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Piriformis Syndrome

mritecmmritec Posts: 1
I have all of the symptoms of Piriformis Syndrome. Getting out of bed in the morning is excruciating. Walking around (in Pain) and taking a hot shower seems to help. NSAIDS help a litte. Pain is relieved by sitting, which doesn't seem to make sense. I need help in finding a way to sleep so that I don't wake up in severe right hip/buttock pain.


I am just starting to see a Chiropractor who is helping, but I so far have had only one session.


  • First let me say welcome to spine-health. Have a look around and you will find some very good articles on piliformis syndrome. One thing that might help more than anything is some pt, and they can stretch that group of muscles to help, also give you a home program to help with it. Swimming of course is also good and some of the stretches are easier in the water. Good luck and once again welcome.
  • Hi and welcome. How about seeing a spine specialist and geting an mri or something before assuming its priformis syndrome?

    Many of the symptoms can be confused with another condition and only the dr can realy sort it out with tests, Before doing chiro and pt always best to find out and confirm what needs to be treated,

    There is a lot of good information on this site but it does not substitute seeing your spine specialist to confirm you condition, Good luck.
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hi there MRITEC.... welcome. I was diagnosed with piriformis syndrome last year, as a way to explain my sciatic/buttock pain.

    Turns out, after several months of intense chiro/physio/deep needling/acupuncture treatments......they ruled it out as piriformis.

    After all that, they sent me for an MRI of my butt/hips, and didn't see any issue with the piriformis muscle. I really wish they would've done that scan first!!!

    To be honest, I think a lot of docs/physios diagnose people with pirifomis syndrome as a quick and easy way to explain sitting pain.

    Amyhow, my suggestion is, to go get yourself an MRI before you waste too much time.
  • An MRI of your butt/hips would not show any soft tissue issues and so would never rule in -- or rule out -- piriformis syndrome. Nor would a CT scan, or an X-ray. It is determined by manual palpation of the muscle while lying prone.

    Piriformis syndrome is a real diagnosis that accounts for an extreme amount of hip/leg pain. Human anatomy is not static; what you learn about as "normal" is only what has been found to be the case in the majority of cadavers studied. In the case of the piriformis muscle, about 30% of the population has been found to have their sciatic nerve running through the center of the muscle. When it tightens down, pressure on the nerve increases.

    The piriformis is one of 5 muscles that externally rotates the leg. If you play a lot of side-to-side sports, or even run or use exercise machines in the gym, chances are pretty good that your muscles are tight.

    Yes, it is also possible that you can have both piriformis syndrome *and* back issues. I have both, and have had both for many years. I worked as a post-rehab exercise trainer all during that time, and when I performed self-stretches, or performed assisted stretches on my clients, most times we all felt like we'd somehow experienced a miracle, that's how dramatic the muscle release can be. But, as with all muscle, that relief is temporary, which is why we tell people over and over and over to s-t-r-e-t-c-h. Your muscles aren't made of plastic, they won't just elongate and remain that way.

    I know everyone here who has experienced what they feel to be a failure on the part of medicine to "fix" them is all about signing up for imaging studies, lab tests, multiple specialists, etc. If you have insurance, you know that's not the way it works, for good reason. You don't contribute enough money to your health insurance to cover each and every person on that insurance for unlimited testing and services, and you're not just contributing to pay for your own use.

    Those who want an answer NOW may not like it, but -- in the absence of an emergency situation -- starting out with the most obvious problems shared by a large proportion of the population, and slowly moving toward the less common, more invasive, and highly expensive, is the responsible thing to do.

    And for those who will complain that the system is just too dang slow for them, you can turn to those who now say they were rushed into a procedure or "cure" they would give anything to reverse. I can assure you that *that* is a situation that all of us, doctors, nurses, or patients, want to avoid at all costs.

