Piriformis Syndrome is defined as a neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve, the largest nerve in the body.
The piriformis muscle is a narrow muscle found in the buttocks. Piriformis Syndrome generally occurs when the piriformis muscle becomes tight or spasms and places pressure on the sciatic nerve running beneath it.
In this condition, the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain is known as ‘sciatica’ and goes down the back of the thigh and then into the lower back.
Piriformis Syndrome – Symptoms
The main symptoms of piriformis syndrome include:
· Tingling, numbness or burning in the back of the thigh to the knee and occasionally the bottom of the foot.
· Pain and tenderness in the buttock.
· Pain and discomfort in the hip, mid-buttock area or back of the thigh.
· Heaviness or fatigue in the leg.
· Pain that worsens with sports activities including running, jumping, long walks and walking upstairs or hills.
In addition, the pain might worsen because of sitting for a long periods of time, climbing stairs, walking or running.
Also known as Sciatic Pain, piriformis syndrome generally occurs due to pressure placed on the sciatic nerve. There are four main reasons why pressure can be put on this nerve, which include:
1. Pressure caused by shortening and tightening of the piriformis muscle, normally caused due to months and years of muscle imbalances in the hip rotator muscles.
2. Pressure caused by spinal stenosis .i.e. decrease in the space between the vertebrae.
3. Pressure due to Isthmic spondylolisthesis, which happens when a vertebrae slips or moves.
4. Pressure caused by a herniated or bulging disc.
Additional causative factors include:
· Tightness of the piriformis muscle
· Direct pressure from wallet or sitting on a hard surface
The piriformis syndrome is primarily diagnosed based on symptoms and physical examination. Though there are no specific tests to confirm the diagnosis, but tools such as X-rays, MRI and nerve conduction tests may be carried out to rule out other diseases.
A) Conservative treatment
The following measures are implemented as a part of this first stage of treatment:
· Physical therapy, for emphasis in stretching and strengthening the hip rotator muscles. This can also include piriformis and hip abductor muscle stretching.
· Rest, which implies avoiding activities that cause symptoms for at least a few weeks.
· Anti-inflammatory medication, in order to decrease inflammation around the tendon.
· Deep massage
B) Surgical intervention
In cases where conservative treatment fails to have any impact, patients are advised for surgical intervention. This is done in order to release or loosen the piriformis muscle tendon.