Piriformis syndrome

Piriformis syndrome is a painful condition in which pain, together with altered sensation, is felt in the buttock, and numbness along the leg resembles nerve involvement. The piriformis muscle irritates nearby structures such as the sciatic nerve, causing pain, weakness and tingling along the leg. The muscle itself runs from the front of the sacrum – more precisely, from its ventral (pelvic) surface – to the greater trochanter. Its function is to rotate the hip, leg and foot outwards. Interestingly, as an anatomical variant, the nerve can also pass through the muscle itself.

Symptoms and diagnosis:
Diagnosis is based above all on the patient's complaints, on provocation tests carried out by the doctor and on ruling out other possible causes. Patients usually report tenderness and pain deep in the buttock that resemble radicular symptoms (nerve root involvement) and overlap with complaints of vertebrogenic origin. The most common symptoms are:
– deep pain in the buttock
– pain along the leg
– pain that gets worse after prolonged sitting
– reduced movement in the hip joint

In more severe cases, pain also occurs when:
– walking or running
– climbing stairs
– lying on your back

Diagnosing piriformis syndrome is a task for an experienced physiatrist and is not straightforward: it takes a series of tests to confirm the diagnosis and rule out other conditions, mainly because the condition is relatively rare compared with problems of the intervertebral discs and vertebrae, the muscle lies deep, and the complaints overlap with a number of other disorders and phenomena.

Besides painkillers, which are also given in the acute phase so that physiotherapy and rehabilitation can begin, the best way to start treating piriformis syndrome is stretching the muscle itself, combined with deep massage and physiotherapy. A change in lifestyle habits is also necessary. In persistent cases, pain blocks/injections with anaesthetics, corticosteroids and botulinum toxin are used.