Piriformis syndrome is a condition that contributes to sciatica, nerve irritation that causes pain from the lower back down the leg. Also known as wallet sciatica, piriformis syndrome can result from repeatedly sitting down with a wallet in the back pocket! It may also arise from injury or issues with anatomical structure. Signs of piriformis syndrome include pain, numbness, and tingling. Read on to learn more about treating and preventing piriformis syndrome.
Piriformis syndrome is an uncommon neuromuscular disorder.
The piriformis muscle is situated in the upper buttocks, near the hip joint. This muscle plays an essential role in our mobility because it stabilizes the hip and allows the thigh to rotate outward. This motion (abduction) enables us to move our weight from one foot to the other, which stops us falling over.
When this muscle spasms and presses on the sciatic nerve, causing sciatica, it is known as piriformis syndrome. Pain and numbness are the most common symptoms associated with the condition. If symptoms affect both sides of the buttocks, it’s referred to as bilateral piriformis syndrome.
Piriformis Syndrome vs. Sciatica
When the piriformis nerve spasms or moves, it can press down on the sciatic nerve in some people. This leads to sciatic pain—a type of referred pain that starts in the buttocks and moves down the legs.
Not everyone is at equal risk of piriformis syndrome, however because the sciatic nerve doesn’t always pass through the piriformis muscle. In fact, only seventeen percent of the population are built like this. People in this subgroup are at higher risk of piriformis syndrome. Other people can develop the condition if the piriformis muscle and the sciatic nerve are very close together.
Piriformis Syndrome Causes and Risk Factors
Piriformis muscle syndrome occurs when this muscle spasms. Because we use this muscle every day—when walking, running, or even rotating the lower body—it can easily get injured.
You may experience a spasm in the piriformis muscle due to:
Long periods of inactivity
Too much exercise resulting in overuse of the muscle
Lifting heavy items
Repeatedly climbing stairs or other inclines
Direct trauma or injury to the gluteal muscle can also cause piriformis syndrome. You might sustain an injury if you:
Suddenly twist your hip
Fall or slip
Are involved in a car accident
Receive a penetrating wound that hits the muscle
Collide with another player or object during contact sports
Piriformis Syndrome Symptoms
Piriformis syndrome by itself doesn’t cause many symptoms. Instead, it irritates the sciatic nerve, which causes several symptoms including:
Pain that travels from the buttocks down through the legs
Difficulty finding a comfortable way to sit
For people with piriformis syndrome, sitting down for too long makes symptoms worse, but so does too much movement. This can make everyday tasks more challenging, especially for those with severe piriformis syndrome that causes disabling pain.
Piriformis Syndrome Diagnosis
If you have pain or numbness in your legs, buttocks, or back for more than two weeks, see your doctor for a diagnosis.
While there is no definitive piriformis syndrome test, your doctor will probably base a diagnosis on your description of your symptoms and a physical examination. They will ask you to move about in a variety of ways to check for pain and tenderness.
They may also order imaging tests, including:
Piriformis Syndrome MRI. An MRI scan shows up soft tissue damage in the body. This scan may help your doctor determine whether other conditions, such as arthritis or a herniated disk, are responsible for the pain.
Piriformis Syndrome Ultrasound. An ultrasound uses sound waves to show images on a screen. It may help confirm a diagnosis of piriformis syndrome.
Piriformis Syndrome Treatment
If you’re wondering how to heal piriformis syndrome quickly, you should know that there’s no instant cure. However, several home remedies can alleviate symptoms within a few days. For best results, use a variety of approaches and seek medical advice if symptoms don’t resolve within two weeks.
The best treatments for piriformis syndrome include:
Rest and Activity Modification
The first step in reducing piriformis syndrome signs and symptoms is to rest and avoid activities that trigger the condition. For most people with piriformis syndrome, running should be avoided until symptoms go away. If sciatica pain returns when you resume running, you may need to work on your form.
Using hot and cold therapy on the buttocks and legs can alleviate pain and numbness, at least in the short term. Wrap ice in a thin towel or use an ice pack and apply it to the affected area for fifteen minutes. Then, apply a heating pad for another fifteen minutes. Repeat this process several times daily until symptoms subside.
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Some over-the-counter painkillers, including ibuprofen (Advil) and naproxen (Aleve), offer quick relief from mild symptoms. If you have more severe pain, you may need to ask your doctor for a corticosteroid shot or a muscle relaxer for piriformis syndrome.
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Transcutaneous electrical nerve stimulation, or TENS therapy, sends electrical pulses through the skin. These impulses alter nerve signals and reduce the pain associated with sciatica. Get a TENS device for home use to enjoy rapid piriformis syndrome relief. As this treatment isn’t suitable for everyone, we recommend speaking with your doctor before trying TENS at home.
