Piriformis Syndrome Signs and Symptoms

Piriformis Syndrome describes as a musculoskeletal condition, characterised by buttock and hip pain with a combination of other symptoms.  In some cases it is defined as the inflammation of branches of the sciatic nerve caused by irritation or injury of the piriformis muscles.

The piriformis muscle performs external rotation, abduction and contributes to extension of the hip joint.  It originates from the anterior S2-S4 sacral segments and sacroiliac joint, passes through the greater sciatic foramen via the sciatic notch, and inserts on the greater trochanter of the femur.

In most of the population, the sciatic nerve passes below the piriformis muscle belly, however several congenital (difference present from birth), normal variations.  Some variations include: 1) the entire sciatic nerve passing through the muscle belly, the sciatic nerve splitting as it passes through the piriformis muscle with the tibial branch passing (2) inferiorly, (3) superiorly or (4) through the muscle belly or tendon even.

Primary Piriformis Syndrome

Primary causes contribute to fewer than 15% of cases.  This occurs when there is an anatomical cause such as a split piriformis muscle, split sciatic nerve or abnormal sciatic nerve path.  However, at present there is no accepted values and little evidence regarding the prevalence of sciatic nerve anomalies in piriformis syndrome and other sciaticas. These findings suggest that piriformis and sciatic anomalies/irregularities may not be as important in piriformis syndrome as previously thought.

Secondary Piriformis Syndrome

Secondary piriformis syndrome occurs as a result of precipitating cause:

Macrotrauma to the gluteal muscles leading to inflammation of the soft tissue and/or muscle spasm, leading to compression of the nerve.  Muscle spasms of the piriformis muscle due to overuse, direct trauma or pathology.  Shortening of the piriformis muscle due to altered biomechanics of the lower back, pelvis or lower limb.  This can cause compression or irritation of the sciatic nerve, causing pain in the sciatic nerve distribution into the glutes, posterior thigh, leg and foot.  Microtrauma due to overuse of the piriformis muscle from activities such as long distance walking or running or direct compression.

Piriformis Syndrome Symptoms

Patients with piriformis syndrome have many symptoms that may include some or all of the following:

  • Low back pain, described as radiating
  • Buttock pain
  • Numbness
  • Pins and needles, tinging or pricking sensations
  • Difficulty or pain with walking, sitting, squatting, standing and/or bowel movements
  • “Splayfoot” position, where the leg is in a shortened and externally rotated position due to contraction of the piriformis muscles

Piriformis Syndrome Treatment

Accurate and thorough diagnosis, soft tissue release, hip muscle strengthening program.
Weakness of the gluteal muscles causes the piriformis to work harder, a strengthening program of gluteus maximus and medius and movement re-education has been shown to provide pain relief and prevent recurrence.  Movement pattern and lifting technique re-training

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Written by: Olivia Strelein

  • BSc. Physiotherapy (Honours)
  • BSc. Exercise and Sport Science
  • Personal Trainer