Piriformis syndrome

By: Peter F. Ullrich, Jr., MD
February 28, 2001

The piriformis muscle and the sciatic nerve

The piriformis muscle is a small muscle located in the buttocks that rotates the hip. It runs horizontally, and the sciatic nerve runs vertically directly beneath the muscle. The muscle can become tight and place pressure on the sciatic nerve, resulting in leg pain which may be difficult to distinguish from a radiculopathy (nerve pinching in the spine), which is also commonly called sciatica.

The patient’s spinal imaging studies will not show any nerve pinching, and on physical exam, motion of the patient's hip will generate the pain.

Conservative care for piriformis syndrome

Treatment for piriformis syndrome typically consists of:

• Physical therapy that includes manual release (deep massage), along with hip range of motion exercises can help piriformis sydrome.

• For severe cases of piriformis sydrome, the muscle may be injected with lidocaine to decrease spasm and help the patient make progress in physical therapy.