What is it?
Piriformis syndrome is an irritation of the piriformis muscle
caused by a compression of the sciatic nerve as it passes through
this muscle, which is located deep in the pelvic and buttocks
region. The sciatic nerve is the principle nerve bundle
emanating from the lower lumbar and sacral vertebrae of the
spine. It passes beneath the piriformis muscle and above the
smaller rotator muscles in most individuals, and through the
piriformis muscle in a small percentage of others. Lying
beneath the larger gluteus maximus muscle and above several smaller
hip rotator muscles, the piriformis muscle connects the sacral
vertebrae to the femur (hip bone) and acts as an external rotator
of the hip when contracted.
How does it occur?
When the sciatic nerve becomes irritated or inflamed due to
excessive tightness, spasm, or hypertrophy (increased size) of the
piriformis muscle. Many circumstances can lead to this.
Here are some of the more common causes.
- Trauma: A hard fall in the seated
position can directly injure the sciatic nerve or cause secondary
nerve compression due to gluteal muscle contusion and
- Acute piriformis muscle
* Bending and twisting while
lifting an object from the floor.
* Carrying heavy objects up and down
* Downhill running.
* Prolonged sitting on a hard surface or in
a crossed leg position.
- Chronic piriformis muscle strain:
* Bony malalignment of the lower
extremities (ie: knock knees or flat
feet) producing excessive hip rotation with walking and
* Increased lumbar spine curvature due
to abdominal weakness, hip flexor
muscle tightness, maternity, and poor posture.
* Lumbar spine and/or sacroiliac joint
* Prolonged driving with the seat rest back
and the knees relatively
* Excessive exercise training involving hip
and gluteal muscles.
What are the symptoms?
- Deep, burning pain in the buttocks or sacroiliac region-
(increases with sitting, walking, climbing stairs, lifting or
carrying objects, and running.)
- Hypersensitivity, numbness, or tingling along back of thigh to
bottom of foot at midstage.
- Muscular weakness and atrophy of hamstrings and calf with
end stage progression.
How is it diagnosed?
Since your sciatic nerve begins in the spine, it can be
irritated from a back injury such as a herniated disk. Your doctor
will discuss how your symptoms began and any previous history of
back or hip injury. He or she will examine your back to
determine if this is where the sciatic nerve is irritated and then
your hip and leg to determine if movement in these areas create
your symptoms. X-rays, a Computed Tomography (CT) Scan, or a
Magnetic Resonance Image (MRI) may be ordered to rule out any spine
pathology or injury. Unfortunately, there are no X-ray tests
that can if the sciatic nerve is being irritated at the piriformis
How is it treated?
Immediate treatment may include:
- Icing the affected area 15 to 20 minutes, 3 to 4 times per
- Resting on your stomach or back with the hips extended.
- Prescribed anti-inflammatory or muscle relaxant
- Avoiding postures and activities which aggravate your symptoms.
- Assessment of your posture and lower extremity alignment
Evaluation of the lumbar spine, hip, and lower extremity joint
mobility, range of motion, flexibility, and strength.
- Symptom provocation testing of the lumbar spine, sacroiliac
joint, hip, and sciatic nerve to determine the source and extent of
- Palpation of the trunk, pelvis, and hip soft tissue structures
to determine the degree of irritability, restriction, and spasm
associated with the individual's condition.
- Gait and functional assessment.
Once the evaluation has been performed, treatment can be
initiated. Physical therapy treatment may include:
- Therapeutic modalities such as moist heat, ice, ultrasound, and
electrical stimulation help to decrease pain and spasm, yet
increase blood flow and soft tissue flexibility.
- Soft tissue mobilization or massage to increase blood flow,
decrease spasm and associated soft tissue restrictions, and improve
soft tissue mobility.
- Joint mobilization to the lumbar spine, sacroiliac joint, and
hip as indicated to restore normal joint mobility, range of motion,
- Manual and self stretching activities to improve trunk and
lower extremity flexibility, and range of motion.
- Postural training exercises emphasizing abdominal and hip
extensor strengthening, low back and hip flexor stretching.
- Instruction in activity and postural modification to decrease
aggravation and perpetuation of symptoms with activities of daily
- Functional foot orthoses may be recommended to restore normal
foot and lower extremity alignment. This may help to decrease
pain and mechanical stresses to the piriformis muscle, and prevent
When can I return to my sport or activity?
The goal of rehabilitation is to return to your sport or
activity as soon as is safely possible. If you return too
soon you may worsen your condition, which could lead to permanent
damage. Everyone recovers from injury at a different rate and
is determined by how fast your nerve recovers, not by the time
elapsed since the onset of your injury. In general, the
longer you have symptoms before you start treatment, the longer it
will take to recover.
You may safely return to your sport when:
- You are completely pain-free.
- You have regained full strength in the affected leg.
- You can jog, sprint, cut, jump, and perform your daily
activities on the affected leg without eliciting pain or
How can I prevent Piriformis Syndrome?
- Maintain good flexibility of the trunk and lower extremity
- Maintain good strength of the abdominal and gluteal
- Sit with your feet flat on the ground.
- When driving, adjust the seat to keep the hips and knees
- Avoid sitting with a wallet in the back pocket.
- Maintain good posture when sitting, standing, and lifting.
- Lift with your legs and not your back.
- When lifting keep objects close to your body.
- Avoid combined twisting and lifting motions with feet planted,
instead, move your feet and keep the object directly in front of
- Warm-up properly prior to starting your sport or activity.