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Piriformis syndrome

Pseudosciatica; Wallet sciatica; Hip socket neuropathy; Pelvic outlet syndrome; Low back pain - piriformis

Piriformis syndrome is pain and numbness in your buttocks and down the back of your leg. It occurs when the piriformis muscle in the buttocks presses on the sciatic nerve.

The syndrome, which affects more women than men, is uncommon. But when it occurs, it can cause sciatica.

Causes

The piriformis muscle is involved in nearly every movement you make with your lower body, from walking to shifting weight from one foot to the other. Beneath the muscle is the sciatic nerve. This nerve runs from your lower spine down the back of your leg to your foot.

Injuring or irritating the piriformis muscle can cause muscle spasms.The muscle may also swell or tighten from the spasms. This puts pressure on the nerve beneath it, causing pain.

Overuse can cause swelling or injure the muscle. Muscle spasms may come from:

  • Sitting for long periods
  • Over exercising
  • Running, walking, or doing other repetitive activities
  • Playing sports
  • Climbing stairs
  • Lifting heavy objects

Trauma can also cause muscle irritation and damage. This may be caused by:

  • Car accidents
  • Falls
  • Sudden twisting of the hip
  • Penetrating wounds

Symptoms

Sciatica is the main symptom of piriformis syndrome. Other symptoms include:

  • Tenderness or a dull ache in the buttock
  • Tingling or numbness in the buttock and along the back of the leg
  • Difficulty sitting
  • Pain from sitting that grows worse as you continue to sit
  • Pain that gets worse with activity
  • Lower body pain that is so severe it becomes disabling

The pain usually affects just one side of the lower body. But it can also occur on both sides at the same time.

Exams and Tests

Your health care provider will:

  • Do a physical exam
  • Ask about your symptoms and recent activities
  • Take your medical history

During the exam, your provider may put you through a range of movements. The point is to see if and where they cause pain.

Other problems can cause sciatica. For instance, a slipped disk or arthritis of the spine can put pressure on the sciatic nerve. To rule out other possible causes, you may have an MRI or a CT scan.

Treatment

In some cases, you may not need medical treatment. Your provider may recommend the following self-care tips to help relieve pain.

  • Avoid activities that cause pain, such as biking or running. You can resume these activities after the pain is gone.
  • Be sure to use proper form and equipment when doing sports or other physical activities.
  • Use pain medicines such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol) for pain.
  • Try ice and heat. Use an ice pack for 15 to 20 minutes every few hours. Wrap the ice pack in a towel to protect your skin. Alternate the cold pack with a heating pad on low setting. Don't use a heating pad for longer than 20 minutes at a time.
  • Follow your provider's instructions for doing special stretches. Stretches and exercises can relax and strengthen the piriformis muscle.
  • Use proper posture when sitting, standing, or driving. Sit up straight and don't slump.

Your provider may prescribe muscle relaxants. This will relax the muscle so you can exercise and stretch it. Injections of steroid medicines into the area may also help.

For more severe pain, your provider may recommend electrotherapy such as TENS. This treatment uses electrical stimulation to reduce pain and stop muscle spasms.

As a last resort, your provider may recommend surgery to cut the muscle and relieve pressure on the nerve.

Prevention

To prevent future pain:

  • Get regular exercise.
  • Avoid running or exercising on hills or uneven surfaces.
  • Warm up and stretch before exercising. Then gradually increase the intensity of your activity.
  • If something causes you pain, stop doing it. Don't push through the pain. Rest until the pain passes.
  • Don't sit or lie down for long periods in positions that put extra pressure on your hips.

When to Call the Doctor

Call your provider if you have:

  • Pain that lasts longer than a few weeks
  • Pain that starts after you have been injured in an accident

Get medical help immediately if:

  • You have sudden severe pain in your lower back or legs, along with muscle weakness or numbness
  • You have difficulty controlling your foot and find yourself tripping over it when you walk
  • You can't control your bowels or bladder

References

American Academy of Family Physicians website. Piriformis syndrome. familydoctor.org/condition/piriformis-syndrome. Updated October 10, 2018. Accessed December 10, 2018.

Hudgins TH, Wang R, Alleva JT. Piriformis syndrome. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 58.

Khan D, Nelson A. Piriformis syndrome. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 67.

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          Review Date: 11/5/2018

          Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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