What is piriformis syndrome?

Piriformis syndrome is a painful condition where the piriformis muscles, which are located in the buttocks, spasm and cause pain. Piriformis muscle spasms can also irritate the nearby sciatic nerve and cause numbness, tingling and pain along the back of the leg and into the foot.

Piriformis syndrome is a severely under-diagnosed problem occurring when the nerves become compressed between the bony inferior rim of the greater sciatic notch of the pelvis and the overlying piriformis muscle. The structures traveling through this relatively tight space include both the piriformis muscle and the 5 nerve roots that make up the sciatic nerve.

What causes piriformis syndrome?  

Piriformis syndrome can be caused by a number of factors including injury and repetitive stress injuries.

Any type of injury involving blunt trauma to the buttocks, forceful flexing of the hip joint or significant traction to the leg can lead to piriformis syndrome. This can happen during slip and fall injuries, car accidents, surgeries to replace the hip or knee, or crush injuries to the pelvis. Often, the injury occurs to the piriformis muscle itself, leading to swelling, bleeding, and scarring of the tissue around the sciatic nerve. This can lead to the piriformis muscle applying pressure to the sciatic nerve, as well as scarring or tethering of the nerves which can prevent the nerves from being able to glide against surrounding tissue with the motion of the body.

Typical causes of piriformis syndrome include:

  • Falls
  • Car accidents
  • Overuse from running or excessive exercise
  • Sedentary lifestyle
  • Long periods of sitting
  • Sudden change from a sedentary lifestyle to extreme exercise
  • Wasting away of the buttocks muscles

Where is the piriformis muscle and what does it do?

The piriformis muscle is buried deep in the buttocks behind the larger gluteus maximus. The piriformis muscle originates on the anterior surface of the sacrum and attaches to the femur. The job of piriformis muscle is to help externally rotate the hip when walking or running and help abduct the thigh in a seated position.

Symptoms of piriformis syndrome

Piriformis syndrome can produce a whole array of clinical symptoms that can mimic other common spine or orthopedic conditions which involve the low back, pelvis, hips, and legs. Patients often undergo unnecessary spine surgery or orthopedic procedures, including total hip replacement surgery, trying to address the symptoms of undiagnosed piriformis syndrome, to no avail.

In general, patients who are suffering from piriformis syndrome tend to feel acute tenderness in the buttocks and sciatic-like pain down the back of the leg and into the foot.

Piriformis syndrome symptoms may include:

  • Low back pain or sacral pain
  • Buttock pain
  • Pain down the back of the thigh, calf and foot (sciatica)
  • Increased pain with sitting

Diagnosing Piriformis Syndrome

Unfortunately, there is no simple diagnostic test that can diagnose piriformis syndrome. Piriformis syndrome can present as anything from isolated pain in the deep buttock to pain that radiates all the way from the low back down into the foot, and anything in between. Most commonly, the symptoms of piriformis syndrome are characterized as “sciatica,” with pain in the buttock that radiates down into the back of the thigh. Patients with piriformis syndrome commonly complain that sitting significantly increases their pain level.

Two patients with the same underlying problem, piriformis syndrome, can present with very different clinical pictures. Diagnosing piriformis syndrome accurately requires taking a careful patient history as well as conducting a detailed lower extremity peripheral nerve examination. MRI imaging of the lumbar spine is critical in order to rule out spinal pathology as the primary or a contributing source of the symptoms. MR Neurography of the pelvis and diagnostic injections into the piriformis muscle can also be useful in confirming the diagnosis.

Surgery for Piriformis Syndrome

Treatment for piriformis syndrome depends on the severity and duration of the symptoms. Mild or acute cases may resolve with physical therapy, steroid injections targeting the piriformis muscle, and medication. For more severe cases or in instances where the symptoms have been present for a long time, surgical decompression is the only real way for the patient to experience excellent, lasting relief from the pain.

Surgery essentially involves removal of the entire piriformis muscle, as well as removing any scar tissue or other structures that might be pressing on the sciatic nerve in the deep posterior buttock area. There are several redundant muscles in the deep posterior pelvis that act synergistically with the piriformis muscle. Therefore, removal of the piriformis muscle does not result in any discernible difference of ability to move the affected leg. In other words, patients never realize the piriformis muscle is gone after surgery.

Recovery from piriformis syndrome surgery

Piriformis syndrome surgery is surprisingly easy for the patient in terms of post-op recovery. Piriformis surgery is done in an outpatient setting. The patient is immediately able to tolerate weight bearing movements on the operated side, and there is usually only mild to moderate pain after the surgery. The pain from surgery typically lasts from a few days to no more than about one to two weeks for most patients. Patients typically have significant early relief from the original pain and are able to return to a normal activity or exercise routine within four weeks from the date of surgery.

Video – Piriformis Surgery in Action

In this fascinating video, Dr. Tim Tollestrup takes you into his operating room to show the difference between Piriformis Release and Piriformis Removal surgery. His patient Kasey had debilitating sciatica pain. Watch how Dr. Tollestrup received his problem. Warning: This is an inter-operative video, so it is graphic.

Patient Stories – Piriformis Syndrome

Watch How Jose Overcame Piriformis Syndrome

Fredericks Story – Frederick suffered from debilitating sciatic pain that required daily narcotic medication. He was in pain from the moment he woke up in the morning until he went to bed at night. Since his piriformis syndrome surgery, his pain is 100% gone.

Diane D – Diane had been suffering from nerve pain for more than 20 years. She had never had any physical trauma or injuries that would explain why she experienced intense pain that radiated from her buttocks to her feet in both legs. With nerve decompression surgery, she is now pain free.

Thomas S – As an active outdoorsman, Thomas’ piriformis pain was keeping him from enjoying the activities he loved. When he finally had to quit skiing, he knew something had to be done. Today, Thomas is pain free and on the slopes again thanks to Dr. Tollestrup.

Sharon W – Sharon suffered from severe, chronic sciatica pain for five years before finally seeing Dr. Tollestrup. She could no longer take long walks or ride her bike, activities she loved. After Dr. Tollestrup performed piriformis surgery, she’s back to enjoying her life again.

Cindy Z – Cindy was in constant pain after she slipped an fell a few years ago. What started as a couple of bruises degenerated into terrible pain that kept her from walking and send her to the ER. After Dr. Tollestrup removed her piriformis muscle, she is now 100% pain free.

FAQs

What is piriformis syndrome?

Piriformis syndrome is a painful condition caused when pathology involving the piriformis muscle results in compression or irritation of the sciatic nerve.

Can piriformis syndrome cause hamstring pain?

Piriformis syndrome can cause pain all down the back of your legs and into your feet, which can present as hamstring pain. If you’re experiencing hamstring pain that lasts last for a long time or doesn’t respond to traditional hamstring stretching and strengthening programs, talk to your doctor. You may be experiencing piriformis pain.

The Tollestrup Team Can Help

Dr. Tim Tollestrup and his team can help. Call us at 702-666-0463 or fill out the form on this page to set up a consultation to determine your options.