What is the Piriformis?
A small muscle in the buttocks that runs from the sacral region of the spine, individuals can find the piriformis muscle under the gluteus maximus. The piriformis muscle runs over the sciatic nerve to the top part of the femur called the greater trochanter. The piriformis muscle has a variety of roles. The main roles of the piriformis muscle include stabilizing the pelvis, allowing for lateral rotation of the leg, stabilizing movement, walking, and running.
What is Piriformis Syndrome?
Piriformis Syndrome occurs from an impingement of the sciatic nerve due to compression from a malfunctioning piriformis muscle. Multiple causes of piriformis syndrome exist. Often, the patient overuses the piriformis muscle. With overuse, the piriformis muscle may damage, leading to spasms or freezing of the muscle in a contracted position. The Piriformis muscle when behaving this way can compress the sciatic nerve causing the same Sciatica symptoms that a spine disorder would achieve. The symptom of Sciatica caused due to the Piriformis muscle remains a rare condition called Piriformis Syndrome.
What are the symptoms of piriformis syndrome?
Every individual processes pain differently but the most common symptoms of piriformis syndrome include:
- Inability or difficulty to sit comfortably
- Pain that radiates down the back of the leg
- Numbness and/or tingling in the buttocks area
- Pain in the buttocks area that worsens with exercise, activity, or sitting for long periods of time
How do orthopedic specialists diagnose Piriformis Syndrome?
Piriformis syndrome feels exacerbated from overuse of the piriformis muscle. The treating orthopedic physician starts with performing a physical examination of the patient. During a physical exam, the doctor asks the patient about their history and daily activities. The doctor then examines the area and palpates the area to feel the piriformis muscle. If the patient suffers from piriformis syndrome, often the piriformis feels hard and noticeably tight. Next, the doctor most likely orders diagnostic imaging. Diagnostic imaging to diagnose piriformis syndrome may consist of X-Ray, MRI, or both. These tests can help the physician rule out any other issues including herniated discs or torn ligaments.
How do orthopedic specialists treat Piriformis Syndrome?
To treat piriformis syndrome, the treating physician always starts with conservative treatments. Doctors often recommend rest and non-steroidal anti-inflammatory medications. Non-steroidal anti-inflammatory medications can reduce inflammation and muscle irritation, in turn decreasing pain. Orthopedic specialists can prescribe steroid treatments in addition to offering injections that may help clear the patients symptoms. The treating doctor may give the patient specific exercises and stretches, or be refer the patient to physical therapy. In physical therapy, the physical therapist can teach the patient specific techniques to clear up the sciatica issues from piriformis syndrome. The physical therapist may ask the patient to acquire a dense foam roller for rolling out the piriformis muscle at home to help relieve symptoms. Depending on the physical therapist, some may perform manual massage and potentially even use dry needling to attempt to release the piriformis. In very rare cases where all conservative treatments fail to alleviate the patients pain, the doctor my opt for surgical intervention. Opting for surgical intervention may occur when patients have developmental variation that has left them with their sciatic nerve running through the piriformis muscle instead of behind it.
During surgery to treat pirirformis syndrome, the surgeon has the patient under general anesthesia. Under general anesthesia, the patient remains asleep for the entirety of the procedure. Depending on the physician and the patient, the physician may use one of two methods to perform the piriformis surgery. For the first method of piriformis surgery, the doctor cuts the area of the piriformis where it attaches to the top portion of the femur. The other most common type of piriformis surgery consists of the surgeon cutting through the piriformis with a goal of releasing pressure. Alleviating pressure allows the sciatic nerve the have more space and therefore decrease the pain. During this procedure, the surgeon may also remove a small portion of the muscle.