Piriformis syndrome describes two conditions involving the piriformis muscle.
- Primary piriformis syndrome involves the anatomical variation where the piriformis muscle splits into two, the sciatic nerve splits in to two or the sciatic nerve travels through the piriformis muscle itself.
- Secondary piriformis syndrome is caused by trauma or ischemia on the actual piriformis muscle.
Piriformis syndrome is caused by shortening and or spasming of the piriformis muscle, this can cause localised pain in the buttock but also lead to neurological symptoms because of the above mentioned anatomical variation in the population.
Common causes are:
- Direct trauma to the buttock muscles.
- Repetitive trauma on the buttocks e.g. sitting on hard surfaces.
- Weak glutes therefore putting excess stress and work on the piriformis.
- Lumbar spine injury or pain.
- Sacroiliac joint injury or pain.
- Anatomical variations of the sciatic nerve where 10% of the population’s sciatic nerve runs through the piriformis muscle.
- Overuse of the piriformis for e.g. long distance running, long distance walking, skiers, tennis players and long-distance bikers.
- Direct compression e.g. truck drivers.
- Surgery of the hip and lumbar spine e.g. total hip replacements.
Common symptoms include:
- Buttock pain.
- Pain on walking.
- Pain on sitting.
- Pain aggravated by prolonged sitting, squatting or rotating the leg.
- Pain radiating into the hip and the back of the leg.
Physiotherapy treatment can consist of:
- Assessment to determine the cause as well as differentiating from sciatica.
- Stretching of the piriformis muscle.
- Lower back and glute treatment if indicated.
- Core stability.
- Massage to the piriformis.