    Start with PT for your piriformis syndrome, then learn and do the stretches on your own. It will probably help tremendously. If it does not, or you still experience hip/leg pain while you are doing your stretches religiously, then it's time to explore the next step.
  • Hi babybubles....great post. As for the MRi not showing piriformis....when my doc looked at the scans, he ruled it out.

    In actuality, he seemed to almost not even believe in piriformis, saying that there hasn't been enough proof of it!

    About piriformis...... if someone has the syndrome, are they born with the nerve running underneath the muscle??
  • Big, I think you're right, he was looking for something he *could* find on the films you had, and piriformis would not be one of those things. I don't know if it's a matter of "believing" in piriformis syndrome or not -- more likely just that specialists are used to spending the amount of time they have for each patient looking for things that are 1) within their usual scope and 2) detectable through the tests available to them. Until or unless another problem is found, piriformis syndrome is something best recognized and treated (in my opinion) by a doctor and/or physical therapist who specialize in sports medicine. They would be the ones as well who would be able to recognize gait problems, limb length discrepancies, and foot problems (over pronation/supination, flat arches, etc.) that very often contribute to pain syndromes.

    As for your other question, yes, you would be born with the sciatic nerve either running outside or through the piriformis. Remember, there are several other muscles that do the same work (external rotation), so when they all tighten up, all I can say is OUCH.

    And oh my gosh, I would never, ever consider removal of the piriformis muscle, not in a million years. Never heard of such a thing. In my experience suffering the pain of severe piriformis syndrome as well as multiple spine issues, as well as the results of personal training and massage clients I've had in the past, release of the piriformis muscle helped to substantially decrease hip and leg pain. It just has to be done correctly, and regularly, for best results.

    I had to give up my Harley, but it was as a result of my neck/shoulder/arm pain and weakness. Broke my heart. I could help make the legs comfortable, but the rest of my body, not so much.

    I'd really recommend trying to get in a good 20-minute stretch sometime before you ride, see if it helps enough. In fact, i'd do it before driving. Think about your leg position when you drive; your knees fall to the outside, which is external rotation. Stretching should help, as should strengthening your internal rotators -- another area where a good PT can really help.

    I really wish you the best. Take care!
  • Thanks for your reply Bbb.... :) And to the original poster...sorry I hijacked your thread!

    Babybubbles..... Have you ever seen people with severe sciatica that not only goes " down" the leg....but almost back UPwards??

    My butt legs kill me when sitting...but the pain travels back up the low back and crisscrosses to the opposite side of my low back.

    Questions questions questions....... I have so many questions, and I'm dying for answers. I would give anything to feel " normal " again.

  • Hey guys! I was talking to one of my customers today about my previous back surgery and how I am still having leg pain and he mentioned to me that he had Piriformis Syndrome. Based on what I am reading here I need to be checked for this. I am currently going to a orthopedic surgeon for follow up on my decompression surgery. Would this Dr. be the best place to start of should I see a different type of Dr? Thanks in advance for your replies.
  • For the past couple of months my piriformis muscle on my left hip has been causing me grief. It's interesting to read the comments in this thread and babybuddies made some very honest, direct but truthful comments. Tamtam also had great comments...there's a lot of information out there so do some searching and check it out.

    Me....well.....I never even considered going to a doc about this pain, I just focused on the right stretches and continued to work on the muscle. There are some stretches on this website you can do, but for me the best one is called "half pigeon pose" in yoga. Along with that I used a foam roller to work out the other surrounding muscles.

    Take care!
  • Hey guys I'm new here and thought I'd share my story. I'm 24 and live in adelaide Australia. I've had bad buttock pain for a year. Mainly cannot sit but standing all day as a teacher is just as bad. the pain readiates down my legs. It started from no where and as I play footy I thought it was just tight glutes etc. So had endless pysio, cortisone injections without any luck and after a couple of months of constant pain got pretty worried.

