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Whether you are a professional athlete or a weekend warrior out catching a few passes with a group of friends, Achilles tendonitis can literally stop you in your tracks. It can have a debilitating and worsening effect on your daily life. If you’re suffering from ankle pain, this is what you need to know.
Piriformis syndrome is a condition in which the piriformis muscle compresses the sciatic nerve. This compression causes pain to travel through your buttocks to the side and back of the leg and down to the foot, often accompanied by tingling or numbness. This type of radiating pain is called sciatica. Sciatic pain may be most often associated with a herniated disc, but it can also occur with piriformis syndrome. This type of pain is a symptom of the condition, not a condition in and of itself.
Piriformis syndrome pain begins with muscle tension and spasms that affect the sciatic nerve. Most patients report an ache deep in the buttocks, which is intensified by sitting or climbing stairs.
Other than sciatic pain, piriformis syndrome symptoms also include:
The intensity of piriformis symptoms varies wildly from person to person depending on their age, activity level, and any comorbid conditions. Some people may only have mild, annoying symptoms, while others may be completely debilitated.
Further, piriformis syndrome can be an acute condition that resolves with rest, or a chronic, debilitating problem resistant to treatment.
The piriformis muscle makes walking and your overall balance possible. It’s a large, flat, pyramid-shaped muscle deep underneath the gluteal muscles in the buttocks. Starting at the sacral spine, the piriformis muscle travels to the greater trochanter of each femur, stabilizing the hip and allowing the thigh to move outward from the body. In most people, the sciatic nerve rests underneath the piriformis muscle, but in about 15% of the population, the sciatic nerve passes through the muscle.
Regardless of where the sciatic nerve travels, the most common cause of piriformis syndrome seems to be overuse or improper use of the piriformis muscle. This can lead to inflammation in the muscle, which then compresses the sciatic nerve. Any injury or trauma to that area of the body can also cause inflammation that leads to nerve compression.
Repetitive motions performed during activities such as running or lunging stress the piriformis muscle, causing contractions that apply pressure to the sciatic nerve. Certain activities can irritate the piriformis, including:
Compression of the sciatic nerve can result in inflammation that exacerbates pain, leading to a chronic condition. Although sciatic pain is equally possible in men and women, piriformis syndrome is more common in women than men.
Certain chemicals may also cause inflammation that, when combined with other factors, can lead to piriformis syndrome. These chemicals include histamine, serotonin, prostaglandin, and bradykinin.
Patients affected with Morton’s neuroma may also be at increased risk for developing piriformis syndrome. This condition involves an anatomical deformity of the second metatarsal that destabilizes the foot during walking, resulting in internal rotation of the leg. The piriformis compensates by contracting repetitively during the push-off phase of walking, which can cause chronic compression of the sciatic nerve.
Other conditions that may result in piriformis syndrome include:
A definitive test for piriformis does not exist, so a diagnosis is made based on a detailed history and physical exam. Your doctor will ask questions to find out when your pain began, how long it lasts, and what makes it worse.
It can be very helpful to keep a pain journal when you first notice symptoms. Record any instances of pain and note:
Keeping a pain journal offers more insight into potential causes of your pain as well as aids in diagnosis.
By palpating the piriformis, your doctor may determine if it is contracted and tense. The Freiberg test determines involvement of the piriformis muscles with a simple movement. When forced internal rotation of the extended leg results in pain in your buttocks or down the leg, piriformis syndrome is a strong possibility.
Another movement that contracts the piriformis muscle selectively is the Beatty maneuver. Lie on the side that is not in pain, bend the knee towards the chest, and then pressing the knee down towards the ground. This activates the piriformis and, when piriformis syndrome is present, results in pain.
A visual exam can also show shortening of the leg on the affected side. You may also have a splayed foot on the affected side when lying on your back.
An X-ray or MRI does not diagnose piriformis syndrome but can rule out other, more common causes of sciatica, such as:
Nerve conduction tests may be helpful in excluding other conditions as well.
In the acute stages of piriformis syndrome, first-line treatment focuses on resting the muscle, avoiding activities that aggravate pain, and pain relief measures. Pain management after the first 24 hours may utilize heat. A heating pad placed on the muscle for 20 minutes at a time may reduce inflammation and pain.
Other treatments include:
For persistent pain that does not respond to conservative treatment options, corticosteroid and anesthetic injection to the area may reduce inflammation and pain.
Surgery is an extreme measure only taken as a last resort in treating chronic, debilitating pain.
If you have any questions or are simply looking for more information please contact us and our friendly team will be happy to answer your questions and help in any way we can.Â
