The higher rate of diagnosis among women may be explained by the difference in biomechanics in men’s and women’s pelvises. Women may also develop piriformis syndrome during pregnancy. Because the pelvis widens during pregnancy, it can cause the attached muscles to contract. [3] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source Pregnant women also often develop a pelvic tilt to accommodate the baby’s weight, which can also lead the attached muscles to become tight.
About 15% of cases are due to a congenital or structural anomaly concerning the relationship between the piriformis muscle and the sciatic nerve.
A macrotrauma is caused by a significant traumatic event, such as a fall or a car accident. Macro-trauma to the buttocks, which leads to inflammation of the soft tissue, muscle spasms, and nerve compression, is a common cause of piriformis syndrome. A microtrauma is a pattern of repeated minor injury to an area. For example, long-distance runners expose their legs to constant micro-trauma, which can eventually cause nerve inflammation and muscle spasm. Running, walking, climbing stairs, or even sitting for long periods of time can cause your piriformis muscle to compress and entrap the sciatic nerve, causing pain. Another form of microtrauma that may cause piriformis syndrome is “wallet neuritis. ” This condition can occur when a person carries a wallet (or cellphone) in his back pocket, which can press against the sciatic nerve, causing irritation.
Pain radiating down the back of your thigh, and sometimes into the back of the calf and into the foot. [7] X Expert Source Karen Litzy, PT, DPTPhysical Therapist Expert Interview. 27 August 2020. Pain when you touch the back of your buttocks. [8] X Expert Source Karen Litzy, PT, DPTPhysical Therapist Expert Interview. 27 August 2020. Tightness in your buttocks. [9] X Expert Source Karen Litzy, PT, DPTPhysical Therapist Expert Interview. 27 August 2020. Increased pain when you rotate your hip. [10] X Expert Source Karen Litzy, PT, DPTPhysical Therapist Expert Interview. 27 August 2020. Pain that improves when you move around and gets worse when you sit still. Pain that is not completely relieved by a change of position. Groin and pelvic pain. This may include pain in the labia for women and pain in the scrotum for men. Dyspareunia (painful sexual intercourse) in women. Painful bowel movements.
Antalgic gait, which means a gait that develops to avoid pain. This usually leads to limping or shortening your gait to keep from feeling pain. Foot drop, which is when your forefoot drops without your control because of pain in your lower leg. You may not be able to pull the foot up towards your face.
These sensations, or “paraesthesias,” may present as “pins and needles,” numbness, or tingling.
You may need to see your primary care physician first to ask for a referral to a specialist.
Some tests, such as a MRI, CT scan, or nerve conduction study, may be used to rule out other conditions such as a herniated disc. [13] X Trustworthy Source FamilyDoctor. org Family-focused medical advice site run by the American Academy of Family Doctors Go to source
The Lasègue sign: Your doctor will ask you to lie on your back, flex your hip at a 90 degree angle, and extend your knee straight out. A positive Lasègue sign means that pressure on the piriformis muscle while you are in this position causes you pain. The Freiberg Sign: In this test, your doctor will internally rotate and lift your leg while you lie flat on your back. Pain in your buttocks when doing this movement may indicate piriformis syndrome. The Pace Sign: In this test, you will lie on the unaffected side. Your doctor will flex your hip and knee, then rotate your hip while press down on your knee. If you feel pain, you may have piriformis syndrome. Your doctor may also “palpate” (examine with the fingers) your greater sciatic notch, a notch in one of your pelvic bones through which the piriformis muscle passes.
Your doctor can also palpate your gluteus (the largest muscle in your buttocks) to determine the condition of the piriformis muscle. When the muscle is very tight and contracted, it can feel like a sausage. Your doctor will also check the amount of pain you experience from pressure on your gluteus muscle. If you experience pain or tenderness deep in the buttocks or hip region, this is a sign that your piriformis muscle is contracted. Your doctor will likely check for gluteal atrophy (shrinkage of the muscle). In chronic cases of piriformis syndrome, the muscle begins to wither and shrink. This can be seen in visual asymmetry, where the affected buttock is smaller than the unaffected buttock.
A CT scan uses computer processes with x-rays to create 3D views of the inside of your body. This is achieved by taking cross-section views of your spine. A CT scan may help identify whether there are abnormalities near the piriformis muscle and can track any arthritic changes. [18] X Research source An MRI uses radio waves and strong magnetic fields to create images of the inside of your body. An MRI can rule out other causes of low back pain or sciatic nerve pain.
A nerve conduction study will use electrodes taped to your skin to evaluate your motor neurons. A needle electrode exam will use a small needle inserted into your muscles to evaluate your muscles’ electrical activity.
If your pain is caused by the pressure from sitting for long periods of time, take regular breaks to get up and stretch. Doctors recommend that you get up, walk around, and lightly stretch every 20 minutes. If you are driving for long periods of time, take frequent breaks to stand and stretch. Avoid sitting or standing in the positions that cause pain.
Your physical therapist will probably guide you through a series of stretches, flexion, adduction, and rotation exercises. Soft-tissue massage of the gluteal and lumbosacral regions may also help relieve irritation.
Because alternative medicine practices generally have not been scientifically researched to the same degree as more conventional medical approaches, you may want to consider discussing these methods with your doctor before beginning treatment. [24] X Research source
Seek a health professional that has training in trigger point therapy, such as a massage therapist, chiropractor, physical therapist or even a physician. If trigger points are the cause, a combination of acupressure, stretching and strengthening exercises will often be recommended.
Roll side to side while lying down. Flex and extend the knees while you are lying on each side. Repeat, alternating sides, for five minutes. Stand with your arms relaxed at your sides. Rotate side to side for one minute. Repeat every few hours. Lie flat on your back. Raise your hips with your hands and pedal your legs as though you were riding a bicycle. Do knee bends six times every few hours. You can use a countertop or chair for support if necessary.
To apply heat, try using a heating pad, or place a damp towel in the microwave for a few seconds before applying it to the area. You can also take a warm bath, which can help relieve the tension and irritation of piriformis syndrome. Allow your body to be buoyant in the water. To apply cold, use ice wrapped in a towel or a cold pack. Do not apply the ice or cold pack for more than 20 minutes.
Common NSAIDs include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). Ask your doctor before using NSAIDs. They may interact with other medications or medical conditions. If NSAIDs do not provide sufficient relief, your doctor may prescribe muscle relaxants. Use these as directed. [30] X Research source
Anesthetic injections, which commonly include lidocaine or bupivacaine injected directly into the trigger point, are successful in approximately 85% of cases in conjunction with physical therapy. [32] X Research source If local anesthetics do not relieve your pain, your doctor may recommend an injection of steroids or botulinum toxin type A (botox), both of which have been shown to relieve muscle pain. [33] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source
Surgical decompression of the piriformis muscle is only effective when neurologic deficits are present. The doctor will use electromyography and other tests to determine whether compressive neuropathy surgery, which will release the sciatic nerve, is necessary to relieve your pain. [35] X Research source
