From the Research
Piriformis syndrome typically presents with pain in the buttock that may radiate down the back of the leg along the sciatic nerve pathway, and the most effective treatment approach is often a combination of conservative measures such as rest, physical therapy, and sometimes muscle relaxants for acute spasms, as supported by the most recent and highest quality study 1.
Symptoms of Piriformis Syndrome
The symptoms of piriformis syndrome include:
- A dull ache or sharp pain in the buttock
- Pain that worsens with prolonged sitting, climbing stairs, or activities that involve hip rotation
- Discomfort when applying direct pressure to the piriformis muscle
- Numbness, tingling, or burning sensations down the leg, similar to sciatica
- Difficulty sitting comfortably or walking normally due to pain
Diagnosis and Treatment
Diagnosis typically involves physical examination, including specific tests like the FAIR test (Flexion, Adduction, and Internal Rotation), which reproduces symptoms by stretching the piriformis muscle, as described in 2. Treatment usually begins with conservative measures, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be considered, although the evidence for their efficacy in pain reduction is very low, as reported in 3 and 1.
Key Considerations
It is essential to note that the quality of evidence for the efficacy of NSAIDs in treating piriformis syndrome is very low, and their use should be carefully considered, weighing the potential benefits against the risks of adverse effects, as highlighted in 1. In clinical practice, a conservative approach, focusing on physical therapy, rest, and sometimes muscle relaxants, is often the most effective and safest initial treatment strategy for piriformis syndrome, as implied by the findings of 4 and 2.