How to Diagnose Piriformis Syndrome

Piriformis syndrome is a neuromuscular condition that is not only poorly understood – it is also frequently misdiagnosed. Furthermore, it be confused with sciatica or lower back pain, & on some occasions, it is difficult to differentiate between piriformis syndrome & a lumbar spinal disc herniation, as they can both cause sciatica. To that end, consulting an experienced Pain Specialist is the best way to ensure a correct diagnosis & appropriate treatment

The Low-Down on Piriformis Syndrome

Piriformis syndrome refers to a rare neuromuscular condition, which is brought about by the piriformis muscle (a band-like, flat buttock muscle, near the top of the hip joint), compressing the sciatic nerve. This muscle plays a vital role in lower body movement, as it: stabilises the hip joint, and rotates and lifts the thigh away from the body. These actions enable us to maintain our balance, walk, shift our weight from one foot to another, and rotate and lift our thighs [1]. – So in a nutshell, the piriformis muscle is necessary for virtually every leg and hip motion.

Piriformis Syndrome Signs & Symptoms That Concern a Pain Specialist

When you have your first in-person or online appointment with a Pain Doctor, they will want to know about any symptoms that you have had, and are, experiencing. Piriformis syndrome usually begins with pain, tingling or numbness in the buttocks region. This pain can be severe, and extend down the length of the sciatic nerve [1]. (Note: the sciatic nerve is a long thick nerve which runs alongside, or travels through the piriformis muscle, runs down the back of the leg, and ultimately branches off into smaller nerves which terminate in the feet).

The pain from Piriformis Syndrome, is generated by the piriformis muscle compressing the sciatic nerve. – For example, whilst out running, or sitting on a car seat. In addition, the pain can be set off by remaining seated for extended periods of time; employing strong pressure directly over the piriformis muscle, and going up the stairs [1].

Piriformis Syndrome Diagnosis

“There is no definitive test for piriformis syndrome. In many cases, there is a history of trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting” [1]

When you are diagnosed by a Pain Consultant, they will review your medical history, and then ask you various questions relating to your symptoms and pain. They will also conduct a physical exam (or arrange an in-person appointment, if your are having an on-line consultation). This will involve
utilising various movements in order to provoke pain in the piriformis muscle. In addition to this, they may give you a MRI scan in order to rule out any similar conditions [1].


[1]. Lightsey, R. (2021). “Piriformis Syndrome.” WebMD.