Piriformis syndrome describes a condition in which the piriformis muscle aggravates and potentially damages the sciatic nerve.
Sciatica (the set of symptoms caused by the aggravation of the sciatic nerve) is painful, disruptive, and very common. However, when considering the causes of sciatic nerve pain, many people (including medical professionals) overlook the possibility of piriformis syndrome. A diagnosis that mistakes piriformis syndrome for a more serious spinal injury may cause people to avoid exercise, which is crucial for bone health.
Today you'll learn about this little-known condition, what causes it, how to recognize it, and how to prevent it and reverse it.
The Piriformis Muscle And Syndrome
The piriformis muscles run diagonally under the gluteus maximus from the base of the spine to the tops of each femur. They assist in rotating the hip to turn the legs and feet outward and are engaged during everyday activities like walking and climbing stairs.
The sciatic nerve runs vertically beneath the piriformis, and in some people, the nerve runs directly through it. Piriformis syndrome occurs when the piriformis over-tightens, swells, or spasms, causing tenderness, burning, or pain in the buttocks and putting pressure on the sciatic nerve.1
Aggravation of the sciatic nerve can cause discomfort, tingling, pain, or numbness in the back of the thigh, calf, or foot. These symptoms may increase in intensity during any activity or physical position that causes the muscle to press against the sciatic nerve, such as running, climbing stairs, or even sitting.
Piriformis syndrome occurs when the piriformis muscle (located in the buttocks) tightens, swells, or spasms, aggravating the sciatic nerve. Symptoms include localized pain or burning in the buttocks, and nerve pain, tingling, or numbness in the legs or feet.
Confusion With Other Causes Of Sciatica
Any symptoms caused by irritation of the sciatic nerve are called sciatica, and the piriformis muscle is only one of many potential causes of nerve distress. Other causes of sciatica include:
- Herniated disc
- Disc degeneration
- Lumbar spine stenosis
- Bone spurs
- Swelling and inflammation around the spine
- Muscle spasms or tightness in the lower back
Many of these causes of sciatica are more common than piriformis syndrome, and as a result, it often goes unconsidered as a possible cause.
A person who suspects that they have a herniated disk or other spinal problem might forgo exercise in an attempt to protect the spine and avoid injury or pain. Since regular weight-bearing exercise is essential for new bone development, a misdiagnosis that keeps someone from exercising can result in bone loss.
Although part of the treatment for piriformis syndrome includes taking a break from any activities that irritate the piriformis muscle, it doesn't preclude all exercise. Indeed, exercise is an important part of treating and preventing piriformis syndrome, as you'll see later.
Piriformis syndrome can be easily mistaken for another cause of sciatica, (such as a herniated disc), which might unnecessarily cause someone to forgo their regular bone-building exercise.
Diagnosis Of Piriformis Syndrome
To diagnose piriformis syndrome, a medical professional may manipulate the leg to find out which movements cause pain, helping to isolate the piriformis muscle as the problem. If your sciatica symptoms are accompanied by any pain, burning, or tenderness in the buttocks, be sure to mention this to your doctor. You could even suggest piriformis syndrome as a possibility.
Pain triggered specifically by walking up stairs or inclines and reduced range of motion in the hips may indicate piriformis syndrome.
There is no test for piriformis syndrome. However, MRIs or CT scans can rule out other causes of sciatic nerve irritation (such as a herniated disc or spinal stenosis) leaving piriformis syndrome as the likeliest cause.
There is no test for piriformis syndrome, but tests can be performed to rule out other causes of sciatic nerve irritation. Your doctor may manipulate your legs to see which movements cause pain, helping to isolate the piriformis muscle as the source of irritation.
Causes Of Piriformis Syndrome
Anything that causes the piriformis muscle to aggravate the sciatic nerve can cause piriformis syndrome. Common causes include:
- Injury such as a fall or a car accident
- Abnormal development or location of the piriformis muscle or sciatic nerve
- Scoliosis or other abnormal spinal alignments
- Prolonged sitting (especially if pressure is placed on the buttocks by an object like a thick wallet)
- Prior hip surgery
- Unusually intensive exercise
Anything that results in tightening, swelling, or spasming of the piriformis muscle can cause piriformis syndrome, including walking, running, climbing stairs, prolonged sitting, or traumatic accidents.
Treatment Of Piriformis Syndrome
The first step in treating piriformis syndrome is the cessation of painful activities. If walking, running, climbing stairs, or another activity is causing pain, you should avoid that activity until the muscle has a chance to return to a less irritated or inflamed state.
Avoid long periods of sitting. If you sit all day for work, set an alarm to remind yourself to get up regularly and walk around so that your piriformis muscle doesn't tighten.
You can apply a cold pack to the buttocks, which will help reduce inflammation that puts pressure on the sciatic nerve. Some people find it relieving to alternate cold with heat, using a heating pad to help the muscle relax. A physical therapist can provide simple stretches and manual manipulation that helps to stretch the piriformis, increase blood flow, and reduce spasms.
Because inflammation can cause the piriformis muscle to irritate the sciatic nerve, reducing inflammation can help calm the affected areas. A health practitioner may advise using a pharmaceutical anti-inflammatory painkiller such as an NSAID, but because they are acidifying and have unwanted side-effects, the Save Institute recommends adopting an anti-inflammatory diet instead.
In severe cases, a medical professional may give a steroid shot at the site of irritation.
Treatment of piriformis syndrome aims to relax and calm the piriformis muscle so that it stops aggravating the sciatic nerve. This may include temporarily avoiding aggravating it, cold or heat application, stretching, physical therapy, and an inflammation-reducing diet.
Prevention Of Piriformis Syndrome
Piriformis syndrome is avoidable through a healthy lifestyle that includes regular exercise and stretching. Here are some simple ways to avoid piriformis syndrome:
- Exercise regularly – walking, running, climbing stairs, yoga, and most full-body activities engage and strengthen the piriformis muscle- especially exercises that engage the hips and buttocks
- Build core strength – strong core muscles support the spine and hips, preventing excessive strain on vertebrae and interior muscles like the piriformis while reducing lower back pain
- Don't overdo it – if you feel pain, irritation, burning, or tightness in your buttocks, reduce the intensity of exercise and be sure to cool down with gentle stretching
- Avoid prolonged sitting – which may cause the piriformis muscle to tighten
- Maintain good posture – keep your spine aligned and supported while sitting and standing, especially for prolonged periods, as while working or driving
- Lift from the knees – don't bend your back to lift anything, always lift from the knees, with the back straight and vertical.
- Never twist while lifting – and avoid lifting anything that's so heavy as to cause strain.
You can prevent piriformis syndrome by maintaining an active lifestyle that includes regular exercise and avoids prolonged sitting, unsafe lifting, or over-taxing physical activities.
A Bone Healthy Lifestyle Helps Prevent Sciatica
Regular exercise helps keep your body strong and flexible, which can prevent injury and conditions like piriformis syndrome. Of course, exercise is also essential for building strong bones and reversing osteoporosis.
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