Piriformis syndrome is deep buttock pain caused when the piriformis muscle tightens or spasms and irritates the sciatic nerve underneath it, sending pain or tingling down the back of the leg. At Advanced Physical Medicine in St. Clair Shores, Michigan, we treat it with ultrasound-guided injections, physical therapy, MLS laser and dry needling.
Piriformis syndrome often feels like sciatica, which is why it is easy to mix up. Typical signs include:
Symptoms usually affect one side. Because they overlap with a herniated disc, hip arthritis and SI joint problems, a careful exam is the first step before any treatment is chosen.
The piriformis is a small muscle that runs from the base of the spine to the top of the thigh bone, right over the sciatic nerve. It can irritate the nerve when it is:
In some people the sciatic nerve passes through the muscle instead of under it, which makes irritation more likely. Because a disc problem in the lower back can cause similar pain, ruling out back problems and spinal stenosis is part of the exam.
Dr. Stephen Wilson, MD, is double board-certified in Physical Medicine & Rehabilitation and Pain Medicine and has more than 25 years of experience treating pain. We examine the hip, back and nerve, and may order an EMG or nerve conduction study to rule out a pinched nerve in the spine. Treatment may include:
Ultrasound lets us see the piriformis muscle and the sciatic nerve, so an injection of anesthetic and anti-inflammatory can be placed precisely. It is one of our interventional procedures.
Trigger point injections and intramuscular stimulation (IMS) release knots and spasm in the buttock and hip muscles.
Targeted stretching of the piriformis and strengthening of the hips and core take pressure off the nerve. Our physical therapy team works on this with you.
MLS laser therapy calms inflammation, and medical massage therapy relaxes the tight muscle.
We teach you stretches to do at home, how to set up your car seat and desk chair, and how to return to running or cycling without the pain coming back.
Make an appointment if buttock pain or pain down the leg lasts more than a couple of weeks, keeps you from sitting through work or a car ride, or keeps coming back. Getting the right diagnosis early means you treat the real source, not just the symptom.
Seek urgent care for leg weakness that is getting worse, numbness in the groin or inner thighs, or loss of bladder or bowel control.
Most people improve with conservative care such as stretching, physical therapy and, when needed, an injection. Staying active and keeping the hip muscles flexible helps keep it from coming back.
Gentle walking on level ground is usually helpful, because it keeps the muscle moving without loading it hard. Hills, stairs and long runs can aggravate it during a flare.
Long periods of sitting, crossing your legs, squatting, climbing stairs and running uphill tend to make symptoms worse.
There is no instant fix, but a combination of stretching, avoiding long sitting and a precise ultrasound-guided injection can bring relief quickly for many patients while therapy addresses the cause.
Sciatica usually comes from a disc or bone spur pinching the nerve in the lower back. In piriformis syndrome the nerve is irritated lower down, in the buttock. The exam and nerve tests help tell them apart.
Book a visit with Advanced Physical Medicine at 24345 Harper Ave, St. Clair Shores, Michigan, or call us at (586) 563-3300. We will find out what is behind your buttock and leg pain and talk you through every option before anything is decided.
