Piriformis syndrome can cause buttock, hip and sciatic pain. There is no definitive answer to how common this condition is, however, over 40% of the population will experience sciatic pain at some time in their life (whether this is caused by piriformis syndrome, or some other condition)

The piriformis is a flat muscle located on both sides of the buttocks, close to the top of the hip joint. It’s an important stabilising muscle for the hip, and allows the leg to lift and rotate away from the body as you take a step. The muscle is also clinically important as the sciatic nerve passes through it, so spasm and tightness in the piriformis can lead to the classic sciatic pain.

Causes of Sciatic Pain

  • Injury/trauma
  • Overuse- particularly common with long distance running
  • Vigorous exercise
  • Scoliosis, or other spinal alignment abnormalities
  • Leg length discrepancy
  • Prolonged sitting (e.g. long transits in a car or a plane)
  • Foot abnormalities e.g. Morton’s Neuroma

Symptoms

  • Pain- buttock and/or hip. Commonly on one side
  • Tingling in the buttock and/or hip
  • Shooting pain down the back of the leg
  • Muscle spasm of the piriformis
  • Difficulty sitting, or putting weight through the affected leg
  • Sciatic pain when moving your leg outwards

It’s important to rule out other causes of similar symptoms, particularly sciatica, which can be caused by a herniated disc. Diagnosis of Piriformis Syndrome is clinical, meaning no blood test or imaging is indicated to confirm the diagnosis. The first port of call for treatment is also conservative, meaning non-invasive.

Seeing a physiotherapist will allow you to receive proper assessment based on the history of the condition and clinical findings, leading you to receive appropriate conservative treatment tailored to your condition.

Physiotherapy management:

  • Advice and education around the clinical findings of the assessment, prognosis, potential causes
  • Exercises specific to clinical findings, likely to include:
    • Piriformis stretching, stretching abnormally tight muscles
    • Strengthening weaker muscles (commonly hip abductors)
    • Gait adjustments if abnormal gait patterns are identified
  • Hands-on treatment
    • Piriformis massage and release
  • Application of heat if appropriate

The prognosis of piriformis syndrome appears to be good overall if identified and treated early. However, there is also a risk of the condition progressing into a chronic state if there is a delay in treatment. Medical management such as injections and surgery may be considered if physiotherapy management does not alleviate the condition.

 

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