Piriformis Syndrome

By Genesis Villanueva, PT

Piriformis Syndrome

Piriformis syndrome is a neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis is a broad muscle that attaches from the lateral pelvic surface of the sacrum to the greater trochanter of the hip. The hip joint is involved in abduction and external rotation. Furthermore, the piriformis provides stability to the hip while walking.

The sciatic nerve is a thick nerve that is comprised of lumbosacral spinal nerves levels L4-S3.  It runs down through the back of the upper thigh. The sciatic nerve is responsible for carrying signals to the muscles of the thigh and lower leg. It also carries sensory information from the thigh to the bottom aspect of the foot. The sciatic nerve starts from the lower back and passes through the sciatic notch of the pelvis.  It then goes under the piriformis muscle down to the back of the legs. There is a small population in which the sciatic nerve passes through the piriformis muscle through the back of the thigh.

Causes of Piriformis Syndrome

Causes of this condition remain unclear, I usually see that muscle spasms or tightness of the piriformis will irritate the sciatic nerve. In some cases, the direct trauma of the region of the sciatic nerve and piriformis can cause scar tissue and bleeding where the sciatic nerve passes.  The most common cause of trauma is falling on ice in the winter months.  Scar tissue is less elastic than muscle fibers and can cause irritation to the sciatic nerve.  In conclusion, physical therapy is where the treatment begins with this disorder.

 

Diagnosis and Treatment of Piriformis Syndrome

As a therapist, I usually see symptoms of pain beginning at the buttocks and radiating to the back of the thigh. Therefore, numbness and tingling can be present in the lower leg to the foot. Also, general weakness in the lower leg may be present as well. Diagnosis of Piriformis Syndrome is often made with a detailed history and physical examination. An MRI test may also be utilized to help with diagnosis.  The most common symptom is pain running down the back of the leg or thigh.

Treatment of this condition often includes a prescription of anti-inflammatory medication to reduce the inflammation of the sciatic nerve and Physical Therapy. In my experience, physical therapy will typically prescribe flexibility and strengthening exercises.  A physician may suggest injections if the problem is not improved with Physical Therapy. If the problem has not improved by physical therapy, a physician may suggest injections. Surgical intervention is very rare for this condition.

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By: Genesis Villanueva PT

Learn about stretching exercises we use for hip pain here at JOI or Pain in the Sciatic Nerve.

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