Piriformis Syndrome

It occurs when the piriformis muscle, which extends from the pelvis to the thigh bone and enables outward rotation of the hip, crushes the sciatic nerve passing through or beneath it like a vise, causing pain.

In a herniated disc, the sciatic nerve is pinched in the spine (lower back). In piriformis syndrome, the lower back is completely healthy, and the nerve is compressed in the muscle inside the buttock. Because the symptoms (pain radiating down the leg) are very similar, they are often confused with each other.

Sitting for long hours on hard chairs with a thick, hard wallet in the back trouser pocket (like drivers or office workers) directly applies pressure to this muscle, triggering the syndrome, which is why it bears this name.

A deep ache exactly in the middle of the buttock, with an electric shock sensation, burning, and numbness traveling from the back of the thigh down to the knee. The pain intensifies when climbing stairs, squatting, or sitting for extended periods.

A Lumbar MRI is performed to rule out a herniated disc. Diagnosis is established through a physical exam when pressing on the piriformis muscle triggers pain radiating down the patient's leg (Freiberg/Pace tests), and sometimes a hip MRI shows a thickened muscle.

Initially, physical therapy aiming to stretch the hip muscles (stretching exercises), hot/cold applications, and muscle relaxants are given. If the spasm does not resolve, local anesthetics, cortisone, or Botox injections are administered directly into the muscle under ultrasound guidance to relieve the pressure on the nerve.