From the Research
Piriformis syndrome cannot be synthesized from articles in 2025 as the current year is 2025 and no articles from this year are provided, however, based on the most recent evidence from 2021, piriformis syndrome is a clinical diagnosis that often involves a multimodal approach to treatment, including physical therapy, NSAIDs, muscle relaxants, and in some cases, corticosteroid or botulinum toxin injections into the piriformis muscle 1.
Overview of Piriformis Syndrome
Piriformis syndrome is a neuromuscular condition characterized by buttock pain and sometimes sciatica-like symptoms caused by compression or irritation of the sciatic nerve by the piriformis muscle.
- The condition occurs when the piriformis muscle, which runs from the sacrum to the greater trochanter of the femur, compresses the sciatic nerve either through muscle spasm, hypertrophy, or anatomical variations where the nerve passes through the muscle rather than beneath it.
- Proper diagnosis typically requires ruling out other causes of sciatica such as herniated discs or spinal stenosis.
Treatment Options
Current treatment typically involves a multimodal approach including:
- Physical therapy focusing on piriformis stretching and strengthening of surrounding muscles
- NSAIDs like ibuprofen (400-800mg three times daily) for pain and inflammation
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) for acute spasm
- In some cases, corticosteroid or botulinum toxin injections into the piriformis muscle Conservative management is usually tried for 4-6 weeks before considering more invasive options, such as endoscopic release, which has been shown to be effective in patients who do not respond to conservative treatment 1.
Diagnosis and Management
Diagnosis of piriformis syndrome is primarily clinical, and there is no definitive proof of its existence despite reported series with large numbers of patients 2.
- Electrophysiological testing and nerve blocks play important roles when the diagnosis is uncertain.
- Injection of local anesthetics, steroids, and botulinum toxin into the piriformis muscle can serve both diagnostic and therapeutic purposes.
- An ultrasound-guided injection technique offers improved accuracy in locating the piriformis muscle. The most effective treatment approach for piriformis syndrome is a multimodal one, incorporating physical therapy, medication, and in some cases, injections, with surgical options reserved for those who do not respond to conservative management 1.