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What is piriformis syndrome?

Piriformis syndrome might not be a household name, but for those who experience it, it causes significant discomfort and pain. The piriformis muscle is a small but vital muscle in the buttock area. It enables the movement of your leg in various directions, including side-to-side and rotational movements at the hip.

Piriformis syndrome occurs when the piriformis muscle is compressed, irritated, or inflamed, putting pressure on the nearby sciatic nerve. This unfortunate situation can lead to symptoms such as pain shooting down your leg and possible numbness, tingling sensations, or weakness in the lower limbs. Consequently, everyday activities such as sitting, standing, or resting can become challenging and painful.

piriformis syndrome singapore
Piriformis syndrome is a painful condition characterised by tingling, shooting pain, and weakness in the lower limbs.

What causes piriformis syndrome?

Piriformis syndrome can be caused by anything that exerts pressure and stress on the piriformis muscle. This causes it to become irritated and inflamed, which presses on the sciatic nerve. Causes of piriformis syndrome include:

  • Inflammation of the piriformis muscle or other soft tissues surrounding it
  • Muscle scarring
  • Muscle spasms
  • Tight piriformis muscle
  • Bleeding in the piriformis muscle

The main factors that can cause the above to occur include:

  • Overuse or injury: overuse or injury of the piriformis muscle can occur due to activities that involve a lot of running, jumping, prolonged sitting, or other repetitive motions.
  • Piriformis hypertrophy: an enlarged piriformis muscle which has gotten bigger due to overuse or genetic predisposition.
  • Anatomical variations: some individual’s sciatic nerve runs through the piriformis muscle instead of underneath it, which can cause problems.
  • Stress or tension in the muscle: like any muscle, the piriformis muscle can become stressed or tense, leading to issues.
  • Other underlying conditions: conditions like sciatica, spinal stenosis, or arthritis can also contribute to or cause piriformis syndrome​.
piriformis pain
Prolonged sitting, typically observed in office workers and drivers, can strain the piriformis muscle, leading to piriformis syndrome.

What are the symptoms of piriformis syndrome?

The symptoms of piriformis syndrome can vary but typically involve discomfort in the buttock area and can include:

  • Pain, especially when sitting or standing for a long time
  • Pain that radiates down the leg, mimicking sciatica
  • Pain that worsens after long periods of inactivity
  • Tightness or spasms in the piriformis muscle
  • Tingling or numbness that can extend down into the leg and foot
  • Difficulty moving the leg or foot due to pain or weakness, which can interfere with daily activities

The pain level can range from mild annoyance to severe discomfort, affecting your ability to perform everyday tasks and engage in physical activities.

piriformis syndrome symptoms
Tightness or spasms of the piriformis muscle is a symptom of piriformis syndrome.

Who is at risk of piriformis syndrome in Singapore?

Certain individuals may find themselves more susceptible to developing piriformis syndrome due to certain risk factors. Risk factors of piriformis syndrome include:

  • Individuals engaged in repetitive physical activities that strain the hips and legs
  • Those who have experienced trauma or injury to the buttocks area
  • People who spend large amounts of time sitting, such as office workers or long-distance drivers
  • Lack of adequate warm-up or cool-down during exercise routines
  • People who frequently handle heavy lifting, putting additional strain on the buttocks and lower back​
  • Individuals with an anatomical variation in which the sciatic nerve passes through or under the piriformis muscle

How is piriformis syndrome diagnosed?

The diagnosis process of piriformis syndrome typically involves:

  • Medical history and physical examination: your pain specialist will examine the area and perform specific movements, such as Freiberg’s test, to try and recreate symptoms. Your gait, spine, and leg length alignment will also be examined to identify the underlying cause of your symptoms.
  • Imaging tests: imaging tests such as ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) may be employed to examine the piriformis muscle and surrounding areas more closely, helping to distinguish piriformis syndrome from other conditions that could cause similar symptoms​ , such as a slipped disc.
  • Electromyogram (EMG): an electromyogram helps to record electrical activity in the muscle and surrounding nerves.

What are the treatment options for piriformis syndrome in Singapore?

A multi-faceted approach is often the most effective in treating piriformis syndrome:

  • Physical therapy: tailored exercises can help alleviate pressure on the sciatic nerve by stretching and strengthening the piriformis muscle and other hip and lower back areas.
  • Medication: non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may be prescribed to reduce inflammation and pain.
  • Injections: in more severe cases, ultrasound-guided corticosteroid or Botulinum toxin injections directly into the piriformis muscle can help reduce inflammation.

Frequently asked questions

Fixing piriformis syndrome often involves a combination of rest, stretching exercises, strengthening the piriformis muscle, and sometimes medication for pain management. Treatments include resting for a few days, home exercises designed to target the piriformis muscle, taking painkillers for pain relief, and massage therapy. Physical therapy focusing on stretching and strengthening the piriformis may be recommended, along with steroid or botulinum toxin injections for more severe cases. Surgery is generally considered as a last resort only if other treatments fail​.

Piriformis syndrome can go away with appropriate treatment and lifestyle adjustments. Most episodes improve within days or weeks. However, the condition can recur, especially if preventive measures are not followed. Severe cases that aren’t adequately treated can significantly impact one’s ability to function.

Piriformis muscle pain typically feels like aching, burning, numbness, or tingling in the butt, hip, or upper leg. The pain may worsen during activities such as sitting for long periods, walking, running, or climbing stairs​.

Distinguishing between piriformis syndrome and sciatica involves assessing the symptoms and possibly undergoing diagnostic tests, as both conditions can cause similar pain. Piriformis syndrome directly involves the piriformis muscle pressing on the sciatic nerve, leading to symptoms. In contrast, sciatica can have various causes, including lumbar spine issues. Physical examinations and imaging tests like ultrasound, CT scans, MRI, or electromyography (EMG) can help differentiate between piriformis syndrome and sciatica.

Exercises that may cause pain include those that put pressure on the piriformis muscle and sciatic nerve, particularly through prolonged sitting or repetitive motions like running or biking. It is advised to avoid sitting for extended periods and be cautious with seated exercises such as biking that could aggravate the condition. Standing up every half hour and considering a standing desk for work can help relieve pressure on the piriformis.