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What is Piriformis Syndrome? What are the Symptoms?

Piriformis Syndrome

Piriformis syndrome is a condition that many people face today, but is often misdiagnosed. It is characterized by pain, numbness and discomfort in the hip and leg and significantly reduces the quality of daily life.

The piriformis muscle is located in the deep gluteal region of our body and enables a range of movements, including external rotation. However, overuse, injury or anatomical abnormalities of this muscle lead to piriformis syndrome.

Our article discusses in detail what piriformis syndrome is, its causes, symptoms, diagnosis and treatment methods. It also includes MRI images associated with piriformis syndrome, while answering the most common questions patients ask.

If you experience pain, numbness or discomfort in your hip and leg area, if these symptoms cannot be explained by MRI imaging of the lower back, that is, if there is nothing in your lower back, you may have piriformis syndrome.

This article not only provides everything you need to know about piriformis syndrome, but also informs you about your treatment options.




What is Piriformis?


Piriformis is the name of a muscle located behind the hip joint. The name is derived from the Latin word 'pirum', meaning 'pear', and 'forma', meaning 'shape', meaning a pear-shaped muscle.

The area where the piriformis muscle is located is called the deep gluteal space. The function of the piriformis muscle is to turn the leg and hip outwards. (External rotation) There are 6 other muscles that perform this function.

The piriformis muscle starts from inside the pelvis (anterior aspect of the sacrum) and attaches to the hip bone. During this passage, the piriformis muscle crosses over the sciatic nerve and crosses it.


What is Piriformis Syndrome?

Especially in sports activities, if the piriformis muscle is activated and worked for more than normal time, the growing (hypertrophy) piriformis muscle compresses the sciatic nerve just below it, causing pain and numbness in the hip and thigh area (numbness continues up to the heel in some patients), i.e. piriformis syndrome.

We also know that in some patients it can start after traumatic situations such as falling on the buttocks.

Some patients are more prone to piriformis syndrome due to anatomical differences. In about one-fifth of the population, the sciatic nerve passes above and below the piriformis muscle, rather than under it, or splits into two. These people are predisposed to piriformis syndrome.

What Causes Piriformis Syndrome?

 The causes of piriformis syndrome are usually the following:

  • Vigorous exercise, sports activities or movements at work that repeatedly strain the piriformis muscle. One-sided rowing is a good example.

  • Piriformis muscle injury after a fall.

  • Abnormal position of the sciatic nerve and piriformis muscle.

  • Sitting for a long time.

  • In diseases and conditions such as scoliosis or different leg lengths, the piriformis muscle on one side may overwork and hypertrophy due to altered biomechanics, leading to piriformis syndrome.

What are the Symptoms of Piriformis Syndrome?

There are various symptoms associated with piriformis syndrome, but piriformis pain is always caused by a compressed sciatic nerve. The earliest symptoms may manifest as numbness or tingling in the buttocks, but the pain will eventually develop.

  • Hip pain, pain can spread over time from the hip to the back of the knee, between the knee and the heel.

  • Reduced sitting time. Most patients report that they cannot sit for more than half an hour.

  • Hip pain that worsens and numbness that occurs when you move your hip or leg.

  • Numbness starting from the buttock and continuing to the back of the knee and even to the heel.

  • Numbness in the whole leg when you wake up in the morning.

  • Pain and numbness triggered by activities such as sitting, running and climbing stairs.

  • Spasm, stiffness in the piriformis muscle felt by the doctor during the examination.

If you have severe hip pain, you can click on the link for our article on symptoms of hip impingement.

How is Piriformis Syndrome Diagnosed?

 Diagnosis of piriformis syndrome is not easy, it requires experience. Especially the fact that the symptoms are almost identical to those of a herniated disc makes the diagnosis of piriformis difficult. The first thing to do in a patient with piriformis symptoms is to examine the lumbar region and show that there is no herniated disc with MRI imaging.

There is no medical test that pinpoints piriformis syndrome. Since there is no specific blood test or imaging test that makes a definitive diagnosis possible, caution is used when diagnosing Piriformis syndrome.

In only 10-15% of patients with a confirmed diagnosis of piriformis, MRI of the pelvis shows that the piriformis is enlarged compared to the contralateral side.

