Conventional Treatments for Piriformis Syndrome

What is piriformis syndrome?

Piriformis syndrome is a health condition that occurs when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is located in the buttocks near the upper portion of the hip joint; it stabilizes the hip joint and enables the rotation of the thighs. The sciatic nerve runs alongside the piriformis muscle, and after branching off into smaller nerves, it ends at the feet. Piriformis syndrome occurs when the piriformis muscle spasms or contracts and irritates or compresses the sciatic nerve. This results in pain that initiates in the buttocks, sometimes extends down the back of one or both legs, and occasionally enters the feet. Tingling or numbness may also be felt in the affected area.

Piriformis syndrome can be prevented by properly stretching prior to exercise and by modifying physical activities. In most cases, piriformis syndrome does not require medical treatment; however, if the pain and numbness associated with piriformis syndrome do not improve with self-care, treatments are available.

What are the treatment options?

Treatment of piriformis syndrome may include one or a combination of the following:

• Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, can lessen the pain and inflammation associated with piriformis syndrome.
• Injections of corticosteroids or anesthetics can decrease piriformis muscle inflammation.
• Physical therapy, such as stretching and strengthening exercises, can reduce symptoms. Strength and flexibility of the piriformis muscle reduces sciatic nerve compression.
• Massage therapy can ease spasms and tension in the piriformis muscle, reducing pressure on the sciatic nerve.
• Myofascial release therapy can loosen the movement of the piriformis muscle and reduce pressure on the sciatic nerve.
• OnabotulinumtoxinA injections can relieve tightness in the piriformis muscle and the compression of the sciatic nerve.
• Transcutaneous electrical nerve stimulation (TENS) is a pain-reduction therapy that uses a device to transmit slight electrical charges through the skin to the nerves. TENS therapy interrupts pain signals sent to the brain.
• Surgery for piriformis syndrome is rare and a last-resort treatment. Surgery aims to decrease pressure on the sciatic nerve by interrupting the piriformis muscle.