Piriformis Syndrome

Piriformis syndrome causes sciatica and involves pain to the buttocks and the affected leg or legs. The piriformis muscle of the hip assists with outward movement of the hip and leg, and if the muscle becomes damaged this can result in injury to the sciatic nerve where it crosses under the muscle. The sciatic nerve is located at the base of the back and runs into the buttocks and legs.

Symptoms

Pain is usually present in the buttock and along the back of one or both legs, sometimes extending to the foot. This can be accompanied by a slight tingling sensation. Sitting may become progressively more painful or hard to achieve, and you might notice that when sitting you avoid placing the body's weight on the injured buttock (or side), preferring to leave it elevated.

Causes

The sciatic nerve is liable to become pinched and irritated by an injured piriformis muscle. How this specifically starts is debated, though specialists often conclude that the muscle begins to spasm before squeezing painfully against the nerve, leading to the nerve being pushed against the pelvis bone. One of the causes of piriformis muscle injury is hitting the ground with the buttocks due to a heavy fall.

For athletes this can occur during almost any sport but the risk might be higher in those with either a strong contact element or those in which falling from a height is possible (e.g. cycling or horse riding). After such an impact the muscle can bleed (due to a hematoma) and become inflamed, causing it to press into the sciatic nerve. The weaker scar tissue that eventually forms over the injured muscle can also serve to prolong the problem.

Treatment

Consult a doctor to assess the extent of the damage. Often the initial treatment will be conservative and may incorporate checkups over a period of weeks in conjunction with anti-inflammatory pain medication like ibuprofen. In addition to relieving pain this medication will seek to reduce the swelling around the piriformis muscle in order to take the damaging pressure off the sciatic nerve. The doctor will also recommend physical therapy, with a professional helping to alleviate your symptoms and maintain movement and strength in the affected muscle.

If the symptoms do not improve despite the above, other methods may be required. A common treatment is injecting stronger drugs straight into the muscle to lessen the pain and swelling or, in some cases, to paralyse the muscle entirely with the result of relieving the strain on the sciatic nerve. In rare cases surgery may be necessary to cut directly through the muscle and ease the pressure. Sometimes this involves removing a section of the piriformis muscle, which should not affect your ability to partake in sports activities because the muscle is not crucial for leg movement and is supported by others.

Rehabilitation

Without surgery you can expect to recover in 2 to 3 months. This includes substantial time spent with a physical therapist and a long program of effective stretching. A professional will guide you through this course of action. Recovery time for patients who have undergone surgery will vary depending on the procedure.