A Piriformis Syndrome (Compression of Sciatic Nerve by Piriformis Muscle)
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and
causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain,
numbness and tingling along the back of the leg and into the foot (similar to sciatica pain).
There is no simple diagnostic test for piriformis syndrome causing irritation of the sciatic nerve. The condition is primarily
diagnosed on the basis of the patient’s symptoms and on a physical exam, and after excluding other possible causes of the patient’s
Symptoms of Piriformis Syndrome
Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the
thigh, calf and foot. Typical piriformis syndrome symptoms may include:
• A dull ache in the buttock
• Pain down the back of the thigh, calf and foot (sciatica)
• Pain when walking up stairs or inclines
• Increased pain after prolonged sitting
• Other signs of Piriformis syndrome include reduced range of motion of the hip joint, especially internal hip rotation (rotating the thigh inwards) is often seen.
• range of motion of the hip joint, especially internal hip rotation (rotating the thigh inwards) is often seen.
Risk factors for piriformis syndrome include:
• being over the age of 40; piriformis syndrome occurs most frequently in people 40–50 years older.
• being a woman; researchers believe more woman are affected than man due to biomechanics associated with the wider quadriceps / hips of
women’s bodies. Some reports show that women are six times more likely to have piriformis syndrome than men.
• a history of trauma to the hip, butt or thigh area
• having a history of sciatic nerve pain, bulging disc or other spinal problems
• performing repetitive, vigorous activities using the lower body (especially long-distance running, squatting and walking using improper form,
without enough rest in between training)
• prolonged sitting — either at your desk at work or during a commute in the car, for example — which can lead to forward head posture, and generally
a sedentary lifestyle
• eating a highly inflammatory diet, which raises risk for deficiencies and electrolyte imbalance
• being overweight or obese, or even being very underweight, which can weaken muscles
• having an anatomical abnormality in the piriformis muscle (a less common cause)
• Role of Physiotherapy Piriformis syndrome Treatment
Treatment consists of two phases:
• First reducing pain by relaxing the muscle through ice or heat, electrotherapy, manual therapy , and
• Then when pain allows strengthening the muscle to help prevent the injury recurring.
• If Piriformis syndrome is acutely painful or inflamed then applying ice may help reduce muscle spasm.
• More chronic or longer-term conditions may respond better to heat therapy to relax the muscle however,
heat should not be applied if an acute injury, inflammation or recent tear of the muscle is suspected. In this case, heat will
only increase swelling, inflammation, and bleeding.
• Applying heat before performing exercises, particularly stretching exercises may help increase the effectiveness of the exercises.
• A professional therapist may use manual therapy such as MET, PTR , HVT and electrotherapy such as ultrasound ,IFT to relax the muscle.
• Gentle piriformis stretching exercises should be done but only if pain allows as this should also reduce the pressure on the nerve causing the pain.
• Stretches should be held for around 20 seconds and done in sets 3, repeated at least two times a day.
• The aim is to stretch and relax the piriformis muscle so in turn it will reduce pressure on the sciatic nerve and relieve symptoms.
Treatment and rehabilitation of piriformis syndrome focus on releasing muscle tension and correcting any muscle imbalances or biomechanical causes which may be
contributing to the condition.
Piriformis syndrome exercises:
As soon as comfortable to do so, piriformis syndrome stretches should begin. Exercises to strengthen the piriformis
muscle and other hip muscles can also begin. This will help to circulate blood through the muscle and strengthen it
so it can cope with the future demands placed on it.
• Muscle energy techniques are an excellent way of improving the stretch of the muscle. This involves repeatedly
contracting and relaxing the muscle whilst it is being stretched by rotating the femur bone inwards.
• In addition to the specific piriformis stretches it is important to stretch the hamstrings, groin, hip abductors
and lower back.
• Foam roller exercises are great for releasing tension and spasm in the piriformis muscle.