Piriformis Syndrome: An Under-Diagnosed and Under-Treated Cause Of Sciatic Pain

Piriformis Syndrome: An Under-Diagnosed and Under-Treated Cause Of Sciatic Pain
November 25, 2013

Sciatica describes leg pain that originates in the lower back, travels through the buttock and down the sciatic nerve in the leg. It is a condition that can prove to be incredibly painful and even debilitating in some cases, preventing those affected from carrying out their normal day-to-day activities. Unfortunately, there remain a large percentage of frustrated patients who, despite months or years of therapy, continue to suffer from painful symptoms. In such cases, the exact source of their pain often remains undiagnosed, even after undergoing extensive scans utilizing highly sophisticated imaging techniques.

But what if all that stood between these patients and a life free of painful symptoms was an accurate diagnosis?

Piriformis Syndrome - a hidden cause of sciatic pain

When a vertebral disc becomes herniated, it swells beyond its normal size and puts pressure on the radicular nerves. This is the primary cause of sciatica. However, there is another, often overlooked, cause of sciatic pain - piriformis syndrome. Due to a lack of available literature and general knowledge, this condition is widely under-recognized.  The piriformis muscle helps to turn the foot and leg outward - it is located deep within the buttock and passes directly over the sciatic nerve. If this muscle becomes inflamed or goes into spasm, it can squeeze the nerve against the bone of the pelvis, almost exactly mimicking the pain associated with sciatica - including numbing and tingling sensations. Trauma to the gluteal region is the most common cause of piriformis syndrome.

Patients with piriformis syndrome have some or all of the following symptoms:

  • Chronic pain in the buttocks that may radiate to the lower leg and worsen when walking or squatting
  • Pain with bowel movements
  • Pain in the labia majora in women; pain in the scrotum in men
  • Pain when getting up from bed
  • Pain exacerbated by hip movement
  • Intolerance to sitting

Put simply, sciatica and piriformis syndrome have two completely different causes; one is muscular in nature, whereas the other stems entirely from the nerve.  Correct diagnosis is vital in giving patients the best possible outcome since piriformis syndrome originates from a muscle, treatment takes a different approach to that of sciatica. Whereas severe cases of herniated lumbar disc can be treated using invasive surgery to relieve pressure on the radicular nerves, treatment for piriformis syndrome can be far less intrusive. Treatment may instead involve physical therapy manipulation techniques, medication therapy and/or administering open MR guided injections to relieve pain. Where necessary, surgical release of the piriformis tendon can be extremely successful; even in those who have not gained any relief with previous treatments.

With this in mind, it is easy to understand why so many people have had such limited success from existing treatments they have tried. In fact, many patients who have undergone unsuccessful surgery in the lumbosacral region were later found to have piriformis syndrome, thus highlighting the importance of correctly identifying the cause of sciatic pain and of doing so in a timely fashion.

Minimally invasive options to treat piriformis syndrome are available at Atlantic Spine Center. Patients who qualify for these treatments can walk away free from chronic pain with a far shorter recovery time than with radical open back surgery.