What is Piriformis Syndrome?
Piriformis syndrome is a pain in the ass. Literally. The principle symptom of piriformis
syndrome is described as ‘buttock pain with or without leg pain’. There is a lot of confusion
surrounding it and still a lack of consensus on the precise definition of this syndrome.
What exactly is Piriformis Syndrome and what are the presenting symptoms?
The principle symptoms of piriformis syndrome are best described as buttock pain with or
without leg pain. Such a broad description of potential symptoms suitably portrays the
complexity and controversy that surrounds this clinical phenomenon. Confusion arises in
existing literature, primarily due to whether or not the sciatic nerve is considered influential in
the syndromes’ presentation. Previous research has either included the involvement of the
sciatic nerve and accompanying neuropathic pain symptoms in the definition of the
syndrome, or, ignored the involvement of the sciatic nerve and referred to piriformis
syndrome as pain that is derived solely from the muscle itself.
What is the function and location of the piriformis muscle?
The piriformis muscle has numerous roles but is primarily a lateral rotator of the hip and is an
important abductor in a sitting position, secondary to its muscular function it also holds the
head of the femur into the socket.
The piriformis muscle is in fact a relatively small, triangle shaped muscle that lies deep to the
gluteal muscles and is situated close to the sciatic nerve. In fact, the anatomical
arrangements in this area have been studied extensively and numerous studies have
demonstrated that in an estimated 10-15% of the population, a separate division of the
sciatic nerve passes through the muscle belly of piriformis before continuing its usual path.
Why has the piriformis muscle become such a problematic muscle in today’s society?
The piriformis muscle is prone to injury like any other muscles due to sustained poor
posture, repetitive strain, direct trauma or overloading of the associated tissue. Our
overexposure to seated flexion in our daily lives and in the workplace is a significant factor in
the increased incidences and diagnosis of Piriformis Syndrome. Both posture and injury-
induced changes to the piriformis muscle not only cause local pain but may also result in
irritation or ‘entrapment’ of the sciatic nerve due to their close proximity resulting in the
development of peripheral neural symptoms such as paresthesia, anaesthesia or weakness
which may occur anywhere along the length of the affected nerve.
How can we treat the acute onset of Piriformis syndrome or if it has been an ongoing issue for some time?
Two principle conservative treatment possibilities exist in the management of piriformis
Syndrome. Either the aim is to restore the nerves’ mechanical tensioning/sliding faults
through the use of neural mobilisation techniques, or secondly, to mobilise the non-neural
irritation with stretches and manual soft tissue mobilisations/pressure release techniques
such as dry needling and manual trigger point release.