Piriformis Syndrome

Written by Dr. Jason Ngan, DC

What is Piriformis Syndrome?

Piriformis syndrome is a type of sciatica where the piriformis muscle impinges on the sciatic nerve (L4-S3). The piriformis muslce is a small muscle located in the buttock below the glute muscles. This nerve runs through or below the piriformis muscle. Injury to the piriformis muscles will irritate the sciatic nerve causing weakness, pain, numbness, or a tingling sensation down the back of the leg. The piriformis muscle externally rotates the hip.

What Causes Piriformis Syndrome?

Piriformis syndromes is caused by irritation of the piriformis muscle. This muscle is prone to spasm with injury or overuse. When the piriformis is inflamed, it compresses the sciatic nerve causing sciatica symptoms. Some common piriformis injury include:

  • Prolonged sitting (compressing the piriformis): especially sitting on a wallet on the back pocket

  • Falling on the buttocks

  • Sports that overuse the piriformis such as running

  • Muscle imbalance

  • Overweight/obesity increases inflammation

What are the Signs and Symptoms?

  • Pain, numbness, tingling, weakness that travels down the back of the leg.

  • Symptoms worsen with certain positions

How is Piriformis Syndrome Diagnosed?

Piriformis syndrome is diagnosed with a thorough medical history, physical examination, orthopedic testing, and EMG/NCV. Diagnostic imaging such as x-ray and MRI can be used to rule out other causes of sciatic symptoms.

  • Muscle weakness.

  • Abnormal sensation (pain, numbness, tingling).

  • EMG/NCV checks for function of nerve and muscles.

What are the Treatment Options?

At Ngan Chiropractic, we properly diagnose the cause of the sciatica symptoms and we treat the source. Some options we provide are:

  • Chiropractic manipulation and mobilization

  • Flexion-distraction

  • Soft tissue therapies

  • Gua-sha

  • Cupping

  • E-stim

  • Ultrasound

  • Ergonomic/postural counseling

  • Rehabilitative exercises and stretches

Other treatments that patients may seek (not provided at Ngan Chiropractic) include acupuncture, steroid or botox injections, and pain medications.

References

  1. Chapman C, Bakkum BW. Chiropractic management of a US Army veteran with low back pain and piriformis syndrome complicated by an anatomical anomaly of the piriformis muscle: a case study. J Chiropr Med. 2012 Mar;11(1):24-9. doi: 10.1016/j.jcm.2011.06.011. PMID: 22942838; PMCID: PMC3315859.

  2. Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/

  3. Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010 Dec;19(12):2095-109. doi: 10.1007/s00586-010-1504-9. Epub 2010 Jul 3. PMID: 20596735; PMCID: PMC2997212.

  4. Roy, Brad A. Ph.D., FACSM, FACHE. Piriformis Syndrome. ACSM's Health & Fitness Journal 18(4):p 3-4, July/August 2014. | DOI: 10.1249/FIT.0000000000000055