Piriformis Syndrome

Alex Clarke Ashgrove Physiotherapist

Article by Alex Clarke

What is Piriformis Syndrome?

piriformis syndrome

If you are experiencing hip, buttock, hamstring or sciatic pain then you may be suffering Piriformis Syndrome

Piriformis syndrome is a disorder that occurs when your sciatic nerve is compressed and/or irritated by the piriformis muscle as it passes deeply through your buttock, resulting in pain. Sometimes the condition is called ‘pseudo sciatica’, as it is often confused with pain in the nerve resulting from a low back disc bulge.

Your diagnosis of piriformis syndrome should be made after a spinal nerve root compression (eg disc bulge) has been eliminated as a cause of your sciatica symptoms.

Where is your Piriformis Muscle?

Your piriformis muscle originates mostly from your sacrum (base of spine) to insert on the greater trochanter of the femur (thigh bone). In the standing position, your piriformis muscle is a lateral hip rotator muscle, but it changes to a medial hip rotator in hip flexion due to its orientation. More information about the piriformis muscles can be found here: piriformis muscle

What are the Symptoms of Piriformis Syndrome?

You may experience one or more of the following symptoms:

  • Pain is usually felt in one buttock - but you may experience a radiation of pain down the back of the leg (sciatica).
  • Pain aggravated by hip activity, eg walking, or prolonged sitting.
  • To avoid pain and pressure in the area you may sit lopsided with your sore buttock tilted up.  
  • Sometimes, you’ll walk with the foot turned out due to shortening of the piriformis muscle.

What Causes Piriformis Syndrome?

Piriformis syndrome is most commonly caused by your piriformis muscle overworking. 

The main reasons that it overworks is due to:

  • protection or dysfunction of the adjacent SIJ or hip joints. 
  • a weakness of your deep hip stability muscles.
  • overpronating feet. 

How is Piriformis Syndrome Diagnosed?

In most cases, a clinical examination that excludes a lumbosacral spinal pathology as the cause of your symptoms will suspect piriformis syndrome. 

Your physiotherapist will perform clinical tests to stretch the irritated piriformis or provoke sciatic nerve compressions, such as the Freiberg, the Pace, and the FAIR (flexion, adduction, internal rotation) manoeuvers. 

CT, MRI, ultrasound, and EMG are mostly useful in excluding conditions that could replicate piriformis syndrome. Magnetic resonance neurography can show the presence of irritation of the sciatic nerve but is rarely required.

What’s the Treatment for Piriformis Syndrome?

After a thorough assessment of your back, pelvis and hips, your physiotherapist will determine the cause of your pain.

Once your diagnosis is established, treatment could involve any of the following:

  • Pelvis and spine re-alignment techniques. 
  • Joint mobilisation to restore normal joint mobility, the range of motion and function. 
  • Massage or electrotherapy to help decrease pain and spasm in your piriformis and increase blood flow plus soft tissue extensibility.
  • Stretching program for muscle length and flexibility
  • Acupuncture or Dry Needling to reduce muscle tightness around the buttock.
  • Deep core stability and hip strengthening exercise to stabilise your hip, pelvis and spine. 
  • Foot orthotics or exercises, if indicated by your physiotherapist or podiatrist, to help restore foot and lower extremity alignment.

What’s Your Prognosis for Piriformis Syndrome?

Piriformis syndrome is effectively treated with physiotherapy in the vast majority of cases.

Short-term symptoms can be reversed within a few days. Longstanding symptoms may take a few weeks to address the biomechanical and muscle habits that have predisposed you to the injury. Only rarely will surgery be required.

For more advice about Piriformis Syndrome please ask your physiotherapist.

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Common Treatment Options for Piriformis Syndrome

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Core Exercises
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Products for Piriformis Syndrome

    Piriformis Syndrome

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    Related Injuries to Piriformis Syndrome

    General Information

    Hip Joint Pain

    Lateral Hip Pain

    Adductor-related Groin Pain

    Pubic-related Groin Pain

    Inguinal-related Groin Pain

    • Inguinal hernia
    • Sportsman's hernia

    Iliopsoas-related Groin Pain

    • Hip Flexor Strain

    Other Muscle-related Pain

    Systemic Diseases

    Referred Sources

    Hip Surgery


    FAQs for Piriformis Syndrome

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • What are the Best Core Exercises?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Does an Exercise Ball Help Back Pain?
  • How Much Treatment Will You Need?
  • Post-Run Soreness: Should You Be Concerned?
  • What are the Common Adolescent Spinal Injuries?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What is the Correct Way to Sit?
  • What's the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Which are the Deep Core Stability Muscles?
  • Why are Your Deep Core Muscles Important?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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    Last updated 14-Feb-2019 10:48 AM

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