What is Piriformis Syndrome? Where is your Piriformis Muscle?

If you are experiencing hip, buttock, hamstring or sciatic pain then you may be suffering Piriformis Syndrome.

Piriformis syndrome is a disorder that occurs when your sciatic nerve is compressed and/or irritated by the piriformis muscle as it passes deeply through your buttock, resulting in pain.

Sometimes the condition is called ‘pseudo sciatica’, as it is often confused with pain in the nerve resulting from a low back disc bulge.

Your diagnosis of piriformis syndrome should be made after a spinal nerve root compression (eg disc bulge) has been eliminated as a cause of your sciatica symptoms.

More information about the piriformis muscles can be found here: piriformis muscle.

What are the Symptoms of Piriformis Syndrome?

Pain is usually felt in one buttock - but you may experience a radiation of pain down the back of the leg (sciatica).

Pain aggravated by hip activity, eg walking, or prolonged sitting.

To avoid pain and pressure on the area you may sit lopsided with your sore buttock tilted up.

Sometimes, you’ll walk with the foot turned out due to shortening of the piriformis muscle.

What Causes Piriformis Syndrome?

The main reasons that it overworks is due to:

protection or dysfunction of the adjacent SIJ or hip joints.

weakness of your deep hip stability muscles.

overpronating feet.

How is Piriformis Syndrome Diagnosed?

Your physiotherapist will perform clinical tests to stretch the irritated piriformis or provoke sciatic nerve compression, such as the Freiberg, the Pace, and the FAIR (flexion, adduction, internal rotation) manoeuvers.

CT, MRI, ultrasound, and EMG are mostly useful in excluding conditions that could replicate piriformis syndrome. Magnetic resonance neurography can show the presence of irritation of the sciatic nerve but is rarely required.

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What’s the Treatment for Piriformis Syndrome?

Once your diagnosis is established, treatment could involve any of the following:

Pelvis and spine re-alignment techniques.

Joint mobilisation to restore normal joint mobility, range of motion and function.

Massage or electrotherapy to help decrease pain and spasm in your piriformis and increase blood flow plus soft tissue extensibility.

Stretching program for muscle length and flexibility

Acupuncture or Dry Needling to reduce muscle tightness around the buttock.

Deep core stability and hip strengthening exercises to stabilise your hip, pelvis and spine.

Foot orthotics or exercises, if indicated by your physiotherapist or podiatrist, to help restore foot and lower extremity alignment.

What’s Your Prognosis for Piriformis Syndrome?

Short-term symptoms can be reversed within a few days. Longstanding symptoms may take a few weeks to address the biomechanical and muscle habits that have predisposed you to the injury. Only rarely will surgery be required.

For more advice about Piriformis Syndrome please ask your physiotherapist.

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