Piriformis Syndrome

//Piriformis Syndrome
Piriformis Syndrome 2016-11-17T09:51:56+00:00

What Is Piriformis Syndrome?

Piriformis syndrome is a neuromuscular condition that is attributable to injury or irritation of the piriformis muscle. The piriformis muscle can be found deep within the gluteal region. The top of this muscle is attached to the base of the spine within the lower back, and the bottom is attached to the top of the femur on the lower limbs.

The piriformis muscle lays flat and somewhat parallel with the gluteus medius muscle. The piriformis muscle is responsible for rotating the femur from the hip. Further, during ambulation, the piriformis muscle can assist with balance and stabilization by flexing of the thigh muscles and shifting weight back and forth between limbs.

Given the location and function of the piriformis muscle, it is at risk for injury or strain due to overuse or trauma. Irritation and damage to the piriformis muscle causes the muscle tissue to become inflamed, which places pressure on the surrounding tissues and structures, including the sciatic nerve. Compression of the sciatic nerve is the underlying cause of pain associated with piriformis syndrome.

back painComplaints of pain in the lower back region are quite common. Recent prevalence rates have estimated that between 40% and 50% of all adults will experience lower back pain at some point in their lives. Prevalence estimates suggest that 5%-36% of these cases of lower back pain may be attributable to piriformis syndrome. However, these numbers may be low since many cases of piriformis syndrome likely go undiagnosed each year.

Symptoms of pain and discomfort associated with injury to piriformis muscle and irritation of the sciatic nerve can widely vary. Patients with this condition commonly complain of pain that worsens following prolonged periods of sitting. The pain is generally localized to the area of the piriformis muscle and the sciatic nerve. The most frequent areas of reported pain are within both the region where the muscle attaches to the base of the spine and the top of the femur.

Reports of piriformis syndrome pain may range from a dull and generalized ache within the area to a more acute and sharp stabbing pain. Unique symptom presentations are not uncommon and typically depend on the specific underlying injury or strain.

Common complaints associated with piriformis syndrome include:

  • Pain that becomes more severe following prolonged periods of sitting
  • A dull and achy pain located in the gluteus region
  • Numbing sensations within the feet
  • Pain walking up stairs or an incline
  • Headache
  • Muscle weakness in the lower limbs
  • Difficulty walking
  • Reduced range of motion within the hip joint
  • Radiating pain
  • Abdominal pain, pelvic pain, or groin pain
  • Muscle spasms
  • Pain during bowel movements
  • In women, pain during intercourse

Causes Of Piriformis Syndrome

Sobo_1909_298The exact cause of piriformis syndrome is not well understood. Previous studies have indicated that only about half of the presenting cases of piriformis syndrome occur in conjunction with a history of injury or trauma to the area. Overburden of the piriformis muscle can be a cause of inflammation within the tissue, which thereby increases the pressure placed on surrounding tissue, including the sciatic nerve.

Several chemicals have been identified as playing a role in the development of inflammation and irritation and include histamine, serotonin, prostaglandin, and bradykinin. Further, some evidence has suggested that individuals who regularly participate in activities involving jumping, running, or lunging are more at risk for developing complications associated with piriformis syndrome. This condition is reported to occur more frequently in women than men.

Your doctor can determine whether your symptoms of pain are associated with piriformis syndrome. Diagnosis of the condition generally includes a physical examination and an in-depth assessment of the pain. Specifically, your doctor will want to know the course of the pain, a description of current symptoms, along with any other relevant information (such as recent injuries, etc.).

Treatments For Piriformis Syndrome

A number of effective treatment options are available for managing the discomfort and pain that can accompany irritation or injury of the piriformis muscle and sciatic nerve.

For more mild cases of piriformis-related pain, at-home treatments can be highly effective in reducing pain and discomfort. These may include ice therapy, ice massage, heat therapy, and rest. Biofeedback may also be recommended as an augment therapy.

Spinal-cord-stimulatorMedications are also available to treat the pain and discomfort associated with piriformis syndrome. In particular, non-steroidal anti-inflammatory medications (NSAIDs), such as naproxen or ibuprofen, are frequently recommended owing to the pain relieving and inflammation reducing properties. Other oral analgesics that may be beneficial for treating piriformis syndrome pain include acetaminophen, antidepressants, and gabapentin.

Though it is relatively uncommon, some cases of piriformis syndrome do not respond to these more conservative methods of treatment. Thus, more significant interventions may be warranted. These procedures may include non-surgical nerve blocks or spinal cord stimulation. Both of these treatments work by blocking the transmission of pain information to the spinal cord and brain.

Conclusion

Piriformis syndrome is a neuromuscular condition characterized by pain owing to compression of the sciatic nerve by inflammation within the piriformis muscle. This muscle, located deep within the buttocks, can become inflamed as the result of strain, overuse, or trauma.

A wide range of treatment options are available to manage the discomfort associated with the condition. These can range from at-home treatments, such as heat or ice therapy, to more significant interventions, such as the nerve block. Individuals are encouraged to speak with their doctor about the risks and benefits associated with each treatment option available.

References

  1. Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: Implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat. 2012;34(6):479-86.
  2. Halpin RJ, Ganju A. Piriformis syndrome: A real pain in the buttock? 2009;65(4 Suppl):A197-202.
  3. Hopayian K, Song F, Siera R, Sambandan S. The clinical features of the piriformis syndrome: A systematic review. Eur Spine J. 2010;19(12):2095-109.
  4. Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 2009;40(1):10-8.
  5. Miller TA, White KP, Ross DC. The diagnosis and management of piriformis syndrome: Myths and facts. Can J Neurol Sci. 2012;39(5):577-83.
  6. Tagliafico A, Bodner G, Rosenberg I, Palmieri F, Garello I, Altafini L, Martinoli C. Peripheral nerves: Ultrasound-guided interventional procedures. Semin Musculoskelet Radiol. 2010;14(5):559-66.

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