Hip > Piriformis Syndrome

What is the Piriformis Muscle?

The piriformis is a muscle located in your buttock area that is one of the hip "rotators." In other words, it assists when you lift your leg to the side and then rotate so that your toes are pointing up. The sciatic nerve, the main nerve to supply your leg, runs close to, and sometimes through, the piriformis muscle.

Piriformis syndrome is a condition in which the sciatic nerve becomes inflamed or irritated as a result of a problem with the piriformis muscle. This can cause pain in the buttock and, more commonly, down the back of the leg.

The piriformis muscle lengthens and contracts when you are walking or running, which can cause it to enlarge and crowd the sciatic nerve. Prolonged sitting, or driving a car for long periods of time, can cause the piriformis muscle to contract and shorten, disrupting the smooth movement of the sciatic nerve. Although incorrect or incomplete stretching or warmup exercises before athletic activity can lead to irritation of the piriformis muscle, with resultant sciatic nerve pain, most pain comes after prolonged activity.

There are usually three parts to an orthopedic evaluation: medical history, physical examination, and tests your physician may order.

To help achieve an accurate diagnosis, your physician will ask you to describe your injury and symptoms, including the location, severity, and duration of your pain; what aggravates your pain and what you do to relieve it, and any history of previous trauma or treatment. You also may be asked about other medical conditions, such as diabetes and allergies, and medications you currently are taking. Your physician may ask you about your physical and athletic goals – information that will help him decide what treatment might be best for you in achieving those goals.

Your physician may start by feeling around your hip and buttock area to assess tenderness of the piriformis muscle. You may also be asked to lie on your side with the affected side on top and your upper leg bent slightly. If you raise your top leg about eight or ten inches and experience pain while holding that position, you may have piriformis syndrome. To test for pain or weakness, your physician may employ resisted abduction – putting pressure on your leg from the side as you push out against it – while you are in a sitting position. Another test for piriformis syndrome is to check for pain while you twist your body with your feet planted, as if you were serving a tennis ball.

X-ray or MRI (magnetic resonance imaging) may be used to rule out other causes of radiating leg pain, such as a herniated disc or tumor.

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