The piriformis is a muscle that lies behind the hip joint in the buttocks. The piriformis muscle is tiny in comparison to other muscles around the thigh and hip. This muscle helps in external rotation (turning out) of the hip joint.
The piriformis muscle and its tendon are closely related to the sciatic nerve (the largest nerve in the body), which provides the lower extremities with sensory and motor function.
The piriformis tendon and sciatic nerve cross one another behind the hip joint, within the deep buttock. Both of these structures are around one cm in diameter.
Piriformis syndrome is a condition that has been described as an irritation of the sciatic nerve from the piriformis muscle. It remains controversial whether or not this represents a distinctive diagnostic entity. However, it has been described multiple times in medical literature.
Southern California Hip Institute (SCHI), led by board certified orthopedic surgeon Dr. Tigran Garabekyan, provides orthopedic surgery to patients in Los Angeles, Century City, CA, and surrounding locations.
If an individual is diagnosed with piriformis syndrome, it is considered that piriformis tendon may be impinging the sciatic nerve, leading to nerve irritation.
It has not been proven, but the theory supported by many doctors is that when the piriformis muscle and its tendon are excessively tight, the sciatic nerve is compressed. This may reduce the blood supply to the nerve and irritate the nerve due to pressure.
A majority of individuals who suspect piriformis syndrome think that it develops due to anatomic variation of the muscle and tendon. In some people, it is believed that this relationship leads to irritation of the nerve causing sciatica symptoms.
The recognized reasons for piriformis syndrome are as follows:
- Abnormal location or development of the piriformis muscle or sciatic nerve
- Abnormal spine alignment, such as scoliosis
- Leg-length discrepancy (when the length of the legs varies)
- Extended periods of sitting, particularly if carrying a thick wallet in a pocket right behind the piriformis muscle
- Before hip surgery
- Unusually aggressive exercise
- Foot problems, such as Morton’s neuroma
The cause cannot be determined in many cases.
There is no reliable method to prevent the occurrence of piriformis syndrome.
The standard recommendations for individuals who have had this or other back issues include a heel-lift (in case the legs are of varying lengths, home exercises and stretching, not carrying a wallet in the back pocket, avoiding extended periods of sitting, and undergoing treatment for other contributory conditions, such as foot problems or spinal arthritis.
Timely diagnosis and treatment enable the prognosis to be quite good. But the condition may become long-lasting. A poor result may be likely in case