What Is Piriformis Syndrome?
One of the most commonly underdiagnosed conditions associated with lower back pain is called piriformis syndrome. This condition often mimics many others, including sciatica and disc problems, but it’s actually something very different.
Piriformis syndrome occurs when a flat band of muscle located between the base of your spine and your hip, called the piriformis, acts up and compresses your sciatic nerve. The piriformis works to stabilize your hip, lift and rotate your thigh outward, allow you to walk, and aids in balance. It’s considered to be a core stabilizing muscle that’s in play whenever you move your hips and legs.
Your sciatic nerve is a large nerve that passes under (or sometimes through) the piriformis muscle. The nerve then runs down the back of your leg, with many smaller nerves branching out from it in your lower legs and feet. Piriformis syndrome is caused when the muscle goes into spasm, and compresses the sciatic nerve.
It’s estimated that up to one-third of all cases of lower back pain are the result of piriformis syndrome. In addition, more women than men experience piriformis syndrome. This may be because women tend to have a wider pelvic angle than men, which also contributes to a variety of women’s sports injuries. In most cases, piriformis syndrome occurs on one side of your body, but in some patients it may occur on both.
Symptoms of piriformis syndrome include pain in the buttock on the affected side, along with pain along the trajectory of the sciatic nerve, which includes the back or side of the upper leg, the side of the lower leg and into the foot. Patients also describe pain and discomfort when sitting for more than 20 minutes at a time and weakness and difficulty when walking. Piriformis is often caused by overuse, poor athletic form, running or walking on irregular surfaces, extended time sitting, direct compression such as sitting on a wallet, and even from prolonged exposure to cold.
Because piriformis syndrome acts like so many other conditions associated with the lower back, it’s frequently misdiagnosed or goes undiagnosed. Health care providers familiar with this condition may diagnose it through the patient’s symptoms, specific muscle tests and movements, and in some instances when palpated, the aggravated muscle feels like a thick cord that runs through the mid-buttock. In some cases, an MRI may be used to rule out other causes of the pain and nerve compression. Piriformis syndrome is most commonly confused with sciatica because of the similarity of the symptoms. However, true sciatica is compression of the sciatic nerve from damaged lumbar discs, trauma, or degeneration of the lower spine.
How Can Piriformis Syndrome Be Treated
Conventional treatments include non-steroidal anti-inflammatory drugs (NSAIDs), prescription muscle relaxants, pain medications, and steroid injections. In severe cases, Botox has been used to relax the muscle, and surgery may be a last resort when all else fails. Physical therapy is usually recommended to help loosen the muscle and relieve compression on the nerve.
In Chinese medicine, piriformis syndrome is considered to be a pattern of stagnation. This simply means that there’s a blockage in the area of the muscle, and circulation, energy, and function has been hampered. Acupuncture can be a good stand-alone or adjunct treatment for piriformis, because it works to increase the circulation of blood and nutrients to the area, decrease inflammation, loosen the muscle, speed up the healing process and increase chemicals in your brain that help relieve pain.
Beyond acupuncture, a practitioner of Chinese medicine may also use heat, a kind of bodywork called Tui Na, stretching, and at home care. Electro-acupuncture can be especially effective in treating piriformis syndrome. During electro acupuncture, standard acupuncture needles are inserted into the area near the muscle, and the needles are then hooked up to a small machine that painlessly delivers an electrical impulse. Electro acupuncture works by helping tight or spastic muscles relax and increases circulation to the area.
Care at home for this condition involves rest and heat. Many health care providers may suggest ice; however when treating a muscle in spasm, heat may be more effective in helping it to relax. While rest is important, avoid sitting for very long periods of time. Stretching the muscle may also be helpful. An easy stretch for your piriformis is to sit in a chair with both feet on the floor and gently lean forward until you feel a stretch in your lower back and butt. To get more of a stretch, place the ankle on the same side as the pain on top of the opposite knee. (E.g. if the pain is on the right, place your right ankle over your left knee, keeping your left foot flat on the floor.) Then very slowly and gently, lean forward until you feel a stretch in your lower back and buttock. Repeat on the other side. If there’s any pain associated with this stretch, stop.
Treating this condition early is important, because over time chronic nerve problems or muscle weakness may persist. The good news is that in most cases piriformis syndrome responds well and fairly quickly to acupuncture treatment.