PT Tip of the Month

Piriformis Syndrome

What is piriformis syndrome?

Piriformis syndrome (PS) is a neuromuscular condition that manifests with symptoms of low back and buttock pain referred to the leg. It is often misdiagnosed as lumbar disc disease, lumbar radiculopathy, sciatica, trochanteric bursitis, and sacral or pelvic dysfunction. PS most frequently occurs during the fourth and fifth decades of life and affects all individuals ranging from a variety of occupations and activity levels, although it is more common in women than men, possibly due to differences in their biomechanics (i.e. wider quadriceps femoris muscle angle). Prevalence rates range from 5-36%. The most common presenting symptom is increased pain in the buttocks after sitting for longer than 15-20 minutes and usually over the areas of the sacrum and medial greater trochanter, where the piriformis muscle attaches. Symptoms may be sudden or of gradual onset, and there may be difficulty with walking, squatting, or sitting cross-legged.

Anatomy

The primary role of the piriformis muscle is to externally rotate the hip, with secondary actions of hip abduction and flexion. It also provides postural stability during walking and standing. In the majority of people, the sciatic nerve runs along the inferior surface of the piriformis muscle, but in up to 22% of people, the sciatic nerve either pierces or splits the muscle, predisposing them to PS.

Causes

PS can be caused by an anatomic reason, such as a split piriformis muscle, split sciatic nerve, or an anomaly in the path of the sciatic nerve (Fig. 2), or as a result of macro/microtrauma, post-surgical injury, or ischemia (temporary blood loss to an area). Overuse of the piriformis muscle, such as from long-distance running or walking, or direct compression to the muscle (e.g. from sitting on hard surfaces or frequent sitting on a wallet) lead to inflammation of the soft tissue and/or muscle spasm, which result in nerve compression.

Treatment

Typical physical therapy treatment of PS includes stretching of the piriformis muscle and connective tissue, strengthening exercises for other supporting hip/thigh musculature, soft tissue mobilization, ROM exercises, and/or use of modalities, as well as an assessment to the lumbar spine. If you feel that you have signs or symptoms of piriformis syndrome, and you would like to schedule an evaluation, call 617-232-PAIN for our Brookline office, and 617-325-PAIN for our West Roxbury office.

References

  1. Boyajian-O’Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108:657-664.
  2. Halpin RJ, Ganju A. Piriformis syndrome: a real pain in the buttock? Neurosurgery. 2009;65;A197-A202.
  3. onley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. J Orthop Sports Phys Ther. 2010;40(2):103-111.

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