What is Piriformis Syndrome?
Piriformis syndrome is a neuromuscular disorder that occurs when the piriformis muscle puts pressure on the sciatic nerve, creating pressure on the nerve that descends from the spinal cord to the hips and legs. This condition causes symptoms such as tingling, pain and numbness, usually in the hips, legs, lumbar region and feet.
The piriformis muscle begins in the lower body, runs from the spine to the hips, and radiates towards the upper thighs. This smooth muscle helps with lower body movements, extending to both sides of the body. The sciatic nerve passes under the piriformis muscle, starts from the spinal cord and extends from the hip area to the back of both legs. This nerve is one of the longest and largest nerves in the body.
What are The Types of Piriformis Syndrome?
Piriformis syndrome comes in two types.
Primary Piriformis Syndrome:
It is related to the anatomical structure of the person. Primary syndrome occurs when the piriformis muscle is not compatible with the sciatic nerve.
Secondary Piriformis Syndrome:
Environmental factors, lifestyle and traumas; It may cause deformation of the piriformis muscle. In such cases, secondary piriformis syndrome may develop. Most people diagnosed with piriformis syndrome are in the secondary group.
What Causes Piriformis Syndrome?
When the piriformis muscle is irritated due to incorrect, sudden reverse movements and sitting for a long time, pressure is placed on the sciatic nerve and piriformis syndrome occurs. Swelling and stretching may occur due to muscle spasms caused by piriformis syndrome.
The most common causes of piriformis syndrome are listed as follows:
- Inflammation in the piriformis or surrounding tissues
- Muscle spasms
- Scarring on the muscle
- Sitting for long periods of time
- Intense exercise
- Doing too much running, walking, or other repetitive activities
- Stair climbing
- Lifting heavy objects
- Car crash
- Hard fall
- Sudden flexion of the hip
- Traumatic situations
- Wrong surgeries performed on or around the hip
Piriformis syndrome can also be caused by not climbing stairs, walking, running, or not warming up before physical activity when your muscles are not strong. In some cases, abnormal anatomy also causes piriformis syndrome.
What are The Symptoms of Piriformis Syndrome?
Symptoms of piriformis syndrome can range from mild discomfort to severe hip pain. If the piriformis muscle puts pressure on the sciatic nerve, symptoms may also spread from the thigh down the leg.
Piriformis syndrome symptoms may remain constant throughout the day or may increase with physical activities that involve hip and leg movements, such as sitting, walking, climbing stairs, and turning. The severity of symptoms depends on the degree of inflammation of the piriformis muscle and the frequency of spasms.
Common symptoms and signs of piriformis syndrome may include:
Hip Pain:
Piriformis syndrome causes pain deep in the hip. Pain usually increases after physical activities such as sitting, walking, running or cycling. These pains; It may also occur as burning, throbbing and pain. At the same time, pain may worsen when you are inactive for a long time (such as working at a desk job).
Numbness and Tingling in the Hips and Legs:
Numbness, tingling, or stinging sensations may occur in the affected area buttock. These symptoms may worsen after sitting or standing for long periods of time.
Difficulty Sitting for a Long Time:
Pain and tenderness in the hip can make sitting for long periods difficult, especially on hard or uneven surfaces.
Weakness in Legs:
The affected leg may feel heavy and stiff. It may be difficult to lift the leg on that side or move it in certain directions, which puts tension on the piriformis muscle.
Who Gets Piriformis Syndrome?
Piriformis syndrome is a condition that can occur in individuals with certain risk factors. Some of these risk factors are as follows:
Age:
Piriformis syndrome can be seen more frequently in middle-aged and elderly individuals. Changes in muscle and joint structures that occur with the aging process may increase the risk of piriformis syndrome.
Job:
Individuals who work in certain professions, such as office workers or weight lifters who have to sit for long periods of time, may experience extra pressure on the piriformis muscle. This may cause piriformis syndrome to occur.
Extreme Sports:
Athletes, especially those who do excessive sports or have to constantly use certain muscle groups, may be at risk of piriformis syndrome. This can lead to spasms and inflammation due to overuse of the muscles.
Anatomical Features:
In some individuals, congenital differences in the anatomical structure of the pelvic area may increase the likelihood of pressure on the piriformis muscle.
Such risk factors may cause piriformis syndrome. Priformis syndrome; It may also be caused by habitually carrying a hard, pressing wallet or phone in the back pocket for a long time while wearing trousers.
How is Piriformis Syndrome Diagnosed?
Piriformis syndrome may not be easy to diagnose. Because it can be confused with other conditions such as sciatic nerve compression or a herniated disc. To make the correct diagnosis, your doctor will perform a comprehensive physical examination, review your medical history, and order additional tests when necessary. For a correct diagnosis, you can consult physiotherapy and rehabilitation specialists, orthopedics and traumatology doctors.
Physical Examination:
Your doctor evaluates the range of motion, muscle strength and reflexes in your waist and legs. It checks for muscle tenderness and signs of inflammation. He performs physical tests to understand the condition of the piriformis muscle strength and the sciatic nerve.
