Piriformis Syndrome

Piriformis Syndrome: Sciatica-Like Pain


Piriformis syndrome is a clinical disorder characterised by prolonged contraction, spasm, or tightness of the piriformis muscle, which contributes to the development of related back pain, gluteal discomfort, and sciatica-like pain.


When the sciatic nerve is inflamed, it might cause tingling, burning sensation or numbness throughout its distribution through the leg, ankle, and foot. The piriformis muscle is a tiny muscle located deep within the buttock, under the gluteus maximus muscle. The muscle's primary function is to aid in hip rotation or moving the leg and foot outwards.


Piriformis syndrome is rather frequent in those who sit for long periods of time, as well as drivers and runners or recreational athletes. Piriformis syndrome can be caused by any repetitive activity or exercise that strains the piriformis muscle. The inflammation and stiffness inside the muscle may add to the strain on the sciatic nerve. Surprisingly, some people are born with their sciatic nerve behind, on top of, or within the piriformis muscle. This may raise your chances of developing piriformis syndrome depending on where you live. Other less common reasons we see in medical practice include people who keep their wallet in their back pocket, those who sit with their legs crossed, and people who have compromised hip muscle.


People suffering from piriformis syndrome frequently exhibit symptoms such as moderate to severe soreness and sensitivity in the buttock area. Palpation may indicate discomfort along the back of the leg into the hamstring muscles and, in certain cases, the calf muscles. Because of the tight link between the hamstring origin and the piriformis muscle, non-musclularskeletal doctors and individuals sometimes mistake piriformis syndrome symptoms with hamstring damage, or sciatic pain. Typical symptoms are quite similar to those of a variety of different lower back diseases, including sciatica, disc herniation, degenerative arthritis, and mechanical lower back pain.

Common symptoms may include:

  1. Pain in the lower back and buttock regions that may refer to the leg, foot and ankle
  2. Changes in walking or running pattern
  3. Difficulty sitting for prolonged periods of time due to pain



The first step in diagnosing piriformis syndrome is to rule out other, more serious illnesses that appear similarly, such as a disc injury. Musculoskeletal experts such as chiropractors can undertake a thorough lumbopelvic examination. Various tests and screening assessments will be conducted during this examination to examine the lower back, pelvis, nerves and muscles.


Piriformis syndrome is particularly responsive to conservative therapy. A mix of home activities and clinic-based treatment ensures adequate and rapid recovery:


The chiropractic care of Piriformis Syndrome is determined by the age at which it is diagnosed and the severity of the condition. If it is found that Chiropractic therapy may be useful to you, the following approaches may be used:


Specific manual adjustments (spinal manipulation) are made to constrained joints during spinal manipulation for pain in order to enhance total joint alignment, flexibility, and movement as well as to reduce pain and pressure.


Joint mobilisation is for those who dislike manual adjustment or during acute episodes of pain where, joint mobilisation is a more gentle therapy that is frequently employed.


Flexion-distraction & traction therapy as a sort of joint mobilisation that gently stretches the spinal joints, flexion-distraction and traction treatment is a particularly useful method for sciatica and sciatica-like syndromes, and other joint-related conditions.


Postural correction & core strengthening exercises are two activities that can help with musculoskeletal issues that are underlying, with your chiropractor being able to subscribe, monitor and tailor those exercises for each individual patient.


Flexibility exercises & stretches are an excellent way to improve overall flexibility, release tension and support mobility. Most exercises and stretches are tailored to busy modern lives and easily integrate into your daily routine.


Activator Technique or Impulse Mobilisation Therapy (hand-held instruments) is used to facilitate improved joint mobility and is appropriate for all persons and levels of severity.


SOT pelvic blocking (mobilisation of pelvic joints) to promote pelvic and sacral joint mobility.


Soft Tissue Therapy (STT) may be applied to the gluteal and piriformis muscles and connective tissue structures to assist with reduction of pain and increase in mobility.


Trigger Point Thearpy (TrP) may be applied to the gluteal and piriformis muscles to assist with reduction of pain and increase in mobility.


Physiological therapeutics to aid in the reduction of inflammation, physiological therapies such as ultrasound, shockwave therapy, and low level (cold) laser treatment are often used.






Massage for muscular tightness and tension is common for sufferers of Piriformis Syndrome due to the abnormal strain on the muscle. Specific massage and muscle releasing techniques are ideal for improving muscle tension and therefore relieving pain




Strengthening and flexibility When the inflammatory process has calmed, exercise prescription may be beneficial later in the therapy process. The emphasis shifts to prevention and muscle group strengthening in normal function.



The most common clinical symptoms experienced by individuals suffering from piriformis syndrome appear to include buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with movements that enhance piriformis muscle tension. Hopayian, K. (2010). The clinical features of the piriformis syndrome: a systematic review. European Spine Journal, 19(12); 2095 – 2109.


Alternative or complementary treatment approaches such as Chiropractic care for piriformis syndrome appear helpful in managing and resolving associated pain and dysfunction. Tonley, J. et al. (2010). Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement re-education: a case report. Journal of Orthopaedic & Sports Physical Therapy, 40(2); 103 – 111.

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