What Is Piriformis Syndrome?
Piriformis syndrome is a rare disorder of the nerves and muscles. When you have it, your piriformis muscle--a flat, band-like muscle located in your butt near the top of your hip joint--presses on the sciatic nerve.
Your piriformis muscle is important for lower body movement. It stabilizes your hip joint and lifts and rotates your thigh away from the body. This is how you're able to walk, shift your weight from one foot to another, and maintain balance. You also use it in sports that involve lifting and rotating your thighs. In short, you need it to perform in almost every motion of your hips and legs.
The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet.
Piriformis syndrome vs. sciatica
Sciatica is the term doctors use to describe pain, weakness, numbness, and tingling where the sciatic nerve travels through the leg. It's a symptom, not a condition on its own. Sciatica is the most common symptom of piriformis syndrome.
Sciatica can also happen for other reasons, such as a herniated disk or spinal stenosis (narrowing of the spine). The symptoms of sciatica can affect the lower back and can travel down through the buttocks and leg. When you have piriformis syndrome, the piriformis muscle presses on a specific part of the sciatic nerve, and you tend to feel sciatic nerve pain specifically in your butt.
When you treat piriformis syndrome, you're also treating sciatica.
Piriformis Syndrome Causes
Anything that makes your piriformis muscle press on your sciatic nerve can cause piriformis syndrome. You might get it from:
- Scarring of the muscle tissue
- Muscle spasms
- Tightness in your piriformis muscle
- Bleeding near your piriformis muscle
These causes may happen because of:
- Injury to your hip, butt, or leg
- Overuse of your piriformis muscle
- Lack of warm-up or stretching after you use your piriformis muscle
- Sitting for long periods of time
It's possible to be born with anatomy that causes piriformis syndrome, such as a sciatic nerve that takes an abnormal path through the body or a piriformis muscle with a different shape than normal. Doctors call this primary piriformis syndrome.
Piriformis Syndrome Symptoms
Most of the symptoms of piriformis syndrome are those caused by sciatica. These include:
- Pain, tingling, or numbness in your butt muscle
- A dull ache in your butt muscle
- Pain down the back of your thigh, calf, and foot
- Pain when walking up stairs or hills
- Increased pain after sitting for a long time
The pain is due to the piriformis muscle compressing the sciatic nerve. Most cases of sciatica, however, are not due to piriformis syndrome.
Can piriformis syndrome cause back pain?
Your piriformis muscle runs from your lower back down to the top of your thigh. And it can compress any part of the sciatic nerve it touches. Lower back pain is common when you have it.
Can piriformis syndrome cause hip pain?
It's typical to feel pain in your hip with piriformis syndrome. It can also reduce your range of motion in your hip joint.
Piriformis Syndrome Diagnosis
There isn't a test that can tell doctors if you have piriformis syndrome. The way they diagnose the condition is by taking your symptom history and giving you a physical exam. They may try to recreate the symptoms by having you do specific movements.
Because piriformis syndrome symptoms can be similar to those of other conditions, your doctor may ask you take one or more of the following tests to rule out other causes of sciatic nerve compression, such as a herniated disc:
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Electromyogram (EMG), a test that records electrical activity in muscles
Piriformis Syndrome Treatment
Treating piriformis syndrome typically involves lifestyle changes and medication. Sometimes other procedures--including surgery--are necessary.
Piriformis syndrome medication
Medications that can help treat piriformis syndrome symptoms include:
- Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin, ibuprofen, and naproxen
- Injections with a corticosteroid or anesthetic
- Muscle relaxants
Some doctors recommend botulinum toxin (Botox). The paralytic properties of the drug may relieve muscle tightness and sciatic nerve compression to minimize pain.
Best muscle relaxers for piriformis syndrome
Your doctor will have to prescribe a muscle relaxer; you can’t buy them over the counter. Muscle relaxers come in two types: antispastic and antispasmodic. Your doctor may recommend:
- Baclofen (Lioresal) which is an antispastic muscle relaxer that treats spasms, pain, and stiffness. You take it as a tablet.
- Cyclobenzaprine (Fexmid, Amrix), which is an antispasmodic that blocks nerve impulses to your brain to relieve pain.
Physical therapy is an important part of treating piriformis syndrome. A trained physical therapist can work with you on exercises that strengthen and stretch your muscle to relieve pain. Your PT may recommend cold or heat before and after sessions to help aid healing.
