternating between ice and heat on the buttocks and legs may also prove effective. Applying ice for 15 to 20 minutes every couple of hours, followed by heat, can help relieve pain.

Exercise and other therapies include:

  • Stretching exercises to relieve tight piriformis
  • Strengthening exercises to help piriformis regain its function.
  • Avoiding activities that worsen pain like running
  • Maintaining a good posture
  • Massaging may also prove effective
  • Medications: anti-inflammatory medications (such as ibuprofen or naproxen) to reduce the swelling that is usually contributing to the patient’s pain
  • TENS unit

What are interventional managements?

When the symptoms persist, interventional pain management is needed. Trigger point injection is the treatment of choice. Ultrasonography of fluoroscopy is needed to increase the accuracy for best results. At times, corticosteroids are added in resistant cases.

Sometimes, few patients need Botulinum toxin of BOTOX injection, which is another very good treatment option. But, it is preferred when there is a recurrence of symptoms even after trigger point injections.

How is the prognosis of Piriformis Syndrome?

People with piriformis syndrome get better by following doctors’ recommendations. The treatment options work well for most people. Since it is soft tissue damage, the condition may become chronic and the nerve damage permanent. Hence, early diagnosis is crucial for a better prognosis and to prevent recurrences of the syndrome.