Piriformis Syndrome

The piriformis is a muscle located deep in the buttock that helps rotate your thigh outwards – external hip rotation. The sciatic nerve is situated either above or below the piriformis muscle and in some cases it penetrates through the muscle. The sciatic nerve continues down the back of the leg toward the knee and foot.

What is piriformis syndrome?
Piriformis syndrome is a condition in which the sciatic nerve becomes inflamed or irritated by a spasm or overuse of the piriformis muscle. It’s essentially one form of sciatica. Those with piriformis syndrome experience pain deep in the buttock, often burning in quality. The symptoms can be either localized to the buttock region or radiate down the back of the thigh. The pain is aggravated by external rotation of the hip such as when sitting cross-legged. Down hill running is a known cause of piriformis syndrome.

How is piriformis syndrome diagnosed?

Clinical examination and patient history will reveal pain in the buttock region and sometimes down the back of the thigh. An x-ray may be used to rule out other problems such as hip or lower back arthritis, lumbar disk disease, bone spurs, and stress fractures of the pelvis or femur. On occasion, an MRI is needed to more fully evaluate the hip and upper thigh region. To evaluate the sciatic nerve a nerve conduction test can be performed.

How is piriformis syndrome treated?
Treatment for piriformis syndrome focuses mainly on reducing inflammation around the sciatic nerve and reducing strain in the piriformis muscle. Rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstays of treating the initial pain. In some circumstances, oral steroids are used to reduce inflammation around the nerve. Stretching and strengthening the piriformis can reduce the stress the muscle applies to the nerve. Physical therapy is often used to address these issues. Rarely is surgery used to treat piriformis syndrome.

When can I return to running?
The goal of rehabilitation is return you to running as soon as is safely possible. If you return to a full training load too soon, the injury may return or worsen. Everyone recovers from injury at a different rate, so don’t compare your rehabilitation to other runners. Returning to running is determined by how well your muscle and nerve respond to treatment rather than a set number of days or weeks. In general, the longer you have had the symptoms, the longer it will take you to recover. Here are some general guidelines for a full return to running. Keep in mind, some runners may not have to completely stop running, but merely reduce their training load (distance, intensity, frequency) during the rehabilitation process.

  • You should be able to flex and extend your hip without pain.
  • You should be able to internally and externally rotate your hip without pain.
  • You should be able to cross the affected leg over the other leg without pain.
  • You should be able to jog in a straight line without limping.
  • You should be able to sprint without limping.
  • You should be able to perform 45-degree and 90-degree cuts without difficulty.
  • You should be able to jump on both legs without pain.
  • You should able to jump on the injured leg without pain.

What can be done to reduce the chances of developing trochanteric bursitis?
The most important factor in preventing piriformis syndrome is best accomplished by optimizing strength and flexibility. Follow a proper training program that includes cross-training to ensure muscle activity is varied.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.