Piriformis Syndrome Test, Diagnosis and Treatment

Piriformis Syndrome Test, Diagnosis and Treatment

The piriformis muscle is deep under your rear end (buttock). One end of the muscle connects deep inside the pelvic area, and the other end attaches to the top of the thighbone. This muscle can press on the sciatic nerve that runs from your spine down your leg. When this happens, you may have pain, numbness, and tingling in the buttock and down the back of your leg. This is called piriformis syndrome. The pain may get worse when you sit for a long time or climb stairs. Also, you may be more likely to develop piriformis syndrome if you run or walk often.

Your doctor will check for other causes of your pain before treating this syndrome. Treatment may include stretching exercises, massage, and medicine for the pain and swelling. If these do not help, you may get a shot of steroid medicine. Until the pain is gone, you may need to rest the muscle and limit activities like running. Exercises and a change in how you move and sit may be enough to stop the pressure on the nerve.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• If your doctor thinks that strenuous exercise is causing your problem, stop or cut back on activities such as running. You may find swimming to be a good exercise for a while.
• Stretch the piriformis muscle.
  • Lie on your back.
  • Bend one leg at the knee and keep the other leg flat on the ground.
  • Raise your bent knee up and then move it across your body. Hold the outside of the knee with the opposite hand.
  • Gently pull the knee with your hand toward the opposite shoulder.
  • Hold the stretch for at least 15 to 30 seconds. Switch legs.
  • Do the stretch several times each day.
• Massage the muscle to relieve pressure.
  • Sit on the floor. Lean to one side so that the hip on your sore side is off the ground. Put a tennis ball under your buttock on that side.
  • As you put weight onto the tennis ball, you may find spots that are especially sore. Move gently so that the tennis ball gently massages each of the sore spots.
• Use ice or heat to help reduce pain. Put ice or a cold pack or a heating pad set on low or a warm cloth on the sore area for 10 to 20 minutes at a time. Put a thin cloth between the ice pack or heating pad and your skin.
• Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
• Have your doctor or a physical therapist watch how you move. You may need physical therapy or special inserts in your shoes (orthotics) to help you move in a way that does not put pressure on your nerves.

Piriformis Syndrome: Exercises

Here are some examples of typical rehabilitation exercises for your condition. Start each exercise slowly. Ease off the exercise if you start to have pain.

Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best for you.

How to do the exercises

Hip rotator stretch

1. Lie on your back with both knees bent and your feet flat on the floor.
2. Put the ankle of your affected leg on your opposite thigh near your knee.
3. Use your hand to gently push your knee (on your affected leg) away from your body until you feel a gentle stretch around your hip.
4. Hold the stretch for 15 to 30 seconds.
5. Repeat 2 to 4 times.
6. Switch legs and repeat steps 1 through 5.

Piriformis stretch

1. Lie on your back with your legs straight.
2. Lift your affected leg and bend your knee. With your opposite hand, reach across your body, and then gently pull your knee toward your opposite shoulder.
3. Hold the stretch for 15 to 30 seconds.
4. Repeat with your other leg.
5. Repeat 2 to 4 times on each side.

Lower abdominal strengthening

1. Lie on your back with your knees bent and your feet flat on the floor.
2. Tighten your belly muscles by pulling your belly button in toward your spine.
3. Lift one foot off the floor and bring your knee toward your chest, so that your knee is straight above your hip and your leg is bent like the letter “L.”
4. Lift the other knee up to the same position.
5. Lower one leg at a time to the starting position.
6. Keep alternating legs until you have lifted each leg 8 to 12 times.
7. Be sure to keep your belly muscles tight and your back still as you are moving your legs. Be sure to breathe normally.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.