Often piriformis is diagnosed by showing that there is no other problem. This is called a diagnosis of exclusion.

The physical examination often involves specific examination tests to understand which parts of the piriformis muscle are causing pain.


Piriformis Syndrome vs Sciatica

 The most common cause of sciatica is due to problems in the lumbar region.  Lumbar disc herniation and spinal stenosis are the most common causes of lumbar sciatica. Both piriformis syndrome and herniated disc and canal stenosis show the same symptoms; sciatica.


The most common cause of non-lumbar sciatica, also called non-discogenic sciatica, is piriformis syndrome. Therefore, the first lumbar region of a patient with sciatica is examined with MRI imaging.




Piriformis Syndrome MR Image

MRI Image of Piriformis Syndrome of the pelvis showing the enlarged piriformis muscle on the right side in the figure above. This patient underwent surgery and got rid of her pain.

How to Treat Piriformis Syndrome?

Treatment of piriformis syndrome involves several options. There is no single treatment. It may be necessary to try different treatment methods to see what works best for a particular condition. Various treatments include a combination of more than one of the following:

  • Modifing activities, rest.

  • Stretching and exercises with a experienced physiotherapist.

  • Cortisol injection under ultrasound.

  • Botox injection (botulinum toxin)

  • Manual therapy by an experienced physiotherapist.

  • Surgery.

The duration of the onset of the disease is important when deciding on treatment. In cases where Piriformis syndrome has just started, stretching exercises, manual therapy, rest and injections are beneficial, while in chronic cases, these applications are almost no benefit. Or they got temporary benefits.

Surgery is the only treatment that chronic cases will benefit from.


Exercises for Piriformis Syndrome


Piriformis syndrome exercises help relieve symptoms by focusing on strengthening and stretching the piriformis muscle. These exercises include piriformis stretching, hip and lower back stretching exercises. To list

  • Piriformis Stretching

  • Hip Stretching Exercises

  • Waist Stretching Exercises


Piriformis Stretching Exercises:


By clicking on this link, you can watch Piriformis stretching exercises:




What is The Best Sleeping Position Who Have Piriformis Syndrome?


The best sleeping position for someone with Piriformis syndrome is typically one that reduces pressure on the piriformis muscle and the sciatic nerve. Here are some tips;


1. Sleep on Your Side with a Pillow Between Your Knees: This position helps keep the pelvis, hips, and spine in better alignment and can relieve pressure on the piriformis muscle. Ensure that the pillow is thick enough to keep your top knee from dropping onto the bed, which can twist and strain the spine and hip.


2.Fetal Position: Curling into a gentle fetal position can open up the spaces between the spine’s vertebrae, relieving pressure on nerves and stretching the piriformis muscle. This can be a comfortable position for those suffering from sciatic pain associated with Piriformis syndrome.


3. Sleep on Your Back with a Pillow Under Your Knees: If you prefer sleeping on your back, placing a pillow under your knees can maintain the natural curve of your spine and reduce the strain on your piriformis muscle. Additional support, like a small, rolled-up towel under the small of your back, can enhance spinal alignment.


Avoid sleeping in a position that puts pressure on the buttocks or lower back, and try to avoid lying flat without any leg support. Also, avoid sleeping on your stomach, as this position can put undue stress on your neck, back, and hips, potentially aggravating your symptoms.


Remember, the best position might vary from person to person, so it may take some experimentation to find what works best for you.


Piriformis Syndrome Surgery


There are two different methods for the surgical treatment of piriformis syndrome;

  • Open surgical method

  • Closed surgical method (endoscopic piriformis release)

Whether closed or open surgery, the success rate of piriformis surgeries is quite high.

Open Piriformis Syndrome Surgery:

In the vast majority of patients, the pain and numbness caused by piriformis syndrome begins to decrease to a noticeable extent even immediately after surgery.

One day after surgery, patients can walk, sit and shower without support. In the following days, as the surgical site heals, the patient realizes better that they do not have old, chronic pain. Especially 10 days-2 weeks after the operation, they can return to their daily activities.

Click for Piriformis Muscle Tenotomy Surgery Youtube Video.

Closed Piriformis Surgery (Endoscopic Piriformis Surgery):

It is much more comfortable than open surgery. While an incision of approximately 7-8 cm is made in open surgery, this surgery is performed through 2 1 cm holes in closed surgery. This means that the postoperative rehabilitation-recovery process of closed surgery is faster.


