Piriformis Syndrome

Piriformis syndrome occurs when the piriformis muscle spasms and compresses the sciatic nerve, causing extreme pain. The Piriformis muscle is found in the buttocks close to the top of the hip joint, starting at the lower spine and running diagonally to connect to the upper part of the thighbone. This muscle assists the rest of the surrounding muscles in the rotation of the hip joint and turning the leg outward; thus it is very important to lower body movement. The sciatic nerve goes from the spinal cord, through the buttocks, down the backs of the legs, and branches off into nerves in the feet and is the largest nerve in the body. Its role is to assist in the motor and sensory function of the lower extremities of the body. Because the piriformis muscle, its tendon, and the sciatic nerve cross each other very closely within the buttocks, they can rub against one another, causing pain, numbness, and tingling in the buttocks and usually causing limited range of motion of the hip joint. Pain is often severe and triggered from long periods of sitting, running, climbing stairs, or other actions that cause stress or pressure on the piriformis muscle. Pain and numbness can also radiate down the sciatic nerve into the legs and feet.

Diagnosis

This syndrome is difficult to identify, so it is best to rule out problems such as herniated discs, spinal Stenosis, sciatica, and hip bursitis before making the diagnosis. A diagnosis of piriformis syndrome is generally made once all other potential causes for the pain have been exhausted. Medical professionals diagnose piriformis syndrome through comprehensive physical exams and a variety of tests, including MRIs and nerve conduction studies. Often, a patient will report a past trauma to the area, or a history of repetitive and/or vigorous activity. The physical exam will usually involve a series of movements of the hip to test for pain in the piriformis muscle.

Treatment and Prevention

Treatments for piriformis syndrome aim to reduce pain and relieve compression of the sciatic nerve. Standard treatment for this syndrome includes rest, ice, heat, specialized exercises and stretches which aim to gradually stretch the piriformis muscle and increase range of motion, anti-inflammatory medications, and muscle relaxants, as well as corticosteroid, anesthetic, and botox injections. A physical therapist can also perform a deep massage, which may increase blow flow and decrease the muscle spasms. Only in the most severe cases, and after all other options have been exhausted, should surgery be considered an option and in all cases, treatment is important in order to avoid permanent nerve damage.

Movements and exercises that place repeated stress on the piriformis muscle, such as lunging and running, can lead to piriformis syndrome if proper form is not employed. It is always important to make sure you are using good posture, even when walking. Those employing these exercises should ensure that they warm up and stretch properly before exercising and gradually increase the intensity of their workout. Also, muscles need time to rest and recover after performing at a high level; if they are not given this time, the typical defensive response of the muscle is to tighten. In the case of an overused piriformis muscle, sufferers run the risk of the muscle tightening around the sciatic nerve and causing pain.

our clinic offers ultrasound guided diagnostic injections with local anaesthetic followed by therapeutic injections with cortisone, dextrose (prolotherapy) and/or botulinum toxin injections, chiropractic, physiotherapy, acupuncture,  medication, active exercises, psychotherapy, biofeedback, TENS/MET devices, and orthotics for patients suffering from piriformis syndrome.

Sources:

http://www.webmd.com/pain-management/guide/piriformis-syndrome-causes-symptoms-treatments

http://www.spine-health.com/conditions/sciatica/what-piriformis-syndrome

https://www.spineuniverse.com/conditions/sciatica/piriformis-syndrome

http://familydoctor.org/familydoctor/en/diseases-conditions/piriformis-syndrome.html