Piriformis Syndrome

How does a diagnosis of piriformis syndrome differ from sciatica?

If we are lucky, we are familiar with sciatica because we have heard friends or family members complain about the sensation that radiates from the lower back all the way down the leg. It can be experienced as a “pins and needles” sort of tingling all the way to severe shooting pain.  Unfortunately, sciatica is estimated to affect up to 40 percent of the population at some point, so there’s a good chance that we have firsthand knowledge.

Actually, the more correct term would be “experience” instead of “knowledge”. Most people refer to sciatica as a distinct diagnosis, but it’s not. Sciatica is a symptom. In the majority of cases, the pain that is experienced along the sciatic nerve, which runs all the way from the lower back down to the foot, is caused by a herniated disc. There are other conditions that can produce similar sciatic symptoms, such as disc degeneration, small stress fractures that allow one vertebrae to slip forward onto another, narrowing of the spinal column and irritation of the sacroiliac joint, which is located at the bottom of the spine.

Is Piriformis Syndrome a Cause for Sciatica Pain?

Should piriformis syndrome be included in the list of conditions that cause sciatic pain? Technically, the answer is “no”.  This is not a true lumbar radiculopathy, which is actual nerve dysfunction and the clinical definition of sciatica. The piriformis muscle is a small stabilizing muscle located deep within the buttocks. Its main function is to stabilize the pelvis during motion and is especially called into play during running and jogging. It runs very close to the sciatic nerve, however, and when it is irritated, the resulting leg pain can feel the same as sciatica.

Even for those familiar with piriformis syndrome, diagnosis can be tricky. It is often mistaken for a herniated disc, a hamstring injury or lower back issue. Some things to look for are pain while sitting, squatting and climbing stairs rather than when actually running; the area is uncomfortable or painful when pressed, not only at the point of injury but also down the leg and the pain is centered in the middle of the glutes.

Causes of Piriformis Syndrome

  • Excessive sitting
  • Inadequate warm-up before activity
  • Inherent weakness in piriformis muscle
  • Pelvic misalignment

Piriformis syndrome is somewhat different than other conditions in that the pain is not necessarily experienced while doing activities that can worsen it. Runners can actually run long distances without realizing the added damage they are causing, which will only prolong the time it will take to heal.

Treating Piriformis Syndrome

The goal in treating piriformis syndrome is to loosen and relax the piriformis muscle. Simple resting is often not enough. As with any condition that may be the result of a more serious underlying cause, it is important to consult a healthcare professional as soon as possible. In this case, the recommendations may include:

  • Massage
  • Stretching
  • Ice
  • Medication – limited use of over-the-counter anti-inflammatory drugs
  • Ultrasound guided trigger point injection to the piriformis or neighboring gluteal musculature
  • Testing – for leg-length discrepancy and muscle-strength imbalances
  • Orthotics

At Long Island Spine Rehabilitation Medicine, our physicians are committed to more than just treating your symptoms. We focus on finding the underlying cause and providing non-surgical, evidenced based solutions tailored to your specific condition and needs. If you have questions or are experiencing any sort of lower back or leg pain, we invite you to schedule a consultation by simply calling (516) 268-0070 or using our convenient online form by clicking here.