What is piriformis syndrome?

Dr. Majid Ghorbanzadeh
24 January 1403

What is piriformis? Before we talk about piriformis syndrome, we need to know a little about the anatomy of the body. The hip joint is formed by the large ball-shaped head of the femur (the long bone of the thigh) and the socket of the pelvis (called the acetabulum). Piriformis is the name of the muscle located in this area. Actually, the piriformis muscle [...]

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What is piriformis?

Before we talk about piriformis syndrome, we need to know a little bit about the anatomy of the body.

The hip joint is formed by the large ball-shaped head of the femur (long bone of the thigh) and the socket of the hip (called acetabulum).

Piriformis is the name of a muscle. which is located in this area.

Actually, the piriformis muscle was created as a function to help rotate the pelvis and rotate the leg and leg outward.

It runs diagonally and the sciatic nerve is located vertically directly below it.

Although in some people the nerve can pass through the muscle.

Anatomy of the piriformis muscle and the sciatic nerve of the pyramidal piriformis muscle

The main function of the piriformis muscle is to externally rotate the femur.

So it is a very important stabilizing muscle.

Piriformis can be the main cause of pain.

It is also very sensitive because the sciatic nerve usually passes under the piriformis muscle.

What is piriformis syndrome?

Piriformis syndrome is a condition in which the muscle The piriformis spasms in the posterior region (buttocks) and causes hip pain.

The piriformis muscle can irritate a known nearby nerve (sciatica) and cause pain, numbness, and tingling in the back and inside of the leg (similar to sciatica).

There are several factors that potentially contribute to the development of piriformis syndrome.

Patients usually report burning and pain in the buttock region. (gluteal) or back of the leg report that this pain may be like sciatica.

Additionally, numbness in the buttock and a tingling sensation along the distribution of the sciatic nerve are not uncommon.

Accordingly, piriformis syndrome occurs when the piriformis muscle compresses the sciatic nerve.

0.3% to 6% of all cases of back pain or sciatica may be a symptom of piriformis syndrome.

During the research, statistics show that 40 million people who suffer from back pain or sciatica have piriformis syndrome.

Also, the incidence of piriformis syndrome will be approximately 2.4 million per year.

In most cases, piriformis syndrome occurs more in middle-aged patients.

During studies, piriformis syndrome is more common in men than women. It has become common.

Scientifically, piriformis syndrome is considered an uncommon neuromuscular disorder.

The piriformis muscle is located above the hip joint.

The work of the piriformis muscle is basically to lift, move and rotate the thigh from the body.

This allows people to walk and maintain their weight and balance.

Types of syndrome Piriformis

There are two types of piriformis syndrome, which are:

Primary piriformis syndrome

This syndrome is caused by anatomical changes such as muscle tears.

This type of syndrome is less common and only 15% of people have this syndrome because of this.

Secondary piriformis syndrome

This is This type of syndrome is caused by blows and sudden injuries to the hip and hip muscles.

It is much more common than the first type and about 85% of people with piriformis syndrome are for this reason.

Causes of piriformis syndrome

This disease is primarily diagnosed based on the patient's symptoms, review of the patient's medical history and physical examination, and after ruling out other possible causes of the patient's pain.

Piriformis syndrome often goes through a process to rule out other possible conditions that may cause the patient's symptoms, such as:

Lumbar disc herniation
Joint dysfunction
Sacroiliac diagnosis

Symptoms of piriformis syndrome

Often, patients describe acute tenderness in the buttock and sciatic pain in the back of the thigh, leg, and foot.

Typical symptoms of piriformis syndrome may include:

Dull pain in the buttock
Pain in the back of the thigh, leg, and foot (sciatica)
Pain when climbing stairs or slopes
Increased pain after prolonged sitting
Decreased range of motion of the hip joint

These symptoms begin early in the disease.

Symptoms of piriformis syndrome often worsen after prolonged sitting, walking, or running.

It may also feel better after lying on your back.

Over time, this pain can go untreated along the sciatic nerve (called sciatica) spreads.

The pain that people feel continuously while sitting on a chair or running or lifting objects.

It is due to the compression of the sciatic nerve by the piriformis muscle.

Making movements such as climbing stairs, sitting for a long time, etc. causes an increase in pain in the upper thigh and back of the leg, as well as the gluteal or buttock area.

However, more Sciatica cases are not due to piriformis syndrome.

How can piriformis syndrome be diagnosed?

will prescribe radiological tests such as an MRI for patients to find the cause of the condition and compression of the sciatic nerve, such as a herniated disc.

