Why Piriformis Syndrome Can Be a Real Pain in the Butt and what to do about it.
Life presents all too many problems that are a “pain in the butt,” but piriformis syndrome literally shows up in this manner, according to Kaliq Chang, MD, of Atlantic Spine Center. A flat muscle located in the buttocks near the top of the hip joint, the piriformis is an unsung hero in our day-to-day lives. The muscle enables us to walk, stay balanced, and shift our weight from foot to foot. When the piriformis muscle presses on the nearby sciatic nerve, symptoms such as pain, tingling and numbness in the buttocks usually show up first. But pain can also be triggered from climbing stairs, sitting for long periods, or pressure on the piriformis muscle itself.
While few are familiar with piriformis syndrome, the condition is more common than you might expect. About 5% of cases of sciatica (severe, sharp pain radiating from the lower back or buttocks down the leg) are actually due to piriformis syndrome, explains Dr. Chang, an interventional pain management specialist.
“Most cases of sciatica aren’t due to piriformis syndrome, even though the symptoms can be so similar,” Dr. Chang says. “That’s just one reason why, if your symptoms are severe or long-lasting, you should see a doctor to get to the bottom of things.”
Causes and diagnosis
Sometimes there’s no obvious reason why piriformis syndrome develops. But the condition does have several established causes, Dr. Chang says. They include:
- Unusually vigorous exercise
- Certain foot problems
- Prior hip surgery
- Prolonged sitting, especially if your wallet is in a back pocket over your piriformis muscle
- Unusual anatomy (such as spine alignment, leg length discrepancy or location of piriformis muscle or sciatic nerve)
Diagnosing piriformis syndrome is typically based on your symptoms and your doctor’s observations during an exam. That’s because no particular medical test can confirm the diagnosis. An MRI imaging test can sometimes rule out other causes of sciatic nerve compression, such as a herniated disc.
“It may be difficult to reveal that piriformis syndrome is indeed the culprit behind a person’s symptoms,” Dr. Chang notes. “And piriformis syndrome sometimes also occurs in tandem with spine or disc problems or conditions such as hip bursitis.” Also, Dr. Chang adds, “while it is difficult to diagnose clinically or with imaging, an injection of local anesthetic can be diagnostic.”
Treatment and prevention
As with diagnosis, treating piriformis syndrome presents its own challenges, Dr. Chang says. Piriformis syndrome is a condition that occurs when the piriformis muscle, a small muscle located in the buttocks, becomes tight or inflamed, leading to pain and discomfort. This can cause pain in the buttocks and down the leg, as well as numbness and tingling in the leg and foot. Treatment for symptoms can be as simple as avoiding positions or activities that trigger pain but applying heat or ice to tender areas can also help.
Other treatment measures include:
- Physical therapy to exercise and stretch the piriformis and nearby muscles, reducing sciatic nerve compression
- Medications such as NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen
- Muscle relaxants
- Injections of anesthetic drugs; Botox, to relieve muscle tightness and sciatic nerve compression; or corticosteroids to reduce inflammation
- Surgery, but only as a last resort, to remove a piece of the piriformis muscle or its tendon
As always, prevention is preferable to needing treatment in the first place. Since piriformis syndrome can often be triggered by repetitive movements, such as lunging or running, Dr. Chang suggests practicing good form when doing these activities.
“Try not to run or exercise on uneven surfaces, such as hills, ”he says. “Also, practice good posture when walking, running and exercising, and warm up beforehand. It’s wise to avoid sitting for extended periods as well.”
Stretching and strengthening exercises can help alleviate the symptoms of piriformis syndrome. Stretching exercises may include seated, lying, supine, and standing stretches. Strengthening exercises may include gluteal muscle exercises, core strengthening exercises, low-impact cardio, and yoga. It is important to consult a healthcare provider or physical therapist before beginning any exercise routine, and to stop exercising if you feel any pain.
There are several stretches that can help alleviate the symptoms of piriformis syndrome. It is important to consult a healthcare provider or physical therapist before beginning any stretching routine.
- Seated piriformis stretch: Sit on the edge of a chair with your feet flat on the ground. Cross your affected leg over your other leg, placing your ankle on the opposite knee. Gently press down on the raised knee to feel a stretch in the buttocks. Hold for 30 seconds and repeat on the other side.
- Lying piriformis stretch: Lie on your back with your knees bent and feet flat on the ground. Cross your affected leg over your other leg, placing your ankle on the opposite knee. Gently press down on the raised knee to feel a stretch in the buttocks. Hold for 30 seconds and repeat on the other side.
- Supine piriformis stretch: Lie on your back with your knees bent and feet flat on the ground. Place a foam roller or rolled-up towel under your affected leg, just above the knee. Gently lift your other leg and rest it on the foam roller or towel. You should feel a stretch in the buttocks. Hold for 30 seconds and repeat on the other side.
- Standing piriformis stretch: Stand with your feet shoulder-width apart and your hands on your hips. Cross your affected leg behind your other leg, keeping your feet parallel. Gently lean forward, feeling a stretch in the buttocks. Hold for 30 seconds and repeat on the other side.
Remember to start slowly and gradually increase the intensity of the stretches as your flexibility improves. It is important to stop stretching if you feel any pain and to consult a healthcare provider if your symptoms persist.