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What is piriformis syndrome?


 What is piriformis syndrome?
 

If you’re experiencing pain in your buttocks, your first thought may be that you have sciatica. But sciatica is just one possible diagnosis. Another possibility is that you have piriformis syndrome, which is not as well known.
 
Sciatica and piriformis syndrome are often confused, as they have similar characteristics and one (piriformis syndrome) can actually be a cause of the other (sciatica).
 
It’s important to note that if you have piriformis syndrome – also sometimes referred to as deep gluteal syndrome, pseudosciatica, hip socket neuropathy or pelvic outlet syndrome – it doesn’t automatically mean you’ll experience sciatica too. Piriformis syndrome is triggered when your piriformis muscle becomes inflamed or goes into spasm, causing mild to severe pain in the buttock region. However, the piriformis muscle can also irritate and press on the sciatic nerve, causing sciatica-like symptoms such as pain travelling from the lower back down to the thigh and leg.
 
Unlike sciatica, piriformis syndrome isn’t that common. Experts reckon it may be responsible for 0.3 to six per cent of cases of low back pain and/or sciatica, with middle-aged people most likely to be affected at a ratio of 1:6 male to female (i).
 

Where is the piriformis muscle?


The piriformis is a flat band of muscle that runs from your lower spine to the top of your thigh bone (one on each side). This pear-shaped muscle originates next to the vertebrae labelled S2 to S4 (S1 is the first vertebra of the lumbar spine). The muscle passes down through the greater sciatic notch – a deep indentation in one of the bones of the pelvis – then attaches to the greater trochanter (the large bony bump near the top outside of the thigh bone).
 
The piriformis muscle is important because it stabilises the hip joint and allows your hip to lift and rotate your leg away from your body – when you swing your leg out to the side, for instance. You need it for important functions such as walking, balancing, turning your lower body and shifting your weight from one leg to another. If you use it too much – or too little – your piriformis muscle can become injured or irritated.
 
The sciatic nerve meanwhile runs very close to the centre of the piriformis, starting from the lower spine then passing beneath or through the piriformis and extending down the back of the leg and to the foot.
 

What causes piriformis syndrome?


The exact cause of piriformis syndrome isn’t clear, but there are a few things that might affect the muscle, causing it to become inflamed or to go into spasm. Some of these include:
 

  • Walking, climbing stairs or running with weak piriformis muscles

  • Tight piriformis muscles caused by inactivity (sitting or standing for long periods, for instance) 

  • Other muscles being tight or weak, which puts a strain on the piriformis

  • Muscle imbalances involving the hip or rotator muscles

  • Overexercising, particularly when an activity includes repetitive motions involving the leg and hip muscles

  • Having an accident such as a fall or a sudden hip twist that results in an injury to your buttock, hip or leg

  • Not warming up properly before exercising or stretching afterwards

  • Lifting heavy objects incorrectly

 

What causes a tight periformis muscle?

 
Some people are more likely to develop piriformis syndrome than others, including those who sit for long periods of time throughout the day and those who are extremely active, especially if their activities involve their hips and legs. 
 

How to help piriformis syndrome      


There are several things you can do yourself to relieve the symptoms of mild piriformis syndrome – see How to help yourself, below, for more details.
 

When should I see a GP?

However, see your GP as soon as possible if you experience any of the following:
 

  • Pain that’s severe and/or lasts longer than a few weeks

  • Pain that started after an injury or accident

  • Severe pain in your lower back or leg that comes on suddenly, accompanied by muscle weakness or numbness in your leg

  • Problems with bowel or bladder control


Your GP can also advise you about treatments if you have piriformis syndrome symptoms that are affecting your day-to-day life (read on to find out more about how piriformis syndrome is treated).
 

Pirifromis syndrome symptoms      

 
The pain of piriformis syndrome has been described as a anything from a dull ache to a shooting, burning or throbbing sensation that becomes worse either when you’re active or when you’re inactive. It can start suddenly, usually following an injury, or develop slowly over several months.
 
The main symptom of piriformis syndrome is pain in the buttock area, which can often feel tender to the touch. This can cause difficulties when you get out of bed, plus the pain may become worse when you perform any sort of movement that involves your hips. You may also find it very painful to sit for any length of time (driving long distances, for instance, can be particularly problematic).
 
If your piriformis muscle is compressing your sciatic nerve, you may also feel pain radiating down the back of the affected leg to the hamstrings (the muscles in the back of your thighs) and possibly also right down to your calves and feet. 
 

Other common symptoms include:

 

  • Numbness and tingling in the buttock and (if the sciatic nerve is affected) down the affected leg – typically the sensation of pins and needles. These symptoms, like pain, can become worse the longer you sit or stand still.

  • Leg weakness on the affected side – for instance, your leg may feel heavy, stiff or weak, and you may find it hard to move it. You may also experience stiffness in your hip and find that its range of motion is limited.

 
Less common symptoms include groin pain and numbness. Very rarely the pain can alternate from one side to the other, or it can affect both buttocks and legs at the same time.
 

