Piriformis syndrome: pain in the buttocks

Piriformis syndrome: pain in the buttocks

Piriformis syndrome describes tension in the piriformis muscle with sciatic nerve irritation. It causes pain in the buttocks and sacrum, which can also radiate into the leg. Other, more severe illnesses are sometimes possible with these symptoms, so other causes should be ruled out before diagnosing piriformis syndrome. Therapy is conservative, including special exercises to stretch the muscle – so surgery is usually unnecessary. Read below which physiotherapy techniques help and which stretching exercises you can do independently.

What is the Piriformis Muscle?

The cause of piriformis syndrome lies in the piriformis muscle. The piriformis muscle (also M. piriformis, Latin for “pear-shaped muscle”) belongs to the deep layer of the hip muscles. It extends between the femur’s greater trochanter and the sacrum’s edge.

Its main functions are external rotation and hip abduction and extension. As part of the gluteal muscles, the piriformis muscle is active with every step and is used frequently in everyday life.


What causes Piriformis Syndrome?

The most common cause of piriformis syndrome is overloading the piriformis muscle, caused by an unfavourable sitting posture. Sitting for long periods, as with professional drivers or desk work, can lead to muscle tension and shortening in the long term.

One-sided strain during sports or physical activities can also be problematic, for example, cycling for long periods or lifting heavy weights from the straddle.

Eine Funktionsstörung der kleinen Wirbelgelenke im Lenden- und Kreuzbeinbereich oder des Iliosakralgelenks (ISG) kann ebenfalls zu einer Verspannung des Musculus piriformis führen. Auch Erkrankungen des Hüftgelenks, zum Beispiel Arthrose, sollten als Ursache für einen schmerzhaften Piriformis in Betracht gezogen werden.

Ein Trauma in Form eines direkten Sturzes oder Schlags auf das Gesäß oder ein längerer “Portemonnaiedruck” in der Gesäßtasche können ebenfalls ein Piriformis-Syndrom auslösen.

Ischiasnerv kann Schmerzen beim Piriformis-Syndrom beeinflussen

Der “Ischiasnerv” (Nervus ischiadicus) zieht in unmittelbarer Nähe des Piriformis-Muskels Richtung Rückseite des Beins. Ist der Musculus piriformis verspannt und verdickt, kann er auf den Nerven drücken, was eine typische schmerzhafte Ausstrahlung in die Oberschenkelrückseite, die Wade oder bis hinunter zur Fußsohle verursacht.


Symptome: Wo schmerzt der Piriformis?

The symptoms of piriformis syndrome are mainly unilateral (sometimes bilateral) pain in the buttocks, sacrum (sacrum) or lower back, often radiating to the back of the leg, especially the thigh, but also down to the foot. The pain occurs most often when sitting due to pressure on the muscle. But the pain can also be triggered by straining the muscle, i.e. when walking, running or jumping.

Pain at night can make it impossible to find a suitable sleeping position. It can often help to sleep on your back with your legs stretched out since bent legs in a side position often put additional strain on the muscle.

In addition to the pain, there are reports of abnormal sensations such as tingling sensations or numbness and the buttocks falling asleep.

Diagnosis of piriformis syndrome

The clinical examination by the family doctor or orthopedist is crucial. The statics of the body, i.e., posture, gait pattern, and leg length, are checked. The piriformis muscle, which lies deep in the buttocks, is palpated. If typical pain patterns can be provoked, piriformis syndrome should be considered. Special clinical tests can confirm the suspected diagnosis, in which the muscle is stretched or indirect pressure is applied to the sciatic nerve.

Trigger points in piriformis syndrome

Some pain points lead to a characteristic radiating pain. These points are called trigger points. These are palpable, punctiform, painful muscle hardenings that express the tension in a muscle. If a characteristic pain can be produced during the medical examination by light pressure on the typical trigger points of the piriformis syndrome, this supports the diagnosis. The trigger points can be treated in a targeted manner as part of physiotherapy and, in the best case, can be made to disappear.


Herniated disc or piriformis syndrome?

An important differential diagnosis of piriformis syndrome is a herniated disc in the lumbar spine or the transition to the sacrum. Spinal cord nerves are constricted, which leads to characteristic radiating pain in the leg region. Since the tense piriformis muscle also leads to sciatic nerve irritation, the symptoms can be similar. Conversely, a herniated disc can also be accompanied by tension in the piriformis muscle.

The two clinical pictures can sometimes be separated, even through a precise examination and tests. In case of doubt, further observation of the course over a few weeks helps. MRI imaging can then provide certainty about the cause of the lower back pain.

Getting rid of piriformis syndrome

Piriformis syndrome is treated conservatively. The focus is on muscle stretching exercises. After a physiotherapeutic instruction, these exercises can also be continued independently at home. Manual therapy applications as part of physiotherapy also promise therapeutic success.

A massage can also provide relief to loosen the muscle.

If physiotherapeutic applications do not lead to the desired success and the piriformis syndrome does not go away, the therapy can be expanded to include acupuncture, shock wave therapy or neural therapy (treatment with local anaesthetics).

It is essential to permanently change the triggering factors, such as an unfavourable sitting position at work. Otherwise, the symptoms can worsen despite treatment.

Stretching exercise of the piriformis muscle

You can stretch the piriformis with the following example exercise:

  1. Sit upright in a chair.
  2. Place the leg on the affected side on top of the leg on the healthy side. The ankle of the affected side is, therefore, on the thigh of the other leg.
  3. Gently press the knee of the crossed leg down toward the floor. If necessary, hold your foot.
  4. Feel the stretch deep in your buttocks. This can be carefully reinforced by leaning forward slightly with your back straight.
  5. Hold the stretch for about 1 minute.
  6. Repeat the exercise three times a day.


Medication for piriformis syndrome

If the pain is very severe, it is advisable to take light painkillers to be able to carry out effective physiotherapy. So-called NSAIDs (“non-steroidal anti-inflammatory drugs”), such as ibuprofen or diclofenac, should be used here to achieve an anti-inflammatory effect in addition to pain relief.

Cortisone injections can also be used to control the irritation.

Can piriformis syndrome be removed with surgery?

An operation can be carried out in very severe cases and long-term symptoms. This involves lifting the sciatic nerve from the piriformis muscle and releasing adhesions. The tendon of the piriformis muscle is separated from its bony origin, and degenerative tissue is removed.

Duration of Piriformis Syndrome

The duration of the symptoms depends on how muscular the muscle tension is. Sometimes, the muscle can relax spontaneously by simply waiting and resting. For more stubborn cases, complete recovery can almost always be achieved through physiotherapy, massages and self-exercises.

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