Piriformis Syndrome

What is piriformis syndrome?

Piriformis syndrome occurs when your piriformis muscle compresses your sciatic nerve and results in inflammation. It can cause pain or numbness in your buttock and down the back of your leg. It can happen on one side of your body or both.

The piriformis is a flat, narrow muscle. It runs from your lower spine through your butt to the top of your thighs. Your piriformis muscle extends to each side of your body and aids in almost every movement of your lower body.

The sciatic nerve most commonly runs underneath the piriformis. The nerve travels from your spinal cord, through your buttocks, down the back of each leg, to your feet. It’s the longest, largest nerve in your body.

How common is piriformis syndrome?

Piriformis syndrome is not very common. Scientists believe that piriformis syndrome causes only about 0.3% to 6% of lower back pain.

What’s the difference between piriformis syndrome versus sciatica?

Although the conditions are sometimes related and both affect the sciatic nerve, they are different.

A herniated disk or spinal stenosis can cause sciatica. The symptoms tend to affect the lower back and can travel down through the buttocks and leg.

Piriformis syndrome only involves the piriformis muscle pressing on one area of the sciatic nerve in the buttock. It can feel a lot like sciatica but in a more specific area.

What causes piriformis syndrome?

Anything that makes the piriformis press on the sciatic nerve can cause piriformis syndrome.

The most common piriformis syndrome causes are:

• Inflammation (swelling) in the piriformis or the tissues around it.
• Muscle spasms.
• Scarring in the muscle.

These issues can result from:

• Climbing stairs, walking or running without strong enough piriformis muscles.
• Injuring the hip, butt or leg, such as a fall or car accident.
• Having tight muscles from lack of physical activity.
• Lifting something improperly and damaging the piriformis muscle.
• Not warming up before physical activity or stretching properly afterward.
• Overexercising or performing repetitive motions, such as long-distance running.
• Sitting for long periods of time (for example, people who sit a lot on the job).

But sometimes, abnormal anatomy causes piriformis syndrome. Healthcare providers call this primary piriformis syndrome. For example, a person can be born with a sciatic nerve that takes an abnormal path in their body. Or a person can be born with an unusually formed piriformis muscle or sciatic nerve.

What are the symptoms of piriformis syndrome?

Piriformis syndrome symptoms occur in the butt, hip or upper leg. People often describe the feeling as:

• Aching.
• Burning.
• Numbness.
• Pain.
• Tingling.
• Shooting.

Symptoms may get worse during certain activities, such as:

• Sitting for long periods of time.
• Walking or running.
• Climbing stairs.

How is piriformis syndrome diagnosed?

Diagnosing piriformis syndrome can be difficult and often involves ruling out other causes.

A healthcare provider will:

• Ask you about your symptoms and activity habits.
• Discuss your medical history, including any injuries.
• Stretch, rotate, press and move your hip, butt and leg to see what hurts and what doesn’t.

There are no specific piriformis syndrome tests. But a healthcare provider may order tests to identify other problems that might be causing your symptoms. These tests include:

• Ultrasound.
• CT scan.
• MRI.
• Electromyogram (EMG).

How is piriformis syndrome treated?

Piriformis syndrome treatment may include:

• A few days of rest.
• Home exercises to stretch or strengthen the piriformis.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Massage, as complementary medicine.
• Medications that relax the muscles.
• Piriformis syndrome physical therapy that focuses on stretching and strengthening the piriformis.
• Steroid injections.
• Botulinum toxin injections (Botox®).

Piriformis syndrome surgery is usually not recommended unless all other therapies fail. Surgery for this condition may involve removing scar tissue or other sources of pressure on the nerve.

How can I prevent piriformis syndrome?

To prevent piriformis syndrome, including recurrent (repeat) episodes, consider some of the following strategies:

• Exercise regularly to keep your muscles healthy.
• Focus on good posture, especially when sitting, driving or standing.
• Lift things properly by bending your knees and squatting, making sure to keep your back straight. Keep objects close to your body, and don’t twist while lifting.
• Warm up before physical activity and stretch after.
• When you must sit for long periods of time, take breaks by standing, walking or stretching.

How long does piriformis syndrome last?

Piriformis syndrome resolves quickly with lifestyle changes and simple treatments. Symptoms often improve in days or weeks.

But the condition tends to come back, especially in people who don’t follow their healthcare provider’s instructions. Severe cases that aren’t treated properly can greatly reduce a person’s ability to function well.

How do I take care of myself with piriformis syndrome?

If you have piriformis syndrome, certain adjustments can help you manage the symptoms when they occur:

• Avoid activities that trigger piriformis syndrome. For example, if the condition acts up when you ride a bike, find another way to exercise, at least for a few days.
• Massage deep into the tissue of the hips and buttocks.
• Get up from your chair regularly. Stand, walk and stretch. This is especially important for people who sit to work, such as professional drivers and desk personnel.
• Take NSAIDs according to package directions to reduce swelling.
• Try cold packs or heat, depending on what works for you. Icing the area several times a day for 15 minutes can reduce swelling. Heat (such as a heating pad) can loosen a tight muscle.
• Stretch the piriformis and surrounding muscles. For example: Lie on your back, then pull one knee toward your chest. Hold it for five to 30 seconds, then do the other leg. Another example: Stand, hinge at your hips and let your head and hands fall toward the floor. This will stretch through the back of the legs and buttocks.

When should I see my healthcare provider for piriformis treatment?

If you have piriformis syndrome, call your healthcare provider if you experience any of the following:

• Frequent trips or falls because of pain or numbness.
• Pain that lasts longer than a few weeks, especially if you’ve been following instructions and adjusting your lifestyle.
• Problems controlling your bowels (pooping) or bladder (peeing).
• Sudden, severe pain in your lower back or leg.
• Sudden weakness or numbness in your back or leg.
• Trauma or injury to your back, hip or leg.
• Trouble picking your foot up off the floor.

A note from Cleveland Clinic

Piriformis syndrome occurs when the piriformis muscle presses on the sciatic nerve. The condition can cause pain, numbness or tingling in your butt, hip or upper leg. Most episodes go away in a few days or weeks with rest and simple treatments. But talk to your healthcare provider if an injury led to the pain or if symptoms last more than a few weeks.