Piriformis syndrome vs sciatica


It can be difficult to differentiate between piriformis syndrome and sciatica because they are often related – not to mention the fact that piriformis syndrome can cause sciatica-like symptoms. But sometimes there can be ways of telling whether you have piriformis syndrome (with or without sciatica symptoms) or sciatica that has a different cause (the most common cause, according to the NHS, is a slipped disc (ii)).
 
The main symptom of piriformis syndrome is buttock pain, which can also be a symptom of sciatica. However, if your pain is limited to just the buttock area, it could be that you’re experiencing piriformis syndrome rather than sciatica. Even if you’re experiencing both buttock pain and sciatica like symptoms, such as pain radiating down your leg, you may be able to tell if it’s caused by piriformis syndrome if the pain in your buttock is localised to a specific area. Also, if the pain in your buttock is intense, that too suggests you have may piriformis syndrome, as buttock pain with sciatica tends to be more of a dull ache (though the pain of piriformis syndrome can be described as a dull ache too if the condition is mild).
 
On the other hand if your symptoms include lower back pain along with pain radiating  down the back of the leg, this usually indicates sciatica, since piriformis syndrome doesn’t cause lower back pain.
 
Both conditions, meanwhile, can cause weakness in the leg and foot, as well as a sensation of heaviness in the affected leg. Numbness and tingling in the affected areas can also be signs of both piriformis syndrome and sciatica.
 

What else could it be?

 
There are several other conditions that could be causing the type of pain that comes with piriformis syndrome, including:
 

  • Pulled hamstring muscle

  • Trochanteric bursitis

  • Pelvic fracture

  • Herniated disc

  • Degenerative disc disease

  • Arthritis of the lumbosacral spine 

  • Kidney stones 

  • Sacroiliitis (inflammation of one or both sacroiliac joints)

 

How is piriformis syndrome treated?


Currently there aren’t any official tests to diagnose piriformis syndrome, but if your doctor thinks that you’ve developed it the first things they may recommend include rest and avoiding any activities that make your symptoms worse. Surgery is another option but it’s only suitable for people who’ve tried all other treatment options and are still experiencing symptoms. That’s because the results of surgery aren’t predictable, and some people still have pain after going under the knife
 

How to heal piriformis syndrome quickly

 
You may also be prescribed pain relief medicines such as anti-inflammatory painkillers or muscle relaxers. Over-the-counter painkillers that may be useful include ibuprofen, which is an anti-inflammatory (please read the information leaflet carefully as ibuprofen isn’t suitable for everyone).
 
Physiotherapy can be helpful too. This may involve various treatments such as soft tissue massage, ultrasound, hot and cold therapy and exercises to stretch and strengthen the muscles. Some people may also need steroid injections into the area around their piriformis muscle to help reduce inflammation and pain. Some doctors may even recommend Botox injections to relieve tight muscles and reduce sciatic nerve compression.
    

Piriformis syndrome exercises

 
Gentle exercises may be helpful with piriformis syndrome. Always, begin each exercise slowly and stop if they are too painful to do.
 
Hip rotator stretch
Lie on your back with both knees bent and your feet flat on the floor
Put the ankle of the affected side on your opposite thigh near to your knee
Using the flat of your hand to gently guide your knee (on your affected leg) away from you until you feel a gentle stretch in the hip area
Hold the stretch for 15 to 30 seconds
Repeat this exercise 2 to 4 times
Repeat on the other side
 
Piriformis stretch
Lie on your back with your legs straight out in front of you resting on the floor
Lift the affected leg and bend your knee. With the opposite hand, reach across your body, and gently pull your knee toward your opposite shoulder
Hold the stretch for 15 to 30 seconds
Repeat 2 to 4 times
Repeat on the other side
    

Can piriformis syndrome be prevented?

 
There are a few things you can do to help reduce your risk of developing piriformis syndrome, including:
 

  • Watching your posture, especially while sitting, standing or driving

  • Staying physically active – experts claim even walking can help prevent piriformis syndrome (i) 

  • Warming up before exercising (and stretching when you’ve finished) 

  • Avoiding spending too much time in the same position (sitting or standing), particularly any position that puts too much pressure on your buttocks – take regular breaks and change your position frequently

  • Wearing a good pair of running shoes if you’re a runner – your shoes should fit well and allow you to move freely without pinching or rubbing

  • Avoiding running up and down hills or on uneven surfaces

  • Lifting heavy object correctly – you should lift by bending your knees and keeping your back straight (don’t twist), while keeping the object you’re lifting close to your body

 

How to relieve piriformis syndrome symptoms

 
If you have piriformis syndrome some of the things you can do to relieve your symptoms include a few of the prevention actions described above, such as avoiding sitting or standing for prolonged periods, watching your posture and warming up and stretching after exercise.
 
If your symptoms are mild, some of the other things you can do include:
 

  • Using heat or ice packs

  • Self-massaging the hip and buttock area

  • Using a TENS machine for pain relief (TENS units are widely available in pharmacies and online)

 
There are also stretches and muscle strengthening exercises you can do at home. It’s always a good idea to learn how to do exercises for any health issue, from a healthcare professional first (e.g. a doctor or physiotherapist). However some of the exercises they may recommend include the following (remember, stop if you feel any pain or discomfort):
 
Glute stretch: lie flat on your back with your knees bent and feet on the floor, then raise one ankle and place it on the opposite knee. Pull that knee gently towards your chest with both hands, so that the foot comes off the floor, and hold for a count of 10. Place your raised foot back on the floor and repeat on the other side. Do the stretch on each side three times.
 
