Piriformis Pain Syndrome: How Physical Therapy Can Help

Most of us have heard of sciatica. This common problem causes intense, radiating pain along the sciatic nerve from the lower back down into the buttock and leg. What you may not know is that approximately 5% of sciatica cases occur from piriformis syndrome.

Your piriformis is a muscle connecting the lowest vertebrae in your back to the upper portion of your leg. However, problems can arise because it passes through the same opening in your pelvic bone as your sciatic nerve — the “sciatic notch.” This small opening puts the muscle and nerve in very close proximity.

Fortunately, physical therapy can provide a noninvasive solution when you experience piriformis pain syndrome. Whether you have muscle issues or sciatica from nerve irritation or compression, our pain management team at Metro Pain Centers can help.

Recognizing piriformis pain syndrome

Piriformis syndrome is relatively common, but often confused with other problems. That’s because its sharp and radiating symptoms can resemble hip bursitis or a herniated disc.

Common signs of piriformis pain syndrome include:

• Numbness or tingling in the buttocks that can radiate into the leg
• Difficulty sitting or bearing weight on the affected buttock
• Muscle tenderness or spasming in the buttock
• Pain in the buttock or leg that worsens with sitting or activity
• Buttock muscle pain during a rectal exam
• Sciatica-like symptoms with outward hip movement and rotation, especially against resistance

The exact cause of piriformis pain syndrome isn’t known, but it’s often in response to injury, overuse, or irritation of the muscle, or structural abnormalities like scoliosis. Our team can usually diagnose piriformis pain syndrome based on your symptoms and a physical exam. 

Physical therapy and piriformis syndrome

While you may not think of your piriformis muscles, you use them every day. Whether your symptoms develop from underused, overused, or injured muscles, physical therapy typically offers the most effective, long-term relief when piriformis pain syndrome occurs.

This customized approach focuses on specific stretches and exercises designed to improve the flexibility and strength of your piriformis. For example, one simple piriformis exercise that provides relief involves lying flat on your back with both knees bent. Then, cross your left ankle against your right knee. Finally, gently pull your right knee toward your chest and hold it for five deep breaths before slowly releasing both feet back to the starting position.

In addition to strengthening and flexibility exercises, your physical therapy could include:

• Osteopathic manipulation to improve bone and tissue alignment
• Hot and cold therapy to reduce muscle spasming and inflammation
• Transcutaneous electrical nerve stimulation or ultrasound to disrupt pain signals

For intense symptoms, we could also recommend adding medications — like pain relievers, anti-inflammatories, and muscle relaxants — or targeted injections into the muscle to decrease spasming. 

After helping get your symptoms under control, we can also provide personalized recommendations to keep your piriformis strong and healthy and prevent reinjury in the future.

If you have buttock pain or sciatica-like symptoms, we can help. Just contact the Metro Pain Centers office closest to you by calling us or clicking the “request appointment” button to book online today.