Piriformis syndrome is a cause of pain that many people experience, but few people recognise. It happens when a small muscle, located in the gluteal region (called piriformis), ends up compressing the sciatic nerve, that very same nerve famous for causing pain that "radiates down the leg".
What is happening in the body?
Think of it this way: there is a large nerve that leaves the spine and passes through the buttock to the leg. This is the sciatic nerve.
Right next to it is the piriformis muscle.
When this muscle becomes tense, inflamed or overly contracted, it can "squeeze" the nerve as if it were a wire being compressed. This generates pain and other symptoms.
How to identify the main symptoms?
The most common signs are:
-
Deep pain in the buttock (usually on one side only)
-
Pain that can radiate down the back of the thigh
-
Tingling or numbness in the leg
-
Burning sensation
It worsens when sitting for long periods, driving, cycling and running
Many people think it is a "spine problem", but it is not always the case.
Why can this pain be so intense?
When the sciatic nerve is compressed, it sends pain signals along its entire course.
That is why the pain does not stay just in the buttock — it can radiate down to the leg and, sometimes, even to the foot.
Is it true that you can "end up unable to walk"?
Yes, in more severe cases, a person can have difficulty walking.
But this does not mean, in most cases, permanent loss of function.
What can happen:
-
Very severe pain when putting weight on the leg
-
Sensation of hip stiffness
-
Temporary weakness due to pain
-
Fear of moving (which makes the condition even worse)
In other words: the person can actually walk, but the pain limits them so much that it seems like they cannot.
Severe cases are less common, but when nerve compression is greater, there may be:
-
Reduction in muscle strength
-
Alteration in sensation
In these cases, medical evaluation is essential.
How is the diagnosis made?
The diagnosis is made mainly through conversation with the patient (history of symptoms), physical examination and movement tests that provoke pain. Imaging tests (such as MRI) generally serve more to rule out other causes, such as spine problems.
Treatment:
In most cases, treatment is simple and effective:
- Activity modification
-
Avoid sitting for long periods
-
Take breaks when driving or working seated
-
Temporarily stop activities that worsen the pain
- Stretching
Specific exercises for the buttock and hip help a great deal
They are one of the most important parts of treatment
- Medication
Anti-inflammatory drugs can temporarily relieve pain
- Physiotherapy
Helps relax the muscle and release the nerve
- Infiltration (in some cases)
Application of medication at the site to reduce inflammation
Surgery is rare.
Summarising it simply
Piriformis syndrome is:
A muscular problem
That compresses an important nerve
And causes pain that can radiate to the leg
Despite being frightening, it has treatment and usually improves well with correct measures.
Dr Rebeca Soares Andrade CRM-GO 39335