Alternatively, in the same lying position with your knees bent, bring one knee up to your chest with both hands and gently push it towards the centre of your body until you feel the stretch in your buttock.
 
The bridge: lie flat on your back with your knees bent and feet on the floor. Your arms should be straight besides your body with the palms of your hands on the floor. While engaging (tightening) your stomach and buttock muscles, slowly raise your hips off the floor until your knees and shoulders form a straight line. Hold for a few seconds and lower yourself back down slowly. Repeat two more times.
 
Start by holding this position for a few seconds, then gradually hold it for longer until you can stay in the bridge position for 30 seconds.
 
Squats: stand with your feet shoulder-width apart, your toes pointed out and your abdominal muscles engaged. Bend your knees and at the same time hinge your upper body forwards from the hips – imagine you’re there’s a chair behind you and you’re trying to sit on it. Keep your knees in line with your toes, with your weight in your heels and your chest lifted. Return to standing by pushing your feet into the ground, then repeat. Build up to a set of 12 repetitions initially, then when you’re stronger aim to do two, then three, sets of 12.
 

Supplements to help with piriformis syndrome      

 
Eating a healthy, balanced diet is important for keeping your muscles strong and in good condition. However there are a few supplements that could give you a little extra support if you have piriformis syndrome, including some that could help reduce pain and inflammation:
 

Turmeric

 
Best known as a curry spice, turmeric contains an active antioxidant ingredient called curcumin that’s thought to help reduce inflammation. This may happen because curcumin blocks the action of cyclooxygenase-2 (COX-2), an enzyme that speeds up the production of compounds that promote inflammation, such as prostaglandins. Indeed, studies suggest curcumin may be an effective painkiller – but without the side effects associated with anti-inflammatory drugs (iii).
 

High-strength fish oils

 
Like turmeric, the omega-3 fatty acids found in oily fish are thought to have anti-inflammatory properties, again because they are thought to affect the production of prostaglandins in the body. There is also evidence fish oils may be a safer alternative to anti-inflammatory drugs (NSAIDs) when used to treat pain (iv).
 
If you’re a vegetarian or a vegan you can still enjoy the benefits of the same omega-3 fatty acids found in fish by taking a vegan omega-3 supplement that contains marine algae instead of fish.
 

B complex  

 
If you have piriformis syndrome with sciatica-like symptoms, taking some B vitamins may help support your nerves. Vitamin B12, for instance, is needed for normal nerve cell activity. However some people – the elderly, for instance, plus vegans and people taking certain medicines – can be at risk of being deficient in B12, which may in time lead to problems with their nerves or even nerve damage. Taking a B12 supplement can be helpful if your levels may be low. Alternatively you may find it more convenient to take an all-in-one B vitamin supplement called B complex.
 

Magnesium

 
An essential mineral, magnesium is needed for more than 300 biochemical reactions in the human body, including maintaining normal nerve and muscle function. However, the typical Western diet is thought to make people more likely to be deficient in magnesium, since it’s absent from many staple foods including processed foods, fat, refined flour and sugars (v).
 
Nuts, wholegrains, pumpkin seeds, spinach and dark chocolate all contain good levels of magnesium. You may also like to consider taking a magnesium supplement – look for a form of magnesium that’s absorbed effectively in the body, such as magnesium citrate.
 

PEA

PEA, short for palmitoylethanolamid, is a fatty acid made naturally by the body and found in all cells, tissues and fluids (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (vi), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. Studies have suggested PEA may be a safer option than CBD, given its more extensive research and more robust safety profile (vii) with no known side effects (vi).

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (vi). This may explain why some natural practitioners recommend taking a PEA supplement for pain reduction.
 

Find out more      

 
If you think you have piriformis syndrome it may also be worth taking a look at our guide to sciatica. There’s also lots more information on pain conditions that include useful self-care information in the pain section of our pharmacy health library.


 

References:

  1. , et al.. Piriformis Syndrome. Available online: https://www.ncbi.nlm.nih.gov/books/NBK448172/

  2. Available online: https://www.nhs.uk/conditions/sciatica/

  3. , et al.. Zingiberaceae extracts for pain: a systematic review and meta-analysis. Nutr J ;14:50. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436156/

  4. , et al.. Omega-3 fatty acids prevent inflammation and metabolic disorder through inhibition of NLRP3 inflammasome activation. Immunity ;38(6):1154-63. Available online: https://www.cell.com/immunity/fulltext/S1074-7613(13)00242-2?_returnURL=https://linkinghub.elsevier.com/retrieve/pii/S1074761313002422?showall=true

  5. , et al.. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart ;5(2): e000668. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786912/

  6. , et al.. Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci ;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/

  7. , et al.. Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl ;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733



 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 
 
Our Author - Christine Morgan

Christine

Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.

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