Piriformis Syndrome & Chiropractic Treatment

What Causes Piriformis Syndrome?

The piriformis muscle works with several other muscles to control movement of the hip and pelvis. Pain in this area may develop after an injury, repeated loading or a change in activity.

Possible contributing factors include:

• A sudden increase or change in exercise
• Running or other repetitive lower-limb activity
• Prolonged sitting
• A direct injury to the buttock
• Reduced hip strength or movement control
• Changes in movement involving the lower back, pelvis or hip

However, finding a tight or tender piriformis muscle does not necessarily mean that it is the primary cause of the symptoms. Buttock pain can arise from several different structures.

What Does Piriformis Syndrome Feel Like?

Symptoms may include:

• Deep pain in one buttock
• Tenderness around the piriformis region
• Pain aggravated by prolonged sitting
• Discomfort during running, walking or certain hip movements
• Pain that may spread into the back of the thigh
• Occasionally tingling or other symptoms extending further into the leg

The pattern varies considerably between people, which is one reason assessment is important.

Is Piriformis Syndrome the Same as Sciatica?

No. Sciatica usually refers to symptoms associated with irritation or compression of a nerve root in the lower back. Piriformis syndrome describes symptoms thought to arise around the piriformis muscle and the sciatic nerve in the buttock.

The symptoms can overlap. A lumbar disc problem, spinal nerve irritation, sacroiliac joint problem or hip condition can also cause buttock or leg pain.

If you have pain travelling down your leg, particularly with numbness, pins and needles or weakness, we will assess your lower back and nervous system as well as the hip and buttock.

You can read more about the different causes of leg pain on our Sciatica Treatment & Chiropractic Care page.

How Is Piriformis Syndrome Diagnosed?

There is no single examination test that can conclusively diagnose piriformis syndrome. Assessment therefore involves looking at the overall pattern of your symptoms and excluding other possible causes.

Your examination may include:

• Movement of the lower back and hips
• Muscle strength and flexibility
• Palpation of the buttock and surrounding muscles
• Tests that load or stretch the piriformis region
• Neurological examination where leg symptoms are present

Imaging is not routinely required. If your history or examination suggests another condition or further investigation is likely to change your management, we will discuss the appropriate next step.

How Can Piriformis Syndrome Be Treated?

Treatment depends on what we find during your assessment. Where the piriformis and surrounding tissues appear to be contributing to the problem, treatment may include:

• Soft-tissue techniques
• Mobilisation or manipulation where appropriate
• Exercises to improve hip and pelvic movement
• Progressive strengthening of the hip and gluteal muscles
• Advice about sitting, exercise and activities that aggravate symptoms
• A gradual return to normal or sporting activity

If examination suggests that the symptoms are primarily coming from the lower back, sacroiliac joint or another structure, treatment should be directed towards that problem instead.

Should I Stretch the Piriformis?

Stretching may feel helpful for some people, but it is not automatically the right treatment for every case of buttock pain. A muscle can feel tight because it is irritated, overloaded or compensating for another problem.

Rather than repeatedly stretching a painful area without knowing the cause, we prefer to identify what movements and exercises are appropriate for your individual presentation.

When Should I Seek Urgent Medical Advice?

Seek urgent medical assessment if back, buttock or leg pain is accompanied by new bladder or bowel problems, numbness around the saddle or genital area, significant or rapidly worsening leg weakness, severe symptoms affecting both legs, major trauma, or feeling seriously unwell with fever or shivering.

Piriformis Syndrome, Sciatica and Back Pain

Buttock and leg pain does not always originate from the piriformis muscle. Problems involving the lower back can produce very similar symptoms. You can read more about assessment and treatment on our Back Pain Treatment & Chiropractic Care page.

If you would like an assessment, chiropractic care is available at our
Milton Keynes Chiropractic Clinic,
Northampton Chiropractic Clinic and
Aylesbury Chiropractic Clinic.

What Happens at My First Appointment?

We will discuss your symptoms and medical history and examine the lower back, pelvis, hips and buttock as appropriate. If you have leg symptoms, the assessment may also include neurological tests.

We will explain what we think may be contributing to your symptoms and discuss the treatment and rehabilitation options that may be appropriate. If we believe further investigation or referral is needed, we will explain this before proceeding.