From the Guidelines
Piriformis syndrome should be treated with a combination of conservative measures, including rest, ice or heat therapy, and over-the-counter pain medications, as well as physical therapy focusing on stretching exercises for the piriformis muscle, to alleviate pain, numbness, and tingling in the buttock and down the leg. The condition occurs when the piriformis muscle in the buttock compresses the sciatic nerve, and treatment typically begins with these conservative measures, including ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks 1. Physical therapy is crucial, focusing on stretching exercises for the piriformis muscle, such as the figure-four stretch and piriformis-specific stretches, performed 2-3 times daily with 30-second holds. Massage therapy can help relieve muscle tension, and for persistent cases, a healthcare provider may recommend muscle relaxants like cyclobenzaprine (5-10mg three times daily) for short-term use, or corticosteroid injections directly into the piriformis muscle 1.
Some key points to consider in the treatment of piriformis syndrome include:
- The use of interventions such as acupressure, acupuncture, and spinal manipulation may be considered, but the evidence for their effectiveness is limited 1
- Proper posture, regular stretching, and avoiding prolonged sitting can help prevent recurrence
- Surgery is rarely needed but may be considered for severe cases unresponsive to other treatments
- The condition can be caused by overuse, trauma, or biomechanical issues, putting pressure on the sciatic nerve that runs beneath or sometimes through the muscle
In terms of diagnosis, piriformis syndrome can be identified by symptoms such as pain, numbness, and tingling in the buttock and down the leg, and can be confirmed by a physical examination and imaging tests if necessary. The straight-leg-raise test can be used to elicit symptoms suggesting nerve root tension, and a positive test is usually considered reproduction of the patient’s sciatica when the leg is raised between 30 and 70 degrees 1.
Overall, the goal of treatment for piriformis syndrome is to alleviate pain, numbness, and tingling in the buttock and down the leg, and to improve quality of life, and a combination of conservative measures and physical therapy is usually the most effective approach.
From the Research
Definition and Symptoms of Piriformis Syndrome
- Piriformis syndrome is a condition that causes sciatica, characterized by buttock pain referred to the leg 2
- The symptoms of piriformis syndrome can be difficult to diagnose due to the lack of validated and standardized diagnostic tests 2
Treatment Options for Piriformis Syndrome
- Conventional treatments for piriformis syndrome include physical therapy, piriformis injections, and caudal epidural steroid injections 3
- For refractory cases, surgical release of the piriformis muscle has been described, but it can be accompanied by morbidity 3
- Perisciatic injection of steroid is another approach to treating piriformis syndrome, which has shown promising results in patients who did not respond to conventional treatments 3
- Botulinum toxin (BTX) has also been used to treat piriformis syndrome, aiming to relieve sciatic nerve compression and inherent muscle pain from a tight piriformis 2
- BTX has demonstrated superior efficacy to corticosteroid injection in some studies, and its use is being increasingly considered for myofascial pain syndromes 2