Medicines for Piriformis syndrome

What it is

Piriformis syndrome is a condition in which pain arises from the piriformis muscle, a small muscle deep in the buttock that helps rotate the hip. It is thought that, in some people, this muscle becomes tight, overused or irritated and presses on or irritates the nearby sciatic nerve, which runs close to it. This causes pain, aching or tightness in the buttock, which can spread down the back of the thigh and leg (similar to sciatica), and may be worse with sitting for long periods, climbing stairs, running, or with certain movements. There may be tenderness deep in the buttock. It is more common in runners and people who sit for long periods. Piriformis syndrome is somewhat debated and can be difficult to diagnose, as its symptoms overlap with sciatica from the spine and other causes of buttock and leg pain — so assessment focuses on distinguishing it from these and excluding a spinal cause. It is not usually serious.

How it is treated

Piriformis syndrome usually responds to a conservative approach focused on the muscle and the nerve. A physiotherapist can guide targeted stretching of the piriformis and hip muscles, strengthening exercises, and techniques to release muscle tension, which are the mainstay and help most people. Modifying activities that aggravate it (such as prolonged sitting — using regular breaks and good posture), applying heat, and simple pain relief help. Addressing contributing factors, such as training errors in runners or prolonged sitting, reduces recurrence. For persistent cases, other treatments — including injections around the muscle — are sometimes used, and it is important that a spinal cause of sciatica has been excluded. Recovery can take some weeks. The reassuring message is that piriformis syndrome is usually a manageable cause of buttock and leg pain that improves with stretching, physiotherapy and activity changes, once other causes have been considered.