Other therapies such as iontophoresis use a mild electric current to help muscles relax. As a last resort, your doctor may recommend surgery. During surgery, your doctor manually releases your piriformis muscle and decompresses your sciatic nerve.
Piriformis Syndrome Exercises
If you sit for long periods of time each day, get up from your chair regularly and take a walk or stretch to keep your piriformis muscle in good shape. Ideally, you should stretch your muscle every 2-3 hours.
Exercises that help your piriformis muscle stay strong and limber include:
- Water aerobics
- Stationary bike
- Walking or jogging
Piriformis syndrome stretches
You can stretch the piriformis and the muscles around it with specific exercises:
- Lie on your back, then pull one knee toward your chest. Hold it for up to 30 seconds (less if you need to), then do the other leg.
- Stand, bend at your hips, and let your head and hands fall toward the floor to stretch through the back of your legs and butt.
Piriformis syndrome massage
A licensed massage therapist can do deep tissue or myofascial release massage on your piriformis muscle to help it relax and release. Some physical therapists include this in their therapy routine for treating piriformis syndrome.
How to heal piriformis syndrome quickly
Several options can help you ease piriformis syndrome pain in the moment at home.
Start with movement and stretching: Warm up your muscle with heat (a heating pad works, or you can warm it by rubbing your hands on it) and then do stretches you've learned in physical therapy or from your doctor.
You can use a tennis ball or foam roller to target the piriformis muscle and work to release it. Over-the-counter NSAID medications are good for short-term release, too.
Piriformis syndrome exercises to avoid
If your piriformis syndrome is triggered by muscle overuse, don't continue to do the same exercises that cause the pain. Don't exercise or stretch without warming up your muscles first. Avoid heavy lifting unless you are supervised by a trained coach who can be sure you're not making your piriformis pain worse with improper lifting.
Prevention of Piriformis Syndrome
Since piriformis syndrome is usually caused by sports or movement that repeatedly stresses the piriformis muscle, such as running or lunging, prevention is often related to good form. Avoid running or exercising on hills or uneven surfaces. Warm up properly before activity and increase intensity gradually. Use good posture while running, walking, or exercising. If pain occurs, stop the activity and rest until pain subsides. See a health care provider as needed.
Living With Piriformis Syndrome
If sitting or certain activities trigger pain, try to avoid putting yourself in these positions. If you're still for long periods, move on a regular basis. If you are using your piriformis too much (such as with long-distance running), take a break from muscle overuse. Learn massage points to focus on at home, and use heat and ice to relieve symptoms. Take pain relievers and anti-inflammatory medication as needed.
How to sit with piriformis syndrome
Your posture can contribute to piriformis syndrome. Focus on good posture when you're sitting at a desk or table, or when you're driving. This is especially important if you have a desk job and spend hours in a seated position. Try to keep your legs at a 90-degree angle and your feet flat on the floor. Make sure your upper body isn't twisted.
How to sleep with piriformis syndrome
On your back is the best position to sleep in for maximum spine health. You should put a small pillow underneath your knees and one under your neck or head. If you sleep on your side, be sure your hips stay in alignment by putting a pillow between your legs.
When to Go to the Doctor
Tell your doctor if your piriformis syndrome symptoms are affecting your quality of life. If you've already been diagnosed and have started treating your condition and it's not getting better, your doctor will want to know that, too.
If you have new or worsening symptoms, call your doctor. These include:
- Tripping or falling a lot because of pain or numbness.
- Pain that lasts longer than a few weeks, even with proper treatment
- Problems controlling your bowels (pooping) or bladder (peeing)
- Sudden, severe pain in your lower back or leg
- Sudden weakness or numbness in your back or leg
- Injury to your back, hip, or leg
- Trouble picking your foot up off the floor
Piriformis syndrome happens when your piriformis muscle presses on your sciatic nerve. This causes pain, tingling, and numbness in your lower back, hip, and leg. See your doctor for help finding lifestyle changes, exercises, and medication that treat it.
Piriformis Syndrome FAQs
What can be mistaken for piriformis syndrome?
Piriformis syndrome is often confused for sciatica, or pain, weakness, numbness, and tingling where the sciatic nerve travels through the leg. But sciatica is actually a possible symptom of piriformis syndrome.
How do I get my piriformis muscle to release?
To get your piriformis muscle to release, you can try certain stretches, massage, or physical therapy. In some cases, surgery or medication may be necessary. Talk with your health care provider to see which treatments are right for you.