What is Piriformis Syndrome (AKA Pseudo-Sciatica)!?

Piriformis Syndrome

Have you ever experienced pain in your lower back or gluteal/buttock region?  

Is this pain aggravated by sitting or standing for prolonged periods or by general movement of the hips, like getting out of bed in the morning?  

Has this pain been accompanied by nerve sensations such as pins and needles, numbness, tingling, muscle weakness, and burning/shooting pain?  

Are these symptoms one-sided and radiate into the lower back, down the back of your leg, and into your foot?  

If you answered yes to any of these questions

A quick online search might have told you that you may be suffering from “Sciatica,” a complex condition typically involving lumbar (AKA lower back) nerve root irritation. While many possible mechanisms of lumbar nerve irritation exist, some of the more common causes include discal injuries (e.g., herniation, degeneration), narrowing of the lumbar vertebral canal (i.e., stenosis), osteoarthritis of the lumbar spine, obesity, as well as in more rare circumstances, growths, infections, and scar tissue formation in the lumbar spine (Abukanna et al., 2022). 

The possible causes are vast and potentially quite serious, adding to the urgency of receiving an accurate evaluation and diagnosis from a qualified health professional. But what if after physical evaluation and diagnostic imaging, it has been found that the lumbar spine is not the origin of your pain? 

Then you may be experiencing a soft tissue condition known as “Piriformis Syndrome,” where the sciatic nerve is compressed by a tight, irritated muscle in the back of your hip: the ‘piriformis.’ The sciatic nerve, being the largest and thickest in the body, has an intimate anatomical course of travel directly adjacent and deep to the piriformis (in >80% of the population), so issues with this muscle can often create sciatica-like symptoms (Hicks et al., 2023).  

How does one develop Piriformis Syndrome? 

Hicks et al. (2023) identified some of the more common risk factors, including: 

• Prolonged sitting (especially on hard surfaces)  

• Blunt trauma to the gluteal/buttock region (e.g., falling onto your hip)  

• Long-distance biking or driving 

• Sedentary lifestyle/lack of exercise  

• Obesity 

• Overuse (e.g. suddenly increasing physical activity over a short period) 

• Postural abnormalities (e.g., from short-term or long-term injuries) contributing to poor body mechanics in the hips 

How to manage Piriformis Syndrome? 

When not addressed, this condition can be physically debilitating and have serious impacts on quality of life. The good news is that Piriformis Syndrome has an excellent prognosis for recovery through the use of conservative treatment methods like massage therapy, acupuncture, and exercise therapy (i.e., stretching and strengthening) (Hicks et al., 2023).  

Furthermore, avoiding prolonged sitting is a key factor in minimizing or preventing piriformis pain. If you work a desk job or spend a lot of time sitting throughout the day, frequent short (~5-10min) walk breaks can make a big difference.  

After receiving treatment, the key to reducing and/or preventing relapse in symptoms is prioritizing consistent adherence to regular stretching and strengthening of your hips (see below for some ideas). Performing an adequate warm-up of hip stretching and mobility before engaging in physical activity can also help reduce the risk of aggravating the injury further.  

Determining the origin of your pain is integral to developing the right rehabilitation plan for you. If you suspect you may be suffering from Piriformis Syndrome (or even true sciatica pain!), come visit us at Active Living Chiropractic, where our highly qualified team can evaluate and treat your condition, as well as create a management plan to help you overcome your pain. At ALC, getting you back to doing the activities you love, pain-free is our primary goal!   

Written by Christopher Boivin, RMT

1.      Ahmed Abukanna, A. M., Tinan Alenezi, A. A., Alanazi, N. M., & Hamoud Alotaibi, A. (2022). Overview of causes, risk factors and management of sciatica: A Review. Asian Journal of Medicine and Health, 64–70. https://doi.org/10.9734/ajmah/2022/v20i130438  

2.      Hicks, B. L., Lam, J. C., & Varacallo, M. (2023, August 4). Piriformis Syndrome. StatPearls - NCBI Bookshelf.