From the Guidelines
Piriformis syndrome is characterized by pain in the buttock and hip area that may radiate down the leg, often mimicking sciatica, and its symptoms and treatment options should be approached with a focus on relieving compression on the sciatic nerve. The symptoms of piriformis syndrome include deep aching pain in the buttock, pain that worsens with sitting or activities like climbing stairs, and sometimes numbness or tingling along the sciatic nerve pathway 1.
Common Symptoms
- Deep aching pain in the buttock
- Pain that worsens with sitting or activities like climbing stairs
- Numbness or tingling along the sciatic nerve pathway
Treatment Options
Treatment typically begins with conservative approaches including:
- Rest
- Physical therapy focusing on stretching and strengthening the piriformis muscle
- Over-the-counter pain medications such as ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily)
- For more severe cases, a healthcare provider may recommend muscle relaxants like cyclobenzaprine (5-10mg three times daily for 1-2 weeks) or injections of corticosteroids or botulinum toxin directly into the piriformis muscle
- Heat or ice therapy can provide temporary relief
- Lifestyle modifications such as avoiding prolonged sitting and using proper posture are important
- In rare cases where conservative treatments fail, surgical release of the piriformis muscle may be considered, as noted in the context of lumbosacral plexopathy and entrapment neuropathies 1.
The syndrome occurs when the piriformis muscle, located deep in the buttock, compresses or irritates the sciatic nerve, often due to muscle spasm, injury, or anatomical variations where the sciatic nerve runs through the muscle rather than beneath it, which can be detected and managed with appropriate imaging and clinical evaluation 1.
From the Research
Symptoms of Pyriformis Syndrome
- Tingling, numbness, and pain are most often felt by patients when they have compression of any of the nerves 2
- Sciatica, buttock pain, and worse pain with sitting are common symptoms of piriformis syndrome 3
- Patients typically have normal neurological examination results and negative straight leg raising test results 3
- Flexion, adduction, and internal rotation of the hip, Freiberg sign, Pace sign, and direct palpation of the piriformis cause pain and may reproduce symptoms 3
Treatment Options for Pyriformis Syndrome
- Physiotherapy techniques such as nerve mobilization, stretching, myofascial release, and deep friction massage have been found to be effective in managing piriformis syndrome 2
- Injection of local anesthetics, steroids, and botulinum toxin into the piriformis muscle can serve both diagnostic and therapeutic purposes 4, 5
- Ultrasound-guided injection technique offers improved accuracy in locating the piriformis muscle 4
- Corticosteroid and botulinum toxin injections may be attempted for recalcitrant cases 3
- Piriformis tenotomy and decompression of the sciatic nerve can be done for those who do not respond to conservative treatment 3
- CT-guided percutaneous botulinic toxin injection is a feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation 6