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. Treatment 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.”