Piriformis syndrome is a disorder involving the neuromuscular system in which the sciatic nerve is compressed or irritated by the piriformis muscle. The piriformis muscle is a muscle located on the buttocks adjacent to the sciatic nerve allowing it to compress the delicate nerve when the muscle becomes spastic and short. The piriformis muscle usually goes into spasms when overused or trauma is experienced.
Piriformis syndrome is one of the entrapment neuropathies because the sciatic nerve becomes entrapped with the piriformis muscle. This nerve entrapment becomes the root cause of the symptoms including:
• Gluteal pain
Pain along the buttocks is the most common symptom of piriformis syndrome. The pain is characterized as dull and may radiate down the buttocks and the legs contributing to difficulty in movement. The pain is generally caused by the shortening of the piriformis muscle causing neuropathic pain and the over stretching can lead to local irritation of the muscle fibers. The pain may intensify when walking on inclined surfaces or up the stairs. The pain may also be aggravated by prolonged sitting. The pain; however, is relieved by walking when the foot on the involved side is pointed outward because of lessening the stretch on the piriformis muscle.
Sciatica may also be experienced as manifested by radiating pain to the back of the thighs up to the foot on the involved side as a result of the entrapment of the sciatic nerve.
• Paresthesia in the groin and saddle
Tingling and numbness can also be felt on the saddle and groin areas as piriformis syndrome can also lead to the entrapment of the pudendal nerve that innervates the bowel and the bladder region. More severe entrapment can lead to fecal and urinary incontinence.
Treatments for Piriformis Syndrome
The main goal of treatment for piriformis syndrome is symptomatic relief, which can be achieved through the following managements:
• Medication therapy
Muscle and nerve pain can be effectively managed though the use of NSAIDs such as ibuprofen and naproxen. For muscle spasms, muscle relaxants are used to reduce spasms on the piriformis muscle and relieving nerve entrapment temporarily.
• Stretching exercises
Stretching exercises is also an effective management for piriformis syndrome. Stretching exercises help the gluteal muscles including the piriformis muscle to increase flexibility and relieve overstretching that causes the shortening of the piriformis muscle.
Massage is also an effective remedy to relieve pain and tension as massage can help the muscles to relax through tactile stimulation (skin stimulation).
• Avoidance of aggravating factors
Avoiding factors that lead to piriformis syndrome such as running, rowing, biking and others is also very important to shorten the recovery time and improve the response of patient to other treatments.
• Physical therapy
Some physicians recommend physical therapy to reduce the muscle strain on the piriformis muscle. Physical therapy may involve the combination of massage, stretching exercises and strengthening exercises.
• Ice and heat applications
Icing and heat is a local and immediate remedy to reduce pain. The cold temperature helps numb the area while the heat helps relax the soft structures around the sciatic nerve to relieve nerve irritation and pain.
• Steroid and anesthesia injections
When NSAIDs are deemed ineffective to relieve pan, steroid injections and anesthetics may also be injected directly into the piriformis muscle.
• Botox injections
For persistent piriformis spasms that do not respond to steroid and anesthetics, botox was also found to provide relief. The goal of botox is to weaken and relax the muscles to relieve pressure on the sciatic nerve.
A more advanced management for piriformis syndrome is the use of electrical stimulation over the gluteal area to help reduce muscle spasms and relieve pain.
When all of these procedures are ineffective to relieve the symptoms, the piriformis muscle is sometimes surgically manipulated to relieve pressure directly on the nerve.