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What Is Piriformis Syndrome?

Piriformis Syndrome is fairly rare neuromuscular disorder. Developing when the piriformis muscle (situated in the gluteal area and involved in nearly every movement we make with our upper legs) compresses or compromises the sciatic nerve, the disorder is more common in runners and those who frequently sit for long periods of time. Piriformis Syndrome can also the the result of a hard fall on the buttocks or other direct impact to the muscle.

What Are The Symptoms Of Piriformis Syndrome? How Is It Diagnosed?

A literal “pain in the butt” is one of the characterizing symptoms of Piriformis Syndrome. Because the piriformis muscle presses on the sciatic nerve, this pain also radiates downwards along its lines. Pain can be felt around the hip, and running down the legs. Any physical activity that places pressure on the piriformis muscle will likely aggravate symptoms, and in addition to pain, numbness and tingling sensations can also occur. Piriformis Syndrome can, with all these combined symptoms, have a major impact on a patient’s quality of life.

Unfortunately, Piriformis Syndrome is rather difficult to diagnose. Most cases of sciatic nerve pain are caused by other medical conditions, and are unrelated to the piriformis muscle. There are no definitive tests that identify Piriformis Syndrome. Before being diagnosed with Piriformis Syndrome, expect to be quizzed about your symptoms and medical history in detail, and prepare yourself for a physical examination. Here, your physician will guide your legs to make those motions that typically create the worst symptoms in patients with this condition — which in turn gives the doctor a good idea that you may indeed be dealing with Piriformis Syndrome. In addition, other medical conditions will need to be ruled out, and here, imaging techniques such as MRI scans can be very helpful. The road to this particular diagnosis isn’t quick and easy however.

What Are The Treatment Options?

Your doctor is likely to initially recommend some lifestyle changes along with expectant management (“wait and see”). Avoid using stairs, running, or sitting for long periods of time, for instance. In some cases, a “standing desk” can make a big difference. You can also use cold compresses directly on the piriformis muscle and the sciatic nerve (the areas where you will have pain and discomfort) to ease your symptoms.

Physician-directed parts of your treatment are likely to include physical therapy and the prescription of muscle relaxants and anti-inflammatories. Those patients who continue to suffer from severe pain may be excellent candidates for corticosteroid injections into the affected area.

Should none of those more conservative treatment options lead to symptom relief, however, surgery is also an option. Piriformis release and endoscopic sciatic neurolysis are promising. During surgery to correct Piriformis Syndrome, the debris around the sciatic nerve is removed and fractional lengthening of the piriformis muscle is performed. This can be done endoscopically now, meaning the surgery is much less invasive than it once was. Research suggests that outcomes are very good, with the vast majority of patients achieving very significant symptom relief and many being freed from Piriformis Syndrome altogether.

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