Risks of Piriformis Syndrome Surgery

The risks of surgery, like any surgery, involve some risks and can include infection, bleeding, nerve damage and complications related to anesthesia. However, when done correctly, surgery for piriformis syndrome is usually an effective treatment option and the risk is low.

For more information about Piriformis Syndrome Surgery, please do not forget to contact us through our communication channels.

Function of Piriformis Muscle:

The piriformis muscle is a muscle located deep in the hip that connects the pelvis to the femur bone and is a very important structure that provides hip joint movements. The main functions of the piriformis muscle are as follows:

  1. External Rotation of the Hip: The piriformis muscle performs external rotation by turning the hip outwards. This movement is especially important when standing or walking.

  2. Hip extension The piriformis muscle supports the hip extension movement by helping to push the hip backwards. This movement is often used when climbing stairs or running.

  3. Hip Stabilization: The piriformis muscle stabilizes the body by increasing stability around the hip joint. This is important in daily activities, sports and other movements.

These functions of the piriformis muscle support hip joint function, ensuring normal movements. The piriformis muscle is also involved in the development of conditions such as piriformis syndrome.

Piriformis Syndrome Surgery - My Patient's Review

Video testimonials from patients sharing their experiences after piriformis syndrome surgery provide important information about the treatment process. These videos clearly reveal the recovery process and the difficulties faced by patients who have undergone piriformis syndrome surgery.

Listening to patients' experiences is a valuable resource for managing expectations before and after surgery and entering the treatment process better prepared. Here is the Comment of My Patient with Piriformis Syndrome Surgery:

Frequently Asked Questions About Piriformis Syndrome

In particular, answers to common questions about Piriformis syndrome help people to better understand their condition and approach the treatment process in a more informed way.

In this section, you can find answers to frequently asked questions about piriformis syndrome. If you also have questions, you can ask us via whatsapp.

  • How Is Piriformis Syndrome Definitively Diagnosed?

Experience is needed to make a definitive diagnosis of piriformis syndrome. It should be remembered that the diagnosis of piriformis syndrome is a diagnosis of exclusion. There are many conditions with the same symptoms as piriformis syndrome, the most common of which is a herniated disc.

  • What is the definitive solution for Piriformis Syndrome?

In chronic cases lasting more than 3 months, surgery is the definitive solution, while in early recognized piriformis syndrome, good results are obtained with relaxation exercises, injections and manual therapy.

  • What is the function of the piriformis muscle, is there a negative situation if this muscle is cut during surgery?

The function of the piriformis muscle is to turn the hip outwards (external rotation). There are 6 other muscles that perform this function. It is also the most powerful external rotator muscle of the hip/leg. Gluteus Maximus muscle. Therefore, if the piriformis muscle is relaxed, patients do not lose any function.

  • Does Injection Help in Piriformis Syndrome?

Especially injections performed under ultrasound and by a physician who has experience in this field are beneficial. However, it is unlikely to get results with injections in chronic cases.

  • Where is the piriformis muscle?

The piriformis muscle is a small muscle group located in the buttock area, between the pelvis and the upper femur (thigh bone).

  • Is Piriformis Syndrome Surgery Successful?

Whether closed or open surgery, the success rate of piriformis surgeries is quite high.

  • What to Expect After Piriformis Surgery?

After surgery for piriformis syndrome, a certain recovery period usually awaits the patient. Here is what happens in stages:

  1. Reduction of Pain and Discomfort

  2. Slow Healing Process

  3. Physical Therapy and Exercise

  4. Sciatic Nerve Problems

  5. Slowly Increasing Activity

  • Does piriformis syndrome go away on its own?

In mild cases, with rest, ice application, anti-inflammatory medication and certain exercises, symptoms are usually relieved and may resolve spontaneously over time.


As a result, if you suspect piriformis syndrome or are experiencing problems with this condition, it is important to consult a health professional. Dr. Utku Erdem Özer has extensive experience with piriformis syndrome. Remember that early diagnosis and appropriate treatment can make a big difference in the recovery process.

Thank you for reading our article. If you wish, you can return to the main page from the link.



Kiss. Dr. Utku Erdem Özer Contact

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