    I had an MRI scan on lumbar spine (clear), had steroid injections into si joints and facet joints to completely rule out the back. pain continued after injections so it was clear my back wasnt the issue (which I basically knew anyway). Had my buttocks MRI scanned and came back clear which really depressed and confused me. I took valium and endone to ease the pain for months. After 6 more months of no answer i got my buttocks ultra sounded by the best in the state. He found my sciatic nerve split and part of it ran through my piriformis muscle. He then looked at the MRI scan I had previousy had on the buttocks and found the issue there aswell. THERE IS A WARNING TO EVERYONE. GET A SECOND OPINION. THE MRI RADIOLIGIST WAS MEANT TO BE THE BEST IN THE STATE BUT STILL MISSED MY SCIATIC NERVE SPLIT AND COST ME 6 MONTHS WORTH OF PAIN.

    So I saw a number of hip surgeons who are not experienced in the area but finally one (the only one in adelaide. and i had given up hope here and had plane tickets booked for sydney) has done piriformis release surgery. He is confident he can fix my problem. He deals and touches the sciatic nerve every day with his hip surgeries. He says I will be fine 2 weeks after surgery aswell as he will be very careful and doesnt cut musce but divides it. (knew age style). Surgery may seem drastic to some...but a year of pain with no help and a dependence on strong pain killers is a ridiculous life style for a 24 year old.

    Anyways I am extremely nervous. Not so much about the surgery but what is riding on it. This is my chance to get my life back and be pain free. The depression of being in constant pain was so overwhelming I considered ending my life. I really need this to work. And I pray to god this is the end of a horror story for me. I will tell you guys if it works and I'll tell you the surgeons name etc...my email is seamoski@hotmail.com if anyone wants to talk

    Shamo xo
  • I have struggled with Piriformis Syndrome for about 7-8 years, with ever growing intensity. It started small and it is sometimes better, but the trajectory has been consistently worse. I have had therapeutic warm water therapy (helpful but not permanent), physical therapy from multiple practitioners (helpful but even shorter relief than the hot pool - maybe an hour or two?), cortisone shots into the muscle (PERFECT, and temporary [2 weeks?], and not a long-term strategy because of side effects), stretching at home (mild relief), a gym with a trainer (meh), NSAIDs (ha -nuthin'!), narcotics ( minor help) ... so you can see I've run the gauntlet.

    Weirdly, tho - inexplicably - and without any reason I can discern, I have found relief 3 times. And the last one has "sunk in" for over a month.

    2 years ago I was diagnosed with an inguinal hernia (small, hardly anything but a lump, but I didn't want to let it get bad), so I had laproscopic surgery for it.
    And the Piriformis pain WENT AWAY. COMPLETELY. I had no explanation.

    Sadly, it came back within weeks.

    But the mesh in the initial repair failed so I had to have open surgery in spring of 2015. Again: sweet relief! But short lived.

    Fast forward to December 2015 and I had another unrelated surgery that put me out of commission almost completely for about a week, in the hospital bed (or at home mimicking that bed) for weeks.

    And THAT is what *appears* to be The Answer. Sleeping on my back, with my knees raised.
    That's it.

    Dumb, almost embarrassing, but IT IS STILL WORKING. Now when I try to sleep on my side for even a few hours overnight, the next day I feel the nagging and my heart clutches in fear that it's coming back.

    But since it sounds so dumb and so coincidental, I haven't wanted to believe it (and sleeping on my back isn't natural for me - I don't like it at all honestly), so I have kept trying to go back to "normal" - sleeping comfortably on my side, only to HURRY back the next night to building a small pile of pillows under my knees because the pain was coming back again.

    Take it for what it's worth. It's one data point. I'm only 1 month and a few days out from surgery, but I am so amazed that when I related it to the doctor I actually got tears of gratitude in my eyes (veeeeery unusual), particularly since they had nothing to do with the relief.

    Whether it's magic or placebo or actually logically associated somehow that I can't figure out, I don't care. And I hope it helps someone else.

  • LizLiz Posts: 7,832
    edited 01/18/2016 - 8:26 AM
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    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
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