What happens with the syndrome
The sciatic nerve exits the pelvic cavity under the piriformis muscle, and in some people passes through it. When overexerted, spasmed, or swollen, the muscle can put pressure on the nerve, causing pain and discomfort in the leg. Pain can also come from the muscle itself with painful seals - trigger points. Unlike radicular pain with a herniated disc, with piriformis syndrome, low back pain is usually not pronounced, and neurological disorders are milder.
- Muscle pain with trigger points
- Compression of the sciatic nerve by muscle
- Primary - with anatomical features
- Secondary - after injury, overload, surgery
Causes and risk factors
The syndrome develops when a muscle is subjected to repeated stress or injury. Sitting on a hard surface for a long time, especially with a wallet in your back pocket, puts pressure on the muscle area. Athletes who run, jump, and twist overload their hip rotators. Impaired biomechanics due to different leg lengths, hip or sacroiliac joint disease also contribute to overexertion.
- Prolonged sitting, sedentary work, driving
- Running, cycling, strength exercises for the buttocks
- Fall on the buttock
- Different leg lengths, poor posture
- Hip diseases
- Intramuscular injections into the buttock
Symptoms
The pain is usually aching, deep, in one buttock, and can radiate to the back of the thigh, less often below the knee. It intensifies after 15–20 minutes of sitting, when standing up, climbing stairs, or squatting. Often a person sits, shifting weight to the healthy side. Tingling and numbness may occur along the back of the leg. Weakness of the leg muscles and urinary problems are not typical for this syndrome and require a search for another cause.
- Deep pain in the buttock
- Referral of pain to the back of the thigh
- Strengthening when sitting and standing up
- Pain when crossing legs
- Tingling or numbness in the leg
- Ease of walking and stretching
Diagnostics
There is no specific analysis for piriformis syndrome, so the diagnosis is made based on a combination of symptoms. The neurologist palpates the area of the muscle, performs stretching and tension tests on the muscle while rotating the hip, which cause familiar pain. MRI of the lumbosacral region helps to exclude disc herniation and root compression; if joint disease is suspected, an X-ray or MRI of the pelvis is prescribed. ENMG evaluates sciatic nerve conduction. A diagnostic injection of an anesthetic into the muscle under ultrasound guidance can confirm the source of the pain.
- Neurological examination and provocative tests
- MRI of the lumbosacral spine
- X-ray or MRI of the hip joints according to indications
- ENMG
- Ultrasound-guided diagnostic blockade
Treatment and prevention
The basis of treatment is regular stretching of the piriformis muscle and strengthening of the pelvic and core muscles under the guidance of a physical therapy doctor or rehabilitation specialist. To relieve pain, the doctor may recommend nonsteroidal anti-inflammatory drugs for a short period of time, heat, massage, and manual work with trigger points. If conservative measures do not help, injections of a local anesthetic with a corticosteroid or botulinum therapy into the muscle are performed under ultrasound guidance. Surgery is rarely needed. For prevention, it is important to take breaks from sitting, choose a comfortable seat and warm up before training.
- Daily piriformis stretch
- Therapeutic exercise for the pelvic and core muscles
- NSAIDs as prescribed by a doctor
- Massage and trigger point work
- Ultrasound-guided injections for persistent pain
- Seating breaks, wallet not in back pocket