The piriformis is a flat band of muscle situated deep in the buttock near the hip joint. The muscle stabilizes the hip and allows movement in the hips and legs. Piriformis syndrome occurs when the piriformis muscle spasms and compresses the sciatic nerve that runs through the muscle and down the back of the leg.
A variety of different factors can contribute to the development of piriformis syndrome, including:
- Irritation in the muscle or the nearby hip or sacroiliac joint can trigger a spasm—this is often the result of overuse and muscle strain
- The muscle can tighten or swell as the result of an injury
- Bleeding in the area around the piriformis muscle can cause spasms and nerve compression
Most patients with piriformis syndrome experience the following symptoms:
- A dull ache and acute tenderness in the buttocks
- Pain, numbness, or tingling that radiates down the thigh to the calf and foot
- Pain that is worse after prolonged sitting or when walking up inclines or stairs
- Decreased range of motion in the hip
Some patients find that the pain improves when they lie down on their back.
For mild discomfort, a regimen of rest, ice, and heat may be enough to relieve your symptoms. Persistent or severe pain may require medical treatment to reduce compression on the sciatic nerve. Some of the most common treatments include:
- A piriformis block involves injecting a local anesthetic and a steroid into the piriformis muscle in the area around the sciatic nerve. The doctor performs the in-office procedure using X-ray imaging to ensure the correct area is targeted. Most patients experience temporary relief almost immediately due to the local anesthetic. The steroid provides more long-lasting relief in about one week.
- A physiotherapy regimen focused on mobility and stretching exercises can loosen the tight muscles that are compressing on the sciatic nerve and improve range of motion in the hip.
- Manual manipulation of the spinal column can often reduce or eliminate pain resulting from a wide range of joint, soft tissue, and nerve disorders, including piriformis pain.
- Chiropractic techniques using cold and heat therapy, ultrasound, and electronic muscle stimulation can help manage piriformis syndrome pain by reducing and regulating inflammation.
- The outer fascial covering of the piriformis muscle can become tight and restricted due to injury or a spasm. A technique called myofascial release places pressure on the affected area in order to stimulate the stretch reflex, which causes the contracted muscle to relax, lengthen, and become more pliable.
- Although originally used for cosmetic procedures, Botox® is being increasingly utilized in pain management due to its ability to relax tight muscles. The injection combines botulinum toxin with saline and a local anesthetic and is precisely targeted into the affected muscle. The local anesthetic provides almost immediate relief while the effects of the Botox® typically take effect within two weeks, and the results can last anywhere from three to six months. Botox® injections can also be combined with physical therapy exercises that stretch and strengthen the muscles.