The piriformis muscle is a muscle that extends in the form of a band in the deep part of the buttocks, and when this muscle presses on the nerves, a condition called piriformis syndrome occurs. Piriformis syndrome, which is confused with this condition, especially because it gives symptoms similar to herniated disc, is 6 times more common in women than in men. The main reason for this situation is that the muscle in the pelvis in women has a wider angle than in men.
What Is Piriformis Syndrome?
Piriformis syndrome is a condition that occurs when the piriformis muscle, located in the hip, compresses the sciatic nerve. The syndrome can develop suddenly or gradually over time. As a result, symptoms such as leg pain, numbness and tingling that radiate to the back of the leg and feet occur. Pain is usually worse in people with piriformis syndrome when sitting. In some cases, movements such as crossing the legs and walking can also be painful or difficult. In addition, piriformis syndrome is characterized by symptoms of herniated disc such as back and hip pain, so this condition is often confused with herniated disc.
Types Of Piriformis Syndrome
Piriformis syndrome is divided into two:
Primary Piriformis Syndrome
It is related to anatomical structure and develops due to the difference in the muscle or nerve from person to person. If the piriformis muscle is not structurally compatible with the nerve that passes under it, primary syndrome occurs.
Secondary Piriformis Syndrome
Traumas, disorders and lifestyle factors are effective in the development of this syndrome. Due to all these factors, the piriformis muscle may deform over time and the syndrome that develops in this case is called secondary syndrome. Most piriformis cases fall into the secondary syndrome group.
What Causes Piriformis Syndrome?
In addition to genetic factors, piriformis syndrome can be caused by a variety of factors, including environmental factors, past illnesses, and lifestyle. In general, the following are among the conditions that can cause this syndrome:
Traumas such as traffic accidents, high intensity bumps and falls can all cause damage to the piriformis muscle. Piriformis syndrome may develop as a result of sudden rotation of the hip and exposure to high-energy movements.
Unhealthy Living Habits
The piriformis muscle can be damaged by prolonged and strenuous exercise, as well as by prolonged inactivity. In particular, in cases where a sedentary and unhealthy lifestyle is developed, this muscle becomes too sensitive to even sudden movements and mild stretching. As a result, damage can occur in the strained and unmoving muscle. In addition, many conditions, such as lifting weights, overworking the muscle with excessive exercise, and performing repetitive movements in the legs for a long time, can lead to piriformis syndrome.
In cases where the length of the two legs is structurally different, in the presence of spinal curvature, or after previous hip surgery, the piriformis muscle becomes prone to deformities. Hip tumors or vascular problems in this area can also trigger piriformis syndrome.
In addition to these, all of the following conditions, such as acquired incorrect sitting and posture disorders, sitting on a hard surface for a long time, or carrying heavy loads in the hip area due to occupational necessity (such as a weapon), can cause damage to the piriformis muscle and can be listed among the causes of the syndrome. Piriformis syndrome can also develop due to many other causes, such as injections to the gluteal region, colorectal cancers, abscesses, hematomas, tumors, and neuromas in the gluteal region.
How Is Piriformis Syndrome Treated?
In patients with piriformis syndrome, there are restrictions on activities such as standing for long periods of time, walking, or running. Since the symptoms are often similar to those of a herniated disc, it is necessary to make a good differential diagnosis of the disease before treatment. For this, in addition to patient history and physical examination; Various imaging tests are performed and a definitive diagnosis is made. In treatment, the most appropriate methods are selected according to the diagnosis and the person’s condition.
Conservative treatment of piriformis syndrome includes muscle relaxant and pain reliever medication, neuropathic pain treatment, physical therapy, manipulative therapy, lifestyle modifications, and psychotherapy.
In physical therapy, various deep heating devices such as ultrasound, hot and cold applications, electrotherapy, soft tissue mobilization, stretching exercises for the piriformis muscle, functional exercise programs, and correction of incorrect movement patterns are used.
The treatment program varies depending on the patient’s complaints and general condition. Generally, it is recommended to do at least 2-3 sessions a week for effectiveness. Long-term compliance is important for the effectiveness of exercises. Exercises should be done regularly for 2-3 months for the effectiveness of treatment to begin and last. It is recommended to continue exercising at least twice a week afterwards.
Various injection applications are used in the treatment of the piriformis muscle and its surroundings. Local anesthetic injection, corticosteroid injection, botulinum toxin injection, ozone injection, prolotherapy applications, dry needle therapy are some of these injections.
In people with piriformis syndrome, it is primarily aimed to change lifestyle habits and solve the problem without the need for surgical intervention.
The recommendations for this are as follows;
- Avoid prolonged immobilisation and sitting,
- Taking a break while driving and doing stretching exercises,
- Avoiding combinations to the gluteal region,
- Regular stretching exercises for the piriformis muscle,
- Regular and frequent short walks,
- Acquiring healthy eating habits,
- Regular performance of home exercises.
If no response is obtained despite all treatments, surgical treatment may be considered. This surgery is considered in very serious and advanced cases.