It starts as a pain that originates from the piriformis muscle, which lies deep under the gluteus maximus – the largest muscle in the buttocks. The pain travels to the thigh and can reach the foot, causing it to go numb. The pain can be mildly annoying or severe enough to bring people to their knees, victims of piriformis syndrome.
The piriformis muscle is responsible for externally rotating the hip joint. The muscle originates from the sacral spine and attaches to the femur at the greater trochanter, which is the bony bump at the outside top of the thigh. If the piriformis muscle is inflamed because of injury, bad habits (e.g., prolonged standing or sitting), chronic use (e.g., long-distance running), or a physical abnormality, it can affect the sciatic nerve.
The sciatic nerve is the longest and widest single nerve in the body, and it runs from the lower back, through the buttock, and down the leg. In most people the sciatic nerve passes underneath the piriformis muscle, but in about 15 percent of the population, it travels through the muscle. If the muscle compresses the sciatic nerve, as well as the arteries and veins, it can cause inflammation of the sciatic nerve, or sciatica. Although sciatica can be caused by several different factors (e.g., disc herniation, chronic hamstring tendinitis), when the piriformis muscle is the culprit, the condition is referred to as piriformis syndrome.
Common symptoms of piriformis syndrome include pain deep in the buttock and back of the thigh that may or may not travel down the leg. Sometimes compression of the sciatic nerve causes numbness in the foot or bursts of nerve pain in different parts of the leg. Sitting or standing in one place for even a few minutes can be painful.
Piriformis syndrome should be diagnosed properly before treatment begins to ensure contributing issues such as disc problems or overpronation of the foot are recognized and treated. Therapy for piriformis syndrome often begins with progressive stretching exercises that are simple to do at home or the office and require no equipment. One easy exercise, for example, involves standing with the left foot flat on the floor and the right foot flat on a chair so that the right knee is at a 90 degree angle with the floor. Place your left hand on top of your right knee and press the knee toward your left leg. Keep your right foot flat on the chair. This stretch relieves pressure on the sciatic nerve.
This stretching exercise and others can be combined with physical therapy such as hydrotherapy, massage, and ultrasound. Over-the-counter anti-inflammatory drugs such as ibuprofen and naproxen can reduce inflammation. For many people who have piriformis syndrome, these noninvasive approaches are enough to relieve the pain.
If the pain is persistent, a physician can inject a local anesthetic such as lidocaine into the muscle. Cortisone, an anti-inflammatory drug, can be combined with an anesthetic for injection. Botulism injection therapy (Botox®) paralyzes the piriformis muscle temporarily. These injection therapies typically last only a few months, but they allow patients time to engage in a stretching program that may fix the problem so that no more injections will be necessary. In rare cases, surgery is suggested.
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