Piriformis Syndrome: A Big Pain in the Butt
Dr. Thomas Patavino of Thoracic Park Alternative Health

      The irony of life is often perplexing. It is human nature to equate the size of something with value and magnitude of importance. We tend to pay more attention to the big things in life and often overlook the small stuff. Unfortunately, when it comes to health, size is often deceiving. Small things tend to cause big problems. A good example is the piriformis muscle. Most people never heard of this pyramid shaped muscle. The piriformis is a small muscle that sits deep beneath the gluteus maximus muscle that assists in turning our legs outward. As it pertains to our health, an irritated piriformis can be a real pain in the butt…literally.

      Piriformis syndrome is a condition characterized by buttock pain that can radiate down the back of the thigh. Many people are probably thinking this sounds a lot like sciatica and this is true. True sciatica is irritation of the sciatic nerve by either a herniated disc, bone spur or inflammation at the lower lumbar spine causing pain and numbness throughout the branches of the sciatic nerve affecting the buttocks, posterior thigh, calf and outside of the foot. Piriformis syndrome and sciatica share similarities because of their anatomical proximity in the body. The sciatic nerve sits right beneath the piriformis muscle. To further complicate things, there is a portion of the population that actually has a split piriformis, and the sciatic nerve pierces the split in the piriformis muscle. A tight piriformis muscle can actually antagonize the sciatic nerve and cause the nerve to radiate pain down the buttocks and the back of the thigh. Trauma to the muscle or an active trigger point in the piriformis can also cause this “pseudo-sciatica” or sciatica-like pain.

     Although very similar in nature, the prognosis is far different. Sciatica can be much more difficult to manage because you are dealing with actual nerve damage. It is not uncommon to undergo spinal injections or surgery for severe conditions of sciatica that fail under conservative care. Piriformis syndrome, although very painful and annoying, is usually managed conservatively and is less life altering. Physical therapy, soft tissue treatments, chiropractic care and appropriate stretching/strengthening often alleviate the condition. Conservative care is successful because we are dealing with a problematic muscle rather than a bulging disc or bone spur piercing the delicate sheath of the sciatic nerve. Diagnosis is mostly based on clinical findings rather than a specific diagnostic test. Palpation and reproduction of symptoms help determine the source of pain and rendering a proper diagnosis.

       How common is piriformis syndrome?  Piriformis syndrome appears a lot in runners, especially those who run down hill. Pregnant women often suffer from piriformis syndrome because of the laxity in their ligaments and the change in position of their pelvis to accommodate childbirth. Athletes who change direction a lot such as soccer, football and hockey can be prone to the injury. Tight hamstring muscles can often increase the stress on the piriformis and dramatically increase the chances of a piriformis flare-up. Stress in non-athletes can also lead to piriformis syndrome. Office workers who sit for many hours often complain of the condition. Surprisingly, carrying a wallet in your back pocket can lead to discomfort related to piriformis syndrome.

  In conclusion, piriformis syndrome can be a very painful annoying condition. Its very presence can set off alarms and lead both physicians and patients to believe sciatica is present.  A thorough evaluation and proper work up will determine the source of the buttock and thigh pain. To the relief of many, piriformis pain is not the same as sciatica and it is much easier to manage once properly diagnosed.  Conservative care can usually provide relief and prevent piriformis syndrome from becoming a chronic problem. To answer any questions, Dr. Tom Patavino can be reached at 758-7250 or by email dr.tpatavino@sbcglobal.net