If you’ve been suffering from painful muscle spasms in your buttocks or sciatic-like pain in your legs, you may have heard of piriformis syndrome. This painful condition is diagnosed in about 200,000 people every year in the United States. If you’ve been experiencing the symptoms listed above, you may be one of them.
What is piriformis syndrome?
Piriformis syndrome is a painful condition affecting the piriformis muscles of the buttocks. In piriformis syndrome, these muscles spasm and cause pain. These muscle spasms can also irritate the nearby sciatic nerve and cause tingling, numbness and pain that travels along the back of the affected leg and into the foot.
What is the piriformis muscle?
You have two piriformis muscles, one on each leg. The piriformis muscle originates on the back of the sacrum, which is the very end of your spine located in the center of the pelvis. The piriformis muscle attaches to the very top of your femur, the large bone of your thigh. The piriformis muscles’ job is to help externally rotate the hip when you’re walking or running, and move your leg away from your body, such as when you step to one side or sit down.
What causes piriformis syndrome?
Your piriformis muscles connect the top of your femur to your sacrum. At your pelvis, the piriformis muscle, your sciatic nerve, and your pelvis bone intersect. If your body was a highway, this would be a traffic jam. All those parts stuck in such close quarters, along with the consistent movement of your legs and pelvis, make this intersection ripe for problems with inflammation and nerve pain. Piriformis syndrome happens when the nerve in that intersection becomes compressed between the pelvis bone and the overlying piriformis muscle.
This compression of the sciatic nerve between the bone and the piriformis muscle can be caused by a number of factors including injury and overuse. Any trauma to the buttocks or forceful flexing of the hip joints can lead to piriformis syndrome.
When an injury happens to the piriformis muscle, swelling, bleeding, and scarring follow. All of these can put pressure on the sciatic nerve. In addition, scar tissue can develop around the sciatic nerve, which can prevent it from gliding properly against surrounding tissue during movement. All of these factors combined can lead to compression of the sciatic nerve and cause or piriformis syndrome.
Common incidents that can lead to piriformis syndrome include:
Overuse – This condition is common in runners
Underuse – Sedentary lifestyle contributes to inflammation
Sitting too much – Like office workers or truck drivers
Surgery – Such as a hip or knee replacement
Wasting away of the buttocks muscles – As in those with paralysis
Symptoms of Piriformis Syndrome
Piriformis syndrome can be difficult for doctors to diagnose because its symptoms can mimic a variety of other medical conditions of the hips, legs, pelvis, and lower back. Unfortunately, some patients with undiagnosed piriformis syndrome even undergo unnecessary surgeries like total hip replacements in an effort to find relief for their symptoms.
It’s critical that if you are experiencing the symptoms listed below, you consult with a doctor who is an expert in piriformis syndrome. It’s important to rule out piriformis syndrome as the cause of your symptoms before undergoing surgery for another condition.
Symptoms of piriformis syndrome include:
Acute tenderness in the buttocks
Pain that runs down the back of the leg and into the foot
Lower back pain
Increased pain with sitting
How is piriformis diagnosed?
Diagnosis of piriformis syndrome can be tough, as it can present as a wide variety of symptoms that mimic other conditions. The most common misdiagnosis for piriformis syndrome is sciatica. The two conditions present almost identically and are in fact quite similar – causing pain in the buttocks and down the leg into the foot. But the difference is that sciatica is caused by a herniated disc or bone spur of the spine, and piriformis syndrome is caused by the sciatic nerve being compressed slightly further down by the piriformis muscle.
Diagnosing piriformis syndrome requires conducting a thorough examination of the peripheral nerves of the lower extremities. Your doctor will likely order an MRI of your lumbar spine to see if your symptoms are caused by a herniated disc, bone spur, or other pathology of the spine. You may also undergo MR Neurography, which is like an MRI of your peripheral nerves. Diagnostic injections into your piriformis muscle may also be used to help with diagnosis.
Treatment for Piriformis Syndrome
If your piriformis syndrome symptoms are on the mild side, you may be able to relieve them with physical therapy and medication. If your symptoms are more severe or have been going on for a long time, surgery may be the best treatment option for you.
Dr. Tim Tollestrup has pioneered a procedure that permanently eliminates piriformis pain! Surgery involves removing the affected piriformis muscle, which alleviates the pressure on your sciatic nerve that is causing your symptoms. If you have any scar tissue surrounding the area of your sciatic nerve, that will be removed, too. This is a permanent solution that completely eliminates the pain and discomfort you’ve been experiencing, and there’s no way for the pain to return since the piriformis muscle cannot grow back.
Will piriformis surgery change the way I walk?
Your piriformis muscles are part of a synergistic system of muscles in your buttocks that help you walk, jump, run, lift and dance. Removing your piriformis muscles will not affect the way you move, because there are so many other muscles in that area that will pick up the slack. The only difference you’ll notice after surgery is that your pain is gone and you’re back to your old self again!
Recovering from piriformis syndrome surgery
As far as recovery, surgery for piriformis syndrome is relatively easy post-op. Surgery is outpatient, so you’ll be home the same day. You will be able to put weight on the affected leg right away with only mild or moderate pain. Of course, you’ll have pain medication to help you as you heal. Pain from surgery lasts as little as a few days to as much as two weeks, depending on factors unique to you. You can expect to return to your normal level of activity in four to six weeks.
The Tollestrup Team Can Help
Suffering from what you believe is piriformis pain? 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.