Piriformis Syndrome Not Sciatica

​The condition known as piriformis syndrome refers to sciatica symptoms not originating from spinal roots and/or spinal disc compression, but involving the overlying piriformis muscle.
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Causes may include trauma to the gluteal muscle, spasms of the piriformis muscle, anatomical variation, or an overuse injury. 

​Piriformis syndrome is a condition which is the result of compression of the sciatic nerve around the piriformis muscle. Symptoms may include pain and numbness in the gluteal region and down the leg. Often symptoms are worsened with sitting or running.

Signs and symptoms
Most commonly, patients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Typical piriformis syndrome symptoms may include:

• A dull ache in the buttock
• Pain down the back of the thigh, calf and foot (sciatica)
• Pain when walking up stairs or inclines
• Increased pain after prolonged sitting
• Reduced range of motion of the hip joint

Pathophysiology
When the piriformis muscle shortens or spasms due to trauma or overuse, it can compress or strangle the sciatic nerve beneath the muscle. Generally, conditions of this type are referred to as nerve entrapment or as entrapment neuropathies; 

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It has been theorized that people who regularly exercise by running, bicycling, and other forward-moving activities may be more susceptible to developing piriformis syndrome if they do not engage in lateral stretching and strengthening exercises. When not balanced by lateral movement of the legs, repeated forward movements can lead to disproportionately weak hip abductors and tight adductors.

Treatment​
Conservative treatment usually begins with stretching exercises, myofascial release, massage, and avoidance of contributory activities such as running, bicycling, rowing, heavy lifting, etc. Some clinicians recommend formal physical therapy, including soft tissue mobilization, hip joint mobilization, teaching stretching techniques, and strengthening of the gluteus maximus, gluteus medius, and biceps femoris to reduce strain on the piriformis.​