Piriformis syndrome

Piriformis syndrome is a condition where your piriformis muscle — a muscle in your buttocks (bottom) — puts pressure on your sciatic nerve, causing pain. This happens when your piriformis muscle tightens. Piriformis syndrome usually happens on one side of your body.

Your sciatic nerve passes above, below or within your piriformis muscle in your buttocks.

Females are more likely to develop piriformis syndrome than males. Piriformis syndrome is most common in middle-aged adults.

If you have piriformis syndrome, you may notice:

• a shooting, burning or aching pain that comes and goes and gradually gets worse deep in your buttocks, hip, sometimes your lower back and down your leg to your foot
• tingling and numbness in your buttocks
• your pain gets worse when you jump, run, sit or stand up
• a reduced range of movement of your hip and tight muscles
• difficulty climbing stairs or sitting for a long time

In some cases, symptoms can be severe, and you may find it hard to work or do your usual daily activities.

Your symptoms can be similar to sciatica symptoms.

You can get piriformis syndrome when your piriformis muscle presses on your sciatic nerve. This can happen because of:

• an injury to your buttocks or back of your thigh
• overusing your piriformis muscle, for example, by walking or running very long distances
• an irregularity in the way your body is structured
• a tumour pressing on your piriformis muscle

Your doctor can diagnose the cause your piriformis syndrome by:

• asking you questions about your symptoms and medical history
• examining you — your doctor will stretch your leg in different positions to see if it causes pain, and feel for a small bump on your buttocks (your piriformis muscle)
• referring you for an ultrasound or MRI scan
• ruling out any other conditions that could be causing your symptoms

There are no official tests to diagnose piriformis syndrome.

Your symptoms may be similar to symptoms of other conditions. For this reason, it can take your doctor a while to diagnose you.

You should see your doctor if you feel pain, numbness or tingling in your buttocks, hip or leg.

If you need to see your doctor but cannot wait for an appointment, you may be able to get treatment at a Medicare Urgent Care Clinic. Use the Service Finder to find your nearest one.

When to seek urgent care

You should seek urgent care if you have sudden lower back pain and:

• suddenly have trouble controlling your bladder or bowels
• have sudden tingling, numbness or weakness in your lower limbs
• have had a recent bacterial infection or fever
• you've had symptoms for longer than 4 weeks
• you are younger than 16 years or older than 50 years
• you have a history of cancer, are immunocompromised (have a weak immune system) or have lost weight without trying to

Treatment for piriformis syndrome will depend on the cause. Your doctor may recommend rest, muscle stretches or physiotherapy. They may treat piriformis syndrome with medicines, injections, acupuncture or sometimes surgery.

Self-care at home

Your doctor will ask you to keep your piriformis muscle as relaxed as possible to reduce any tension on your sciatic nerve. They will also recommend that you:

• rest at home for a few days
• apply a hot pack or cool pack to your muscle to relax it
• do some muscle stretches

Medicines for piriformis syndrome

If your symptoms do not get better with your resting and stretches, your doctor may prescribe medicines to relieve your symptoms, such as:

• medicines that relax your muscles
• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• medicines that relieve nerve pain — gabapentin and pregabalin, if NSAIDs do not help
• injection of botulinum toxin into your piriformis muscle
• steroid injections, if rest, stretches, NSAIDs and physiotherapy have not helped

Other treatment options

Your doctor may recommend that you try physiotherapy. A physiotherapist can treat you by:

• stretching your piriformis muscle
• using different massage techniques, such as releasing trigger points with myofascial release or deep friction massage
• teaching you how to stretch at home

If medicines, rest and physiotherapy do not help, your doctor may suggest acupuncture, dry needling or even surgery.

If you have piriformis syndrome, it may affect your quality of life. If you are an athlete, it can also affect your performance.

While you can't always prevent getting piriformis syndrome, you can try to avoid it by regularly stretching your piriformis muscle.

• Read about nerve pain (Opens in new tab) at Pain Australia.
• Learn more about musculoskeletal conditions (Opens in new tab) at Musculoskeletal Health Australia.
• Visit the Agency for Clinical Innovation (Opens in new tab) for helpful fact sheets and videos on pain and physical activity.
• You can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

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