You can also develop piriformis syndrome after a traumatic event, such as a car accident or fall.

Physical examination

The physical examination includes examining the hip joints and legs to determine if movement increases back pain or pain. lower limb (sciatica pain).

Typically, movement of the pelvis can trigger back pain in the buttocks and thighs.

This examination also identifies or rules out other possible causes of sciatica pain, such as testing for local tenderness and muscle strength.

Medical History

Medical history includes an in-depth review of the patient's symptoms.

Also examines what positions or activities make the symptoms of piriformis syndrome better or worse.

Or how long the symptoms of this condition have existed in the patient.

In addition to the above, the doctor and orthopedic specialist will investigate whether this condition gradually occurred to the person or whether the piriformis syndrome disease occurred after an injury in the hips and thighs.

Another issue that is of concern to orthopedic doctors and specialists is whether or not they took medication during the illness to treat and reduce pain.

It is also possible that the cause of piriformis syndrome is hereditary, such as arthritis.

Diagnostic tests

X-ray and other imaging studies of the spine cannot detect Whether the sciatic nerve is irritated in the piriformis muscle.

However, diagnostic tests (such as X-rays, MRIs, and nerve conduction tests) may be done to rule out other conditions that can cause symptoms similar to piriformis syndrome.

An anesthetic or steroid-free injection may help confirm whether the piriformis muscle is the source of the symptoms.

When to See a Specialist

Pain can be a common occurrence that goes away on its own, but you should see a doctor if:

The pain started with a specific injury.
The pain lasts for more than a few days or gets worse.
The pain is debilitating and debilitating.
The pain radiates to the legs or other parts of the body.
Weakness or numbness. You experience it in your lower body
You have signs of infection such as redness, warmth, swelling, or fever.
You have a history of cancer.
You have unexplained health changes such as weight loss or urinary problems.

Prevention About piriformis syndrome

In most cases, piriformis syndrome is caused by continuous and heavy sports movements.

Movements such as running, going up and down the stairs continuously, with the passage of time puts pressure on the piriformis muscle.

Accordingly, it is suggested to all people who have this condition to avoid running or exercising on hills or uneven surfaces.

People should Be sure to warm up your body well before your sports activities.

When running, walking or exercising, use a proper and standard posture.

If any pain occurs in the back of the leg, thigh, or buttock, stop your activity and rest until the pain subsides.

Muscle spasm may occur when the piriformis muscle is damaged or irritated.

Sometimes the muscle may become swollen or stiff as a result of muscle spasm. From things like:

Excessive exercise
Sitting for a long time
Climbing stairs
Running, walking or performing other repetitive activities
Lifting heavy objects

Any impact or trauma can also cause irritation and damage to the piriformis muscle. This may be caused by things such as:

Falls
Penetrating wounds
Car accidents
Sudden hip rotation

Treatment of piriformis syndrome

To treat this condition, orthopedic doctors advise patients to avoid sitting and long-term activities. rest.

In addition to that, ice and heat can also reduce pain.

The doctor and orthopedic specialist can suggest and prescribe a program of exercises and stretches for you to reduce the compression of the sciatic nerve.

To help relieve pain and increase the range of motion, osteopathic manipulation therapy is used.

Using and taking drugs such as:

Antibiotics Inflammatory
Muscle relaxant drugs
Corticosteroid injection
Injection of anesthetic drugs can also reduce pain in the said areas.

There are other treatments that are performed by doctors and orthopedic specialists for severe pain, which include:

Iontophoresis, which uses mild electric current in the affected areas.
Injection of botulinum toxin (Botox) reduces pain.

Due to its paralyzing properties, botulinum toxin injection can minimize pain and muscle stiffness and compression of the sciatic nerve.

Now if the patient does not improve with the above treatments, the desired area should be treated by an experienced orthopedic specialist and doctor such as Dr. Majid Ghorban Zadeh, undergo surgery.

Depending on the severity of the patient's sciatica pain and other symptoms, a number of treatment options may be recommended by the doctor and orthopedic specialist.

A comprehensive approach to the management of piriformis syndrome may include a combination of non-surgical treatments such as ice and heat therapy for piriformis syndrome.

A simple way to help relieve discomfort at home is to apply a cold compress or heating pad to the skin in the painful area.

Ice bag and ice massage

At the onset of pain, lie on your stomach in a comfortable position and place an ice bag on the painful area for approximately 20 minutes.

Repeat every 2 to 4 hours as needed.

Combining a gentle massage with ice may be more helpful.

Lie on your stomach and have someone gently massage the painful area with a large ice pack.

