Piriformis syndrome is referred to as sciatica resulting from compression of the sciatic nerve by the piriformis muscle. Most patients state that they have buttock pain with numbness and tingling travelling down the thigh and upper leg, less reported is associated low back pain. Other features include painful sitting; tenderness over the sciatic notch; pain with hip movements that stress the pirifomis (internal rotation) and relief with shortening of the piriformis (external rotation of hip, or walking with the toe pointing out). The condition must be differentiated from lumbar disc herniation in younger people, and advanced degeneration or tumors that narrows the spinal or lateral canals in the older population.
It is estimated that 15-20% of the population are predisposed to piriformis syndrome as the sciatic nerve passes through the piriformis muscle body rather than underneath, making it more susceptible to compression. Other causes of piriformis syndrome include: muscle imbalance of weak hip extensors/abductors and tight hip flexors/adductors caused by prolonged sitting; overuse injuries in a sitting position, such as rowing or biking; stiff sacroiliac joints causing gait changes and shearing of the piriformis; and overpronation of the foot causing the knee to turn inward and piriformis to compensate.
Conservative treatment will generally resolve the symptoms, and can include: ice, NSAIDS or acupuncture for inflammation and pain control; avoiding aggravating activities (uphill running, biking, rowing); stretching tight muscles and strengthening weak muscles; massage or using a tennis ball to target tight muscles; manipulation to restore SI joint function; gait correction with orthotics; and tissue healing with therapeutic laser.
