How Can You Tell If You Have Piriformis Syndrome
You can test yourself for piriformis syndrome by lightly pressing the middle of the muscle in each buttock and taking note of any pain

Piriformis syndrome is a neuromuscular condition caused by sciatic nerve compression. Because piriformis syndrome is often confused with sciatica, proper diagnosis is critical so that appropriate treatment can be administered.

You can test yourself for piriformis syndrome by lightly pressing the middle of the muscle in each buttock and taking note of any pain. Note whether the pain is persistent or worsens when you sit down. Stretches can also help determine whether you have piriformis syndrome.

What stretches can help diagnose piriformis syndrome?

Straight leg test

Lift your leg straight out while on your back. If the pain radiates down the back of your leg, it could be a sign of sciatic nerve irritation. If you have piriformis syndrome, the straight leg lift test can produce sciatica-like discomfort, but it can also suggest the existence of lower back problems.

Knee resistance test

While seated, tie together both of your legs above the knee with a rope. Push your legs outward while resisting the movement with the ropes. If pain occurs, it may indicate piriformis syndrome.

What causes piriformis syndrome?

The piriformis muscle is located around the apex of the hip joint, deep in the buttocks. It connects to the lower spine and extends in a triangle-shaped pattern toward the thigh bone (femur). This muscle helps with lower body movement and supports the hip joint, being used in many leg and hip movements. The sciatic nerve runs down the back of the legs through the piriformis muscle.

Piriformis syndrome occurs due to inflammation or injury to the piriformis muscle. Causes of piriformis syndrome include:

  • Hip injury
  • Piriformis muscle separation
  • Problems with the sciatic nerve
  • Increased piriformis muscle growth as a result of training or heavy weight lifting
  • Overuse of the piriformis muscle, such as excessive running or hip use
  • Sitting for long periods of time

A sedentary lifestyle contributes to a tight piriformis, resulting in spasms or a compressed sciatic nerve. If you spend most of your day sitting at a desk, you are at a higher risk of developing the condition. When you sit for long periods of time, especially with bad posture, the sciatic nerve becomes compressed. This may result in piriformis muscle spasms and a feeling of soreness or achiness.

How to tell the difference between piriformis syndrome vs. sciatica

Both piriformis syndrome and sciatica impair sciatic nerve function. However, sciatica is caused by spinal dysfunction, such as a herniated disc or spinal stenosis. Piriformis syndrome, on the other hand, develops when the sciatic nerve is compressed by the piriformis muscle.

Since the conditions produce similar symptoms, they are easily confused with one another. The following are major symptoms of piriformis syndrome that can help with appropriate diagnosis:

  • Buttock pain that worsens when sitting or squatting
  • Pain in the contralateral sacroiliac joint after 20 minutes of sitting or standing
  • Pain radiating from the sacrum down the back of the thigh, generally ending slightly above the knee
  • Spasms of the piriformis muscle
  • Pain relief with movement
  • Bleeding around the piriformis muscle
  • Any injury to the buttocks or hips that leads to swelling of the piriformis muscle

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How is piriformis syndrome diagnosed?

Although there is no straightforward way to diagnose piriformis syndrome, an orthopedic expert will start by taking a detailed medical history and examining the area for injury. 

Diagnosis is made after performing radiologic tests, such as an MRI, and considering both your symptoms and the results of a physical examination. These will help rule out other disorders that cause similar symptoms, such as hip bursitis and disc herniation.

What are treatment options for piriformis syndrome?

Piriformis syndrome does not typically require treatment. Adequate rest can help with the condition. If the pain recurs, you may consider the following measures:

Exercises

Physical therapy is a common first step in treatment. A physical therapist will work with you to conduct stretching exercises to relieve piriformis muscle strain. Exercise can help ease tension and strengthen the weak areas around the muscle, enhancing blood flow and promoting faster recovery.

It is crucial to listen to your body when stretching or exercising. If you experience increased pain with certain movements, stop immediately. Start slowly with any new exercise, and make sure you are using the correct form.

Medications

  • Over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen may help relieve pain and inflammation if necessary.
  • Corticosteroid injections can help reduce muscle spasms and discomfort. 
  • Botox injections to the affected region may help alleviate symptoms by relaxing the muscle, which decompresses the sciatic nerve.

Heat and cold therapy

Alternating between heat and cold application can help ease pain caused by piriformis syndrome.

Heat can help relax tense muscles. Use a heat pack on the area for up to 20 minutes at a time, with at least 45 minutes between applications. 

Ice can also help relieve discomfort. Place an ice pack on the affected area, being careful to avoid placing it on the skin directly. Apply the ice pack for a total of 20 minutes, pausing for 45 minutes between applications.

Electrotherapy

Transcutaneous electric nerve stimulation can help suppress pain impulses by substituting them with a tingling feeling. This type of treatment may also aid in reducing muscular spasms. 

Small electrode pads are connected to wires and put on the skin. Cables are then connected to a device that provides electricity to the pads through the wires. 

Surgery

In very rare cases, surgery may be required. This is only done if there is a significant injury that will not heal on its own. It may also be performed if anomalies such as a split piriformis muscle are causing the condition.

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Medically Reviewed on 11/9/2022
References
Image Source: iStock image

Piriformis Syndrome: https://my.clevelandclinic.org/health/diseases/23495-piriformis-syndrome

Prevalence Of Piriformis Syndrome Among the Cases of Low Back/Buttock Pain with Sciatica: A Prospective Study: https://www.jmedsoc.org/article.asp?issn=0972-4958;year=2013;volume=27;issue=2;spage=94;epage=99;aulast=Singh