Piriformis Syndrome Test:
It is important to note that there is no single test to diagnose piriformis syndrome. During a physical exam, doctors perform several tests to examine the health of the piriformis muscle and sciatic nerve. These tests help amplify the patient’s pain by increasing pressure on the sciatic nerve by stretching the piriformis and surrounding muscles and include: Freiberg sign test, Pace sign, Beatty test.
Evaluation of Medical History:
Your doctor evaluates your general health condition retrospectively. It obtains information for diagnosis by finding out how long your symptoms have been present and in which situations they worsened.
Display Methods:
For further evaluation, your doctor may use imaging methods. These methods are used to examine the bones, joints and soft tissues in the hip area in detail and to find the source of the problem.
These:
- X-ray,
- MRI (MRI)
- Magnetic Resonance Imaging (MRI),
- CT (Computed Tomography),
- EMG (Electromyography) and
- Ultrasound
These are the imaging methods that can be used.
How is Piriformis Syndrome Treated?
- Resting the muscles for a few days
- Home exercises to stretch or strengthen the piriformis muscle
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Massage for the piriformis muscle
- Muscle relaxants
- Physical therapy applied by a specialist
- Steroid injections
- Botulinum toxin injections
In cases where these methods are unsuccessful and insufficient, piriformis syndrome surgery may be recommended. This situation requires surgical intervention.
Piriformis Syndrome Surgery
There are two different methods in the surgical treatment of Piriformis syndrome;
- Open Surgery Method
- Closed Surgical Method (Endoscopic Piriformis Relaxation)
Whether closed or open surgery, the success rate of piriformis surgeries is quite high.
Open Piriformis Syndrome Surgery:
In the majority of patients, pain and numbness caused by piriformis syndrome begin to decrease enough to be noticeable even immediately after surgery.
One day after the surgery, patients can walk, sit, and take a shower without support. In the following days, as the surgery site heals, the patient becomes more aware that he does not have old, chronic pain. They can almost return to their daily activities, especially 10 days to 2 weeks after the surgery.
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 two 1 cm holes in closed surgery. This means that the post-operative rehabilitation and recovery process of closed surgery is faster.
How to Prevent Piriformis Syndrome?
Regular Exercise:
Regularly doing exercises that strengthen muscles and increase flexibility may reduce the risk of piriformis syndrome. Exercises that specifically target the hip, waist and thigh muscles may be beneficial.
Warm-up and Cool-Down:
You can relax the muscles and reduce the risk of injury by warming up the muscles before exercising and cooling them down after exercise.
Correct Body Mechanics:
Using correct body mechanics in daily activities and sports helps support the healthy support of your spine and hips.
Taking Regular Breaks:
Taking breaks at regular intervals to avoid prolonged sitting or remaining in the same position can prevent overloading the piriformis muscle.
Good Posture and Sitting:
Maintaining correct posture and sitting position helps in the correct alignment of the spine and muscles.
Avoiding Excessive Exercise:
It is important to do the exercises without overdoing it and by listening to the body. Tired muscles and excessive exercise can put stress on the piriformis muscle.
Stretching Exercises:
Stretching exercises increase muscle flexibility and reduce muscle tension, reducing the risk of piriformis syndrome.
Choosing the Right Shoes:
If you have to stand for long periods of time, it is important to choose shoes that provide proper support and are comfortable.
Weight Control:
Having a healthy body weight helps your body function in a balanced way and prevents muscles from becoming overloaded.
Stress Management:
Stress can increase muscle tension and increase the risk of piriformis syndrome. Managing stress and using relaxation techniques can be helpful.
What Happens If Piriformis Syndrome Is Untreated?
If piriformis syndrome is left untreated, symptoms can often worsen and negatively impact a person’s quality of life.
Potential consequences of untreated piriformis syndrome may include:
Chronic Pain and Discomfort:
If piriformis syndrome is left untreated, constant or chronic pain may occur in the hips, legs, waist and feet. This condition can affect daily life, making it difficult for the person to do work, do sports, and perform other activities.
Movement Restriction:
Ongoing pressure and inflammation in the piriformis muscle can lead to muscle stiffness and limited movement. This can reduce a person’s mobility.
Numbness and Tingling:
If piriformis syndrome is left untreated, numbness, tingling, and numbness may occur in the legs, knees, and feet due to pressure on the sciatic nerve.
Fatigue and Muscle Weakness:
Piriformis syndrome can cause muscle fatigue and weakness. This may cause the person to get tired more quickly and have difficulty doing daily activities.
Loss of Functionality:
Untreated piriformis syndrome can make it difficult to perform daily tasks and activities and affect a person’s functionality.
Depression and Anxiety:
Chronic pain and physical limitations can negatively impact a person’s mental health and trigger emotional states such as depression or anxiety.
If left untreated, the negative effects of piriformis syndrome can significantly reduce quality of life and negatively impact daily living. Therefore, it is important for people with suspected piriformis syndrome to contact a healthcare professional and receive proper diagnosis and treatment. With early diagnosis and appropriate treatment, symptoms can often be controlled and the person’s quality of life can be improved.
