We often identify a health condition by its symptoms as we are still not aware of the various terms mentioned in the medical dictionary. When we have specific health conditions and consult our doctors, we tend to get quite surprised by the terms they use to refer to that condition! Have you ever come across the term "Piriformis Syndrome"? No! This was expected! But have you ever felt symptoms like dull pain in the lower buttock region or tingling or numbness along the sciatic nerve? Some people may say that they have experienced these symptoms. These may indicate the signs of Piriformis Syndrome.
Piriformis is a small muscle that runs behind the hip joint. It is a deep seated muscle in the buttocks which helps in the external rotation and abduction (hip flexed) of the hip joint. The piriformis muscle runs horizontally and the sciatic nerve (largest nerve in the body which supplies the lower extremities with motor and sensory function) runs vertically beneath it. However, in 15 to 30 percent of the population, the sciatic nerve passes through the piriformis muscle and some studies have reported greater incidence of piriformis syndrome in these people.
Piriformis syndrome is a clinical disorder in which the sciatic nerve gets compressed by the piriformis muscle, causing irritation of the nerve. It is also known as deep buttock syndrome, pseudosciatica or fat wallet syndrome. It is more commonly present in women. Long distance walkers and runners are also susceptible to this condition. Interestingly, majority of people with piriformis syndrome have been found to have led a sedentary lifestyle.
What Causes Piriformis Syndrome?
It is predominantly caused due to the shortening or tightening of the piriformis. The nerve compression can be due to a direct injury to the piriformis or due to the compression at the pelvic outlet (pelvic outlet syndrome). Other factors that can lead to the Piriformis Syndrome include Spinal stenosis (narrowing of the spinal cord that exerts pressure on it), herniated discs (a back condition which causes irritation of the spinal nerves), hyperlordosis (caused when the lower back region faces excessive stress or weight) and biomechanical inefficiency (such as poor body mechanics, poor posture and improper gait).
What are the Symptoms of Piriformis Syndrome?
- Dull aching pain at the buttock region is a common observation in people with Piriformis Syndrome. The pain may or may not radiate towards the leg.
- Reduced range of motion of internal rotation at the hip joint.
- Weak and restricted hip adduction.
- Tingling and numbness along the sciatic nerve which runs downwards from the back region of the thigh and into the foot.
- The pressure on the sciatic nerve can also cause low back pain, shortening of the involved lower extremity and difficulty in sitting due to inability to bear weight on the buttock.
How to Diagnose the Condition?
The diagnosis is largely clinical and is one of exclusion. Indications include sciatica (radiating pain in the buttock, posterior thigh and lower leg) and a physical examination of the rectum may reveal tenderness at the lateral pelvic wall. Frieberg's sign will be present (passive abduction and internal rotation of the hip produces pain). Pace test is also positive in case of piriformis syndrome (resisted external rotation and abduction of hip produces sciatic-type pain).
MRI, CT scan and neurography procedures are used to differentiate the piriformis syndrome from sciatica (compression or irritation of the sciatic nerve originating from spinal roots and/or spinal disk compression). X-ray and other imaging techniques are used to exclude the discogenic and the degenerative factors that contribute to the condition.
What are the Treatment Options Available?
- Initial treatment consists of rest and administration of analgesic and anti-inflammatory drugs in order to get a symptomatic relief. If the pain is severe, then injections with steroids or local anesthetics may be prescribed for the management of piriformis syndrome.
- Once the signs and symptoms settle down, physical therapy may be initiated. Majority of the cases recovers completely with physical therapy approaches. In physical therapy, major emphasis is given on stretching of the hip rotators and adductor muscles. According to the duration and severity of the condition, cold and hot therapies can be used. Soft tissue release, trigger point release, muscle energy techniques (MET), spray-'n-stretch and myofascial treatment are physical therapy maneuvers done to treat soft tissue problems. Stretching is an essential component of the treatment program and should be done regularly in order to prevent recurrence.
- As mentioned above, most cases show good response to conservative management (rest, analgesics, injections, physical therapy etc.) but, in rare cases surgery may be needed. In such cases, resection of the muscle or its tendon from its insertion may be done in order to relieve compression from the nerve.
Is There Any Way to Prevent Piriformis Syndrome?
Prevention is the key as the recurrence rate of piriformis is high. Some important preventive measures include maintaining proper postures and using ergonomically designed chairs with cushioned seats. Kickoff a regular exercise program with proper warm-up and stretching! If you are an athlete or engaged in strenuous physical activities, then make sure to give adequate amounts of rest to your body to allow it to conduct the necessary repairs.
Many people complain about lower back pain. And it may be due to a variety of reasons. Lifestyle patterns and the professions mainly contribute to the development of lower back pain in majority of the individuals. Proper and early diagnosis is necessary to facilitate a faster relief. And since Piriformis Syndrome has a probability to come back again and again, so it is extremely important to put the idea "Prevention is better than cure" into actual practice.