If you apply ice directly to the skin instead of a cold pack, limit it to 8 to 10 minutes to avoid ice burn.

If Certain activities tend to increase pain, so it may be a good idea to apply ice immediately after activity.

Heat Therapy

In some people, instead of using cold, heat therapy is used to treat piriformis syndrome .

If using a heating pad, lie on your stomach and place the heating pad on the painful area for up to 20 minutes.

Make sure Do not sleep on the heating pad, as it may lead to Burn the skin.

Medications for sciatica pain

Since most episodes of pain involve some form of inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help reduce inflammation in the affected area.

Piriformis steroids

For severe sciatica pain caused by piriformis syndrome, injections may be part of the treatment.

Piriformis injection

A local anesthetic and corticosteroid may be injected directly into the piriformis muscle to help reduce spasm and pain.

The goal of the injection is usually to reduce acute pain to allow for progress in physical therapy.

Botox injection

For persistent piriformis spasm that is resistant to anesthetic injection (corticosteroid) treatment. Botulinum toxin (Botox) injection is used. Botulinum toxin (Botox) injection is a muscle-weakening agent that is very useful for treating and reducing pain in sciatica. The purpose of the injection is to help relax the muscle and help reduce pressure on the sciatic nerve. When finished, keep the muscle stretched and relaxed.

Electrotherapy

Electrical stimulation of the buttocks is performed with a transcutaneous electrical nerve stimulation unit or interfrontal electrical stimulation.

Helps prevent pain and reduce muscle spasms associated with piriformis syndrome.

In cases where pain persists, the piriformis muscle can be cut to relieve symptoms, but this is rarely done.

Physiotherapy

As soon as you notice the symptoms of a piriformis strain, if your doctor prescribes it, you can start your physical therapy under the supervision of an experienced physical therapist.

If you neglect your treatment, your injury is likely to become more chronic and permanent.

It will make your rehabilitation period longer.

Stretching Piriformis

Stretching the piriformis muscle helps reduce painful symptoms and increase the patient's range of motion.

There are many ways to stretch the piriformis muscle, two of which are simple:

Exercise 1

Lie on your back and place both feet flat on the floor and bend both knees.

Raise your right knee to your chest, grab your knee with your left hand. and pull towards your left shoulder and hold the stretch.

Do this for both sides.

Second exercise

Lie on your back and place both feet flat on the floor and bend both knees.

Place the right ankle on the left knee.

Pull your left thigh towards the chest and keep the stretch.

It is necessary to do this movement. Do it for both sides in several repetitions a day.

One of the exercises that is very effective for stretching the piriformis muscle is yoga.

Each piriformis stretch should be held for 5 seconds to start and gradually increase to 30 seconds and be repeated 3 times a day.

The best orthopedic doctor in Tehran

All people who have back pain, leg pain, muscle spasm, swelling or stiffness muscle weakness and end up with piriformis syndrome, they should definitely go to an experienced orthopedic doctor like Dr. Majid Gurbanzadeh for treatment.

Why? that Dr. Majid Ghorbanzadeh is one of the best experienced specialists in all fields of surgery, orthopedics and bone and spine treatment in Tehran.

His office is located both in the west of Tehran in the Marzdaran area and in the east of Tehran in the Pirizh area.

You can easily enter the website of Dr. Majid Ghorbanzadeh href="https://www.drghorbanzadeh.com/contact-us/">Call and make an appointment online.

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Dr. Majid Ghorbanzadeh

Surgeon and specialist in bones and joints and spine (orthopedic), knee and hip surgery, arthroscopy, arthroplasty, member of the American Orthopedic Association with a specialized board and member of the Association of Orthopedic Surgeons

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8 replies

Good time, physical therapy for piriformis syndrome Is it helpful?
Answer
1. Hello, dear friend, yes, physical therapy can help strengthen the muscles around the hip area and reduce pressure on the sciatic nerve.
  Answer
Is massage therapy helpful for piriformis syndrome?
Answer
1. Hello dear friend, massage therapy can be helpful, because it can help reduce muscle tension and improve blood flow in the buttock area and around the sciatic nerve.
  Answer
Can this syndrome get better by itself or does it definitely need treatment?
Answer
1. Hello, in mild stages it can get better with rest, stretching and proper exercise, but in severe cases, medication or physical therapy is needed.
  Answer
What exercises are suitable for improving piriformis syndrome?
Answer
1. Hello, stretching exercises for the hips and back of the thigh are very helpful and should be done under the supervision of a physiotherapist.
  Answer