The piriformis is a thin muscle that stretches across the buttocks and intersects with the sciatic nerve. When this muscle experiences direct trauma, a microtrauma from overuse, or compression, it can spasm and cause lots of pain and discomfort. This condition is called piriformis syndrome.
The piriformis muscle runs from each side of the lower spine to the greater top knob of each femur. It has a diagonal angle that crosses over the sciatic nerve, which runs vertically beneath it. Because of this anatomy, piriformis syndrome can irritate the sciatic nerve and cause symptoms similar to Sciatica. It may trigger a radiating numbness or tingling, and pain in the buttocks and hips, earning it the alternative name of extra-spinal sciatica. In 50% of the population, the sciatic nerve runs underneath the piriformis muscle and the other 50% of the population, the sciatic nerve runs in-between the piriformis muscle. The latter can cause increased symptoms of Sciatica.
In general, piriformis syndrome is caused by pressure to the piriformis muscle. The piriformis muscle plays an important role in external rotation and partial extension of the hip, and is used to turn the leg outward. Sometimes, this pressure builds up through microtraumas caused by lots of walking or running. At MOTUS, we tend to see this condition in long-distance runners who experience repetitive trauma to the piriformis by overuse. In other cases, direct injury or trauma to the buttocks and the piriformis muscle can lead to the condition.
In our sports specific clinic, we sometimes treat cases of piriformis syndrome that resulted from a sports-related injury that directly impacted the piriformis muscle.
Piriformis syndrome can have anatomical causes, as well. An irregular piriformis muscle or an irregular sciatic nerve will often put pressure on the piriformis muscle, causing pain, numbness, and tingling in the buttocks.
Although the causes of piriformis syndrome vary, we consistently see it more often in women. Because their quadriceps femoris muscle angle is wider, women are more likely to experience compression to the piriformis muscle that will lead to piriformis syndrome.
When we’re screening for piriformis syndrome, we will ask you about both symptoms and lifestyle. Our goal is to narrow down the cause of sciatic pain so that we can treat the overall cause instead of just the pain itself.
Once we have the diagnosis down, we can start to address your pain with innovative tools like shockwave therapy or Pulsed Electromagnetic Field Therapy. In almost every case, we can improve piriformis syndrome with conservative treatments. As soon as your pain is managed and you’re ready, we move on to strengthening, stretching, and postural training that will help prevent pressure to the piriformis muscle in the future.