WHAT IS PIRIFORMIS SYNDROME?
Piriformis syndrome refers to irritation of the sciatic nerve as it passes through the piriformis muscle located deep in the buttock. Inflammation of the sciatic nerve, called sciatica, causes pain in the back of the hip that can often travel down into the leg.
HOW DOES IT OCCUR?
The piriformis muscle is located deep in the buttock and pelvis, and allows you to rotate your thigh outward. The sciatic nerve travels from your back into your leg by passing through the piriformis muscle. If the piriformis muscle is unusually tight, or if it goes into spasm, the sciatic nerve can become inflamed or irritated. Piriformis syndrome may also be related to intense downhill running.
WHAT ARE THE SYMPTOMS?
You will have pain deep in your buttock that may feel like a burning pain. The pain usually travels down across your lower thigh. Your pain may increase when you move your thigh outward, such as when you are sitting cross-legged.
HOW IS IT DIAGNOSED?
Your doctor will talk to you about when your symptoms began. Since your sciatic nerve begins in the back, it can be irritated by a back injury, such as a herniated disk. Your doctor will ask if you have had any injuries to your back or hip. He or she will examine your back to see if the sciatic nerve is irritated there. He or she will examine your hip and legs, and move them to see if movement causes increased pain. Your doctor may order x-rays, a computed tomography scan (CT), or a magnetic resonance image (MRI) of your back to see if there is a back injury. There are no x-ray tests that can detect if the nerve is being irritated at the piriformis muscle.
HOW IS IT TREATED?
Treatment may include:
- placing ice packs on your buttock for 20-30 minutes every 3-4 hours for the first 2-3 days, or until the pain goes away
- rest
- taking prescribed anti-inflammatory medications or muscle relaxants
- learning and doing stretching exercises for the piriformis muscle
WHEN CAN I RETURN TO MY SPORT OR ACTIVITY?
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon the nerve recovers, not by how many days or weeks it has been since your injury occurred.
In general, the longer that you have symptoms before you start treatment, the longer it will take you to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
- you have full range of motion in the injured leg compared to the uninjured leg
- you have full strength of the injured leg compared to the uninjured leg
- you are able to jog straight ahead without limping
- you are able to sprint straight ahead without limping
- you are able to do 45 degree cuts, first at half speed, then at full speed
- you are able to do 20 yard "figure 8" runs, first at half speed, then at full speed
- you are able to do 90 degree cuts, first at half speed, then at full speed
- you are able to do 10 yard "figure 8" runs, first at half speed, then at full speed
- you are able to jump on both legs without pain, and jump on the injured leg without pain
HOW CAN I PREVENT PIRIFORMIS SYNDROME?
Piriformis syndrome is best prevented by stretching the muscles that rotate your thigh inward and outward.
It is important to have a good warm-up before starting your sport or activity.
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