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Piriformis Syndrome – Symptoms, Causes, Treatment

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Piriformis Syndrome is a type of neuromuscular disorder which is caused by the periarthritis or irritation of the sciatic nerve by the piriformis muscle. Irritation is a response from the compression of piriformis muscles which deliberately causes pain and even traumatic injury to the hip region. The tingling or numbness are extended in the deep buttocks area and crosses the other lower parts such as in legs, thighs or ankles.


To visualize, the piriformis muscle (looks like a long-pyramid shape muscle) is located in the buttocks and is anchored in the base of the spine. Piriformis Syndrome is very painful, but often surgery is needed to alleviate the pain. People who are experiencing this syndrome can benefit from simple muscle management such as stretching, yoga, or even enrolling in therapeutically muscle sessions.

As mentioned, the piriformis muscle is stationed in the pelvis and is normally connected to a sacrum. The product of this connection is called sacroillac joint and is divided into two regions (the left and right of the lower back). The trochanter- the bumpy bone of upper side of the hip- is the last anchor of the other end of the muscle. In short, the collaboration of these muscles especially the function of piriformis muscle is to regulate the movements of legs and hip. As the muscle works with great tension, the piriformis muscle enhances in mobilizing the lower body muscles outward.

Now this is where the problem begins. Turning around can cause problematic mechanism in the sciatic nerves. While the sciatic nerves travels under the piriformis muscle, it causes frictional motions that can pressure, bump, irritate or squeeze the nerve areas (sacral vertebrae). This is where people begin to complain with the symptoms of sciatica.

Piriformis Syndrome Causes

The causes of this syndrome are still under investigation and in poll for consensus. But the general causes of medical professionals summarize it into two:

  1. Mechanical
  2. Chemical irritation

Starting with mechanical, people who used to sit for a long period of time may experience this syndrome. Presumably, because of the weight and pressure of the buttocks in the chair, some nerve endings specifically in the buttock region and lower spine tend to constrict with each other.

The compression of sciatic nerve will lead to the back pain. Another reason, nerve entrapments are also caused from extreme exercise such as overuse of the pedal in the bicycle, hardcore mountain hiking, abdominal exercises that use the lower body, and abuse of the back from some yoga exercises. That’s why it is important to stretch first or undergo kinesthetic before venturing to abdominal bombing. Sometimes the compression is not originating from the spinal roots per se, but specifically on the adjacent piriformis muscle.

Furthermore, those who may be recovering from accidents such as those injured from falling, sliding, jumping and running are in great risk of giving this syndrome. Careful management of footwork should also be observed because when the foot is constricted, it may force the piriformis to overuse thus resulting in this syndrome.

Chemical imbalances from the brain also contribute to the formation of piriformis syndrome. When there are overpopulated serotonin, histamine, bradykinine and connected neurotransmitters, the piriformis becomes compressed therefore leading to twisted effects. The neurotransmitters target the sciatic nerve which causes irritation to the pirformis muscles.

Piriformis Syndrome Symptoms

Piriformis syndrome is the source of back pain in many people. Though simple back pains are inadvertently mistaken as the sign of this syndrome, the pain should be chronic or extended over time. As indicated there should be chronic back pains, numbness of the legs (back part) or hips, tingling of the buttocks which extend up to the thighs, and other descending areas of the lower spine. The symptoms may be simple but those who suffered from it tend to have difficulties in sitting or doing on some footworks.

Aside from the vague sensation of the leg and buttocks, there are also loss of senses in the hips and thighs. To easily detect this, try to stretch and touch the lower back of your legs. Stand then seat. If you notice that you’re having difficulty time in leaning and seating your chair, the syndrome might be with you.

Piriformis Syndrome Treatment

Diagnosis is done by examining carefully the condition of legs, back and thigh muscles. Patients will be asked to get in a full physical exam with corresponding medical background checkup. In here, patients will be asked about their latest injuries, medical problems, and the onset of pain from different activities. Next the doctor will examine your posture and the way on how you walk to detect the pain.

To rule out other pains, the doctor will make use of multiple tests such as examining the threshold level of your back, thigh and legs and analyzing the sensory reactions on your skin. Normally, patients will go through x-ray to detect any abnormalities in the sacroiliac joints. This also includes other parts such as the pelvis, hips, lumbar spine and the lower back. Radiology tests are also proven to be useful as long as it is coupled with magnetic resonance imaging in analyzing any trauma from the pelvis and lumbar spines.

Magnetic Resource Imaging provides a clear image of trauma conditions especially the damage soft and adjacent tissues of the body. Neurography, a special form of MRI, is often used to examine the damage nerve areas. After ruling out any co-morbodity of the syndrome, treatment will follow.

Treatments can be classified as normal and surgical. Normal treatments are done by prescribing several effective medications such as naproxen and ibuprofen. Patients may also seek help from physical therapists. During the sessions, the physical therapist will treat the affected muscle and will advice several muscle exercises to alleviate the pain. Physical therapist suites the pain by relaxing the muscle tensions in piriformis area.

Certain home exercises will also be planned by a physical therapist. If the pain did not disappear, an injection with lidocaine or corticosteroid shall be used to ease the irritation. In extreme cases, patient who failed to benefit from the normal treatment do not have choice but to undergo surgery.

The surgery for this syndrome is truly invasive. There will be surgical resections in the piriformis to cut the pressure in the sciatic area. Some surgery targets the deepest part of the buttocks where the pressing tendon of piriformis resides. As your condition becomes better, general maintenance in strengthening and shaping your piriformis muscle will follow.

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