Piriformis Syndrome

Piriformis Syndrome

Article by Alex Clarke

Piriformis Syndrome

What is Piriformis Syndrome?

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

It’s a disorder that occurs when your sciatic nerve is compressed and irritated as it passes deep through your buttock, resulting in pain and/or numbness down the leg. 

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 (e.g. disc bulge) has been eliminated as a cause of your sciatica symptoms.

Where is your Piriformis Muscle?

piriformis syndrome

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 radiation of pain down the back of the leg (sciatica).
  • Pain aggravated by prolonged sitting or activities that stress the piriformis muscle.
  • To avoid pain and pressure on 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 overworking your piriformis muscle or decreased space in the buttock area, which in turn compresses the muscle and nerve.  

The main reasons that the piriformis muscle overworks are:

  • Protection or dysfunction of the adjacent SIJ or hip joints 
  • A weakness of your deep hip stability muscles
  • Overpronating feet

Decreased space to the buttock area is most commonly due to: 

  • Hypertrophy of other buttock muscles 
  • Inflammation from the sciatic nerve or piriformis muscle itself.
  • After trauma to the buttock area.

How is Piriformis Syndrome Diagnosed?

In most cases, a clinical examination excludes a potential lumbosacral spinal pathology.

Your physiotherapist performs clinical tests that potentially irritate your piriformis or provoke sciatic nerve compressions. They will then interpret the findings. Some piriformis-related tests are the Freiberg, the Pace, the FAIR, the HCLK and Laseguese’s manoeuvres. 

CT, MRI, ultrasound, and EMG are mostly useful in excluding conditions that could replicate piriformis syndrome. Electromyography (EMG) can show sciatic nerve compression but only in cases of chronic piriformis syndrome. 

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 diagnosed, your treatment could involve any of the following:

What’s Your Prognosis for Piriformis Syndrome?

Piriformis syndrome responds favourably in the vast majority of cases. Short-term symptoms usually reverse within a few days. Long-standing 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 seek the professional advice of your physiotherapist.

Common SIJ & Buttock Pain Sources

The following conditions may cause buttock pain or SIJ issues.

Joint Injuries

Pregnancy-Related Pain

Muscle-related Injuries

Lateral Hip Pain

Nerve-related Injuries

Bone-related Injuries

SIJ & Buttock Pain Treatment Guidelines?

While SIJ and buttock pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.

PHASE I - SIJ Pain Relief & Joint Protection

Pain Relief While pain relievers or anti-inflammatory medications are often prescribed for acute SIJ dysfunction they will not address the true cause of SIJ pain. Chronic cases of SIJ dysfunction should be thoroughly assessed by a healthcare practitioner who has a comprehensive understanding of the biomechanics and muscular control of your SIJ, pelvis and hip complex. Managing your sacroiliac pain is the main reason that most people seek treatment for sacroiliac joint dysfunction. In truth, it was actually the final symptom that you developed and should be the first symptom to improve in most cases. If this is the case, the prevention of a recurrence becomes your priority. Natural short-term pain relief can often be achieved by using ice or heat packs applied to your SIJ's. Reduce Inflammation Managing your inflammation. Sacroiliac joint inflammation it best eased via ice therapy and techniques or exercises that unload the inflammed structures. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen. Some seronegative arthritis condition can predispose you to sacroiliitis. Special blood tests can be arranged by your doctor to assist diagnosis in these conditions. Prolonged morning stiffness is a common complaint. See Ankylosing Spondylitis. SIJ Protection & Support Sacroiliac joint instability occasionally requires additional passive support until your muscles successfully control the joint. Supportive taping is often beneficial during the initial pain reduction phase. SIJ Stability Belt Longer-term instability may be managed with a sacroiliac joint stabilisation belt. However, an exercise protocol to specifically address your SIJ issue is normally more effective. If you have any questions please seek the advice of your physiotherapist.

PHASE II - Restoring Normal ROM and Strength. Early Hip Core Exercises.

As your SIJ pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal pelvic joint alignment and normalisation of the dynamic muscle control that affects the SI Joints. Your physiotherapist may commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. They will also implement a similar activation and strength program that addresses your deep gluteal muscles. These muscles are sometimes referred to as your hip core muscles. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for your specific needs.

PHASE III - Restoring Full Function

As your sacroiliac joint dynamic control improves, your physiotherapist will turn their attention to restoring your normal pelvic alignment and maintaining sacroiliac joint range of motion during more functionally stressful positions and postures plus work on your muscle power, proprioception, balance and gait (walking pattern). Depending on your chosen sport or activities of daily living, your physiotherapist will aim to restore your SIJ function to safely allow you to return to your desired activities. Everyone has different demands for their sacroiliac joints that will determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon. Your physiotherapist will tailor your sacroiliac joint rehabilitation to help you achieve your own functional goals.

PHASE IV - Preventing a Recurrence

Sacroiliac joint dysfunction does have a tendency to return if a thorough muscle control program is not undertaken. The main reason it is thought to be chronic and specific muscle weakness. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely or periodically. In addition to your muscle control, your physiotherapist will assess your SIJ, spine, hip and lower limb biomechanics and correct any deficits that may predispose you to SIJ pain and dysfunction. Fine-tuning and maintenance of your sacroiliac joint stability and function are best achieved by addressing any deficits and learning self-management techniques. Your physiotherapist will guide you.

Experience the PhysioWorks Difference?

You'll be impressed with the experienced physiotherapists, massage therapists, allied health team and reception staff representing PhysioWorks.

If you've been searching for health practitioners with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at a representative level.

To ensure that we remain highly qualified, PhysioWorks is committed to continuing education to provide optimal care. We also currently offer physiotherapy and massage services for numerous sports clubs, state and national representative teams and athletes. Our experience helps us understand what you need to do to safely and quickly return to your sporting field, home duties, or employment.

How You'll Benefit from the PhysioWorks Difference?

At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long-lasting results by providing high-quality treatment. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.

What are Some of the BIG Differences?

We aim to get you better quicker in a friendly and caring environment conducive to successful healing. Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they provide you with the most advantageous treatment methods. They are continually updating their knowledge via seminars, conferences, workshops, scientific journals etc. Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that, in reality, only last for a short time. We attempt to treat the cause, not just the symptoms.

PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge. Our staff care about you!  We are always willing to go that 'extra mile' to guarantee that we cater to our client's unique needs. All in all, we feel that your chances of the correct diagnosis, the most effective treatment and the best outcomes are all the better at PhysioWorks.