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Massage is a fantastic way to reduce muscle spasms and trigger points in the buttocks and legs. To target trigger points in the piriformis muscle, use massage balls. Lie down on the floor or other firm surface. Place a massage ball under the buttocks. With your legs bent, roll around on the ball until it moves toward the hip joint. Then, drop your bent knee to the side. You should feel the tight piriformis muscle. Leave the ball in place until you feel the muscle release.
Piriformis Syndrome Exercises
Exercises can gently stretch and strengthen the piriformis, along with other supporting muscles in the buttocks and legs.
The best piriformis syndrome stretches include:
Lie on your back and bend your knees. Move the outer foot (at the ankle) of one leg onto the lower thigh of the other leg. Place your hands behind the thigh and pull your knee in toward your chest until you feel a stretch in the buttock. Hold for 30 seconds before repeating on the other leg. Repeat five times, up to three times daily.
Standing Outer Hip Stretch
Standing upright, raise one leg and rest the foot on the knee of the other leg. Gently sit back, as if about to sit in a chair. Keep your back straight and your shoulders back. Engage your stomach muscles to keep you upright. Your hands can rest on your raised leg for extra stability if needed. Hold for 30 seconds before repeating on the other leg. Repeat three times daily.
Lie on your side and place your arm under your head. Bend your knees, keeping your legs together. Slowly raise the top knee so that your legs resemble a clamshell opening. Hold for five seconds before closing the clamshell. Repeat ten times before changing to the other side.
Lying Hip Abduction
This strengthening exercise involves moving the leg out sideways against resistance. You’ll need a resistance band that you can attach to a door or other fixed object. Lie down on your side and raise your upper body on your forearm. Keep your elbow directly under your shoulder. Raise your upper leg as much as you can without straining, before lowering it in a controlled motion. Repeat 20 times on each side. Work up to three sets of 20 reps each day.
Kneeling Hip Extension
Get on the floor on all fours. Your shoulders and hands should be in alignment, as should your hips and knees. Raise one knee off the floor, keeping it bent, so the sole of the foot moves towards the ceiling. In a controlled motion, lower the leg almost to the floor. Repeat fifteen times before changing legs. Do two sets of fifteen repetitions per leg each day.
Piriformis Syndrome Physical Therapy
If your symptoms don’t go away with home treatments, you may need to see a physical therapist who can show you the best exercises for piriformis syndrome. They will also be able to tell you what exercises to avoid.
Wearing a brace can help with posture and alignment, which may reduce pressure on the piriformis muscle and sciatic nerve. A brace also provides compression therapy to increase circulation and reduce stiffness. You can wear a brace during everyday tasks or workouts to reduce symptoms.
Osteopathic treatment aims to fix misalignments that contribute to piriformis syndrome. This type of joint manipulation can also increase range of motion in the lower body.
Piriformis Syndrome Surgery
In rare cases, some people with chronic piriformis syndrome may need surgery to loosen the piriformis muscle and reduce pressure on the sciatic nerve. Surgery is usually minimally invasive and has a high success rate.
Piriformis Syndrome Recovery Time
Recovery from piriformis syndrome depends on the severity of your condition, your anatomical makeup, and the treatments you use.
Piriformis syndrome recovery is generally easy to achieve using home treatments such as rest, hot and cold therapy, and supportive braces. It’s also important to engage in a regular stretching routine or attend a physical therapist.
Those who have more severe cases of piriformis syndrome usually experience relief after taking medications or undergoing surgery.
Piriformis Syndrome Prevention
To prevent piriformis syndrome, try the following:
Engage in regular physical activity to develop strong and flexible muscles and joints.
Stretch fully before workouts.
Use a heating pad on the buttocks and legs before exercising to help warm up the piriformis muscle, especially in cold weather.
Gradually build up the intensity, duration, and frequency of activities.
Avoid running on uneven terrain or up and down inclines.
Never remain inactive for too long. If you have a desk job, you should walk around for a few minutes every hour.
Wear a brace during activities that trigger symptoms if you have experienced piriformis syndrome in the past.
Do not keep your wallet in your back pocket when sitting down.
Enjoying Relief from Piriformis Syndrome
Although piriformis syndrome is an uncommon condition, a significant percentage of the population are at risk of developing it. If you experience sciatica symptoms, try using some of the most effective piriformis syndrome cures, including rest, hot and cold therapy, TENS, and medication. To avoid pressure on the sciatic nerve, stretch daily and massage the piriformis muscle to prevent spasms.
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