Piriformis Syndrome


The piriformis muscle is a muscle that runs from your lateral hip region to your tailbone region and lies underneath your gluteal muscles.  Beneath this muscle, the sciatic nerve emerges and begins its pathway down the back of the thigh.  Thus, you can see how if there were a problem in the piriformis muscle, causing it to press on the nerve, or bring inflammation in to the area, a person may experience what is commonly referred to as “sciatica”.

Sciatic nerve entrapment can occur through adhesions on the piriformis due to injury (ie: a fall).  Compression of sciatic nerve can occur when it passes through the piriformis muscle (7-22% of population) or if the piriformis is hypertonic and compresses the nerve as it exits below the muscle. 

Who gets it?

Females are more predisposed than males, especially in the 30-40 year old age group.  It occurs sporadically in the younger population.

How does it happen?

Piriformis syndrome can occur secondary to blunt trauma to the gluteal area, or can be exacerbated through increased activity of the external rotators of the leg.  Prolonged sitting, or even pregnancy can also cause this pain.

What does it feel like?

Patients will complain of buttock pain with or without radiation into the posterior thigh or, sometimes, below the knee.  They will commonly describe it as a “sciatic” type pain.  This pain gets worse with activity, especially adduction of the hip and internal rotation (which stretches the piriformis).  The cardinal sign is an inability to sit for a long period of time due to the compression on the sciatic nerve.  There may also be pain noted with bowel movements. 

How is it diagnosed?

A qualified therapist will take a through history of the complaint, followed by a series of tests.  The following tests may be positive:

•Pain in SLR

•Buttock tenderness at greater sciatic foramen

•Active piriformis muscle contraction test – Pace test (abducting the affected leg)

•Stretching tests – Freiburg test (forceful internal rotation of the extended thigh) and FADIR (flexion, adduction, and internal rotation)

•Resisted seated leg abduction – pain

•Resisted active external rotation of the hip from a position of full passive internal rotation with the patient seated

•Rule out spinal pathology and sacroiliac joint pathology

What else could it be?

The following conditions should be ruled out:

1.Pathologic condition of all structures adjacent to the piriformis

2.Lumbar disc herniation

3.Spinal stenosis

4.Facet syndrome

5.Intrapelvic diseases – tumors, endometriosis

What can I do to treat it?

Conservative treatment is typically preferred.  Stretching of the muscle, trigger point therapy, transrectal massage, or other soft tissue therapies are indicated.

Questions?  Contact us!

Written by

Dr. Craig Coghlin, B.A., CPT, CSCS, D.C.

Empowerment Health and Fitness