Diagnosing and Managing Piriformis Syndrome

22 Jun Diagnosing and Managing Piriformis Syndrome

Piriformis syndrome is a neuromuscular condition that occurs as a result of the piriformis muscle going into a spasm and compressing the sciatic nerve, which is a thick and long nerve in the body that passes through or alongside the mentioned muscle. This nerve travels along the leg and splits up into smaller nerves that end in the feet.

The piriformis muscles is a flat, band-like structure that is located in the buttocks near the top of the hip joint. The function of the muscle is:

• To enable one to walk.
• To maintain balance while mobilizing.
• To allow one to shift weight from one foot to another.
• To provide appropriate control for those who take part in sports that require lifting and rotation of the hips.
• To provide almost every motion of the hips and legs.

Signs and Symptoms of Piriformis Syndrome

Piriformis syndrome causes signs and symptoms of sciatica which occurs due to compression of the sciatic nerve. This is an uncommon cause of sciatica as there are other conditions that cause compression of the sciatic nerve as well.

Signs and symptoms of sciatica include:

• Pain, tingling sensation, or numbness experienced in the buttocks.
• Pain getting worse when performing actions such as sitting in a car or for long periods of time, running, climbing stairs or applying pressure directly over the piriformis muscle.
• Pain referring down the legs.

Diagnosing Piriformis Syndrome

Due to piriformis syndrome being a rare condition and since the signs and symptoms of sciatica can be caused by other conditions, radiological investigations such as an MRI of the pelvic region and hips may need to be performed in order to exclude other possible causes of compression of the sciatic nerve, such as a prolapsed disc.

A history of vigorous and repetitive motions involving the hips such as long-distance running and prolonged sitting, as well as trauma to the area of the piriformis muscle together with signs and symptoms of sciatica should make once suspect piriformis syndrome.

Management

The following suggestions and therapies are incorporated for the management of piriformis syndrome:

• Avoid positions that trigger or aggravate pain caused by the syndrome.
• Non-steroidal anti-inflammatory medications such as ibuprofen or naproxen can be used to help reduce inflammation of the piriformis muscle.
• Rest and applying ice and/or heat packs to the affected area may help to relieve symptoms.
• Referral to a physical therapist may be needed to suggest exercises and stretches to help reduce swelling and tension in the piriformis muscles so that there is less compression of the sciatic nerve.
• Corticosteroids may be injected into the muscle to reduce inflammation directly if oral medication is not effective enough.
• Iontophoresis, which is a therapy that combines stimulation of the piriformis muscle with a mild electrical current together with the administration of botulinum toxin to relax the anatomy, has been used effectively enough in some patients.

If all these suggestions and therapies have been proven to be ineffective, then surgical intervention may be warranted as a last resort.