Piriformis syndrome is a condition that occurs when the piriformis muscle in the hip region presses on the sciatic nerve. It can develop suddenly or over time. It is more common in women than in men. It manifests itself with symptoms such as leg pain, numbness and tingling in the back of the leg. Since it has similar symptoms to a herniated disc, it can often be confused with a herniated disc.
The main cause of the condition is trauma to the piriformis muscle, which compresses the sciatic nerve and results in inflammation. In some cases, pain and difficulty when sitting or walking are experienced. The sciatic nerve passes mostly under the piriformis. It is known as the longest and largest nerve in the body. Patients often report increased pain when sitting for long periods of time or getting out of bed. It is usually aimed to relieve the pain by resting or doing some exercises. In some cases, there are differences in treatment planning.
Symptoms and Types of Piriformis Syndrome
Symptoms of piriformis syndrome usually occur in the buttocks or upper leg. The pain develops in the leg area, usually in the back, and progresses to the feet, causing tingling and difficulty walking. This condition can often be confused with a herniated disc. The pain can also occur on both sides at the same time.
The signs and symptoms observed in the majority of cases can be listed as follows:
- Increased pain when sitting, lying down or standing
- Weakness in the legs
- Difficulty sitting
- Difficulty walking
- Limping during walking
- Pain that increases with rest and decreases with movement
- Pain when standing up after sitting
- Pain in the buttocks and coccyx
- Pain, numbness and tingling radiating from the back of the leg to the feet
- Loss of strength in leg muscles and night pains in progressive cases
The types of piriformis syndrome are divided into two. It is classified as primary and secondary piriformis syndrome.
Primary syndrome is linked to anatomical structure. It develops depending on the variation of the muscle or nerve from individual to individual. It is the syndrome that occurs as a result of the incompatibility of the muscle with the nerves.
Secondary syndrome is related to traumas such as accidents, injuries, disorders and lifestyle factors. Depending on the factors, the piriformis muscle may deform over time.
Causes of Piriformis Syndrome
Any condition that can cause the piriformis muscle to press on the sciatic nerve can be among the causes of piriformis syndrome . Common causes include swelling or inflammation of the piriformis or surrounding tissues, muscle spasm and scarring of the muscle. In addition to these, other possible causes include
- Falls or injuries
- Traumatic events such as traffic accidents
- Negative effect on the piriformis muscle as a result of sudden movement
- Intense exercises on the piriformis muscle
- Adopting a sedentary lifestyle
- Prolonged sitting on a hard surface
- Heavy lifting and transportation
- Distortion or curvature of the spine
- Surgery on the hip or surrounding tissues
How is Piriformis Syndrome Diagnosed?
There is no standard method for the diagnosis of piriformis syndrome . It is mostly diagnosed by anamnesis and physical examination. In addition, it needs to be differentiated from diseases such as herniated disc as it shows similar symptoms and complaints. The specialist may ask some questions to learn the patient's medical history.
Situations such as the patient's mobility in daily life, working conditions and physical activities are learned in detail. The patient is then physically examined. During the physical examination, the patient is asked to perform movements such as bending, stretching, bending and lifting his/her legs to check for muscle strain.
If no definite result is obtained as a result of the physical examination, the doctor may resort to some imaging techniques. These methods include Ultrasound, Computed Tomography, Magnetic Resonance Imaging (MRI) and Electromyography (EMG).
Magnetic Resonance Imaging (MRI), one of the imaging methods, helps to determine the condition of the sciatic nerve and piriformis muscle. When an abnormality is detected during imaging, the condition is diagnosed. However, most of the time, these conditions can be determined by physical examination.
Piriformis Syndrome Treatment
Treatment of piriformis syndrome is done by planning the appropriate methods depending on the diagnosis and the patient's condition. Treatment methods deemed appropriate by experts may include painkillers and muscle relaxants, physical therapy and lifestyle changes. In addition, if this condition is diagnosed early, the cure rate is much higher.
Depending on the patient's complaints, pain and condition, the treatment plan can be modified. In acute pain, rest and treatments to eliminate muscle spasm can be applied. Activities such as prolonged standing or running may be restricted. If there is edema; cold application and some stretching exercises are performed. Physical therapy can be applied afterwards.
Mostly applied treatment methods can be listed as follows:
- Rest
- Exercises to strengthen muscle
- Muscle relaxants
- Steroid injections
- Physical therapy
- Botulinum toxin injections
- Local anesthesia injection
- Corticosteroid injection
Patients are usually advised to make lifestyle changes. This problem is tried to be solved without the need for procedures such as surgery. However, surgical operation may be applied in advanced cases after all methods have been tried and failed.
In addition, there are some recommendations that individuals should make as a precaution against such disorders. These can be listed as follows:
- Not staying still for a long time and not sitting for a long time
- Taking frequent breaks while driving
- Regularly practicing exercises to exercise the piriformis muscle
- Taking regular walks
- Adopting healthy eating habits
- Regular home exercises for people at home