Piriformis Pain - What Are the Causes, Symptoms and Available Treatments?

spinal stenosis

Piriformis pain is the pain due to Piriformis Syndrome which is apparent in around 10 to 15% of hip and lower back pain patients. Unlike nerve impingement issues like sciatica, stenosed spinal foramen and canal, and spinal abnormalities like scoliosis, lordosis, and kyphosis, Piriformis Syndrome is a neuromuscular disorder.

The Development. Generally, the sciatic nerve should pass underneath the piriformis muscle though for some lower back pain patients, it goes directly through the muscle which brings about pain when the muscle contracts and suffocates the nerve.

The issue can be further irritated when sitting for extended periods of time since the gluteal muscles remain inactive. Flexion of the hips leads to overactivity in the psoas major, iliacus and rectus femoris muscles at the cost of the gluteals, like the gluteus minimus and the obturator internus. As a result of this, the hamstrings, adductor magnus, and the piriformis, which are the synergist muscles of the gluteals, will have to perform a lot harder which they shouldn't. This disease mechanism induces the piriformis to hypertrophy resulting in pain.

The Symptoms. Known by extreme pain in the gluteal, piriformis pain may expand down to the leg. Certain exercises like running, walking, bicycling, and rowing may lead to pain. If pain is eased by walking with the foot of the impacted side directed outward and if pain is experienced when sitting in an awkward placement, Piriformis Syndrome should be assumed.

The Diagnosis. Piriformis pain is identified clinically by stretching the irritated piriformis muscle and causing sciatic nerve compression through physical exam procedures like the Race and Freiberg maneuvers. Imaging procedures are only utilized to exclude other disorders, such as herniated discs, spinal stenosis, facet arthropathy, and lumbar muscle strain. The MRN or the Magnetic Resonance Neurography is the only imaging technique that can discover Piriformis Syndrome. The presence of the inflammed sciatic nerve where it passes through the muscle can be visualized.

The Treatment. There are obviously, numerous traditional treatments that are shown useful in relieving piriformis pain. These treatments are:

• NSAIDs and/or muscle relaxants


• Stretches and other gentle workout routines


• Therapeutic massage


• Cold compresses at the onset of pain followed afterwards by hot compresses


• Osteopathic and chiropractic manipulation

Shots of anti-inflammatory drugs and/or steroids, local anesthetics (such as lidocaine), botulinum toxin (BOTOX), or a combination of the three may be provided if traditional treatments are unsuccessful. Although surgery is rarely suggested, the latest procedures of minimally-invasive surgery have been proven successful in freeing the entrapped sciatic nerve from the piriformis muscle. All of these procedures help in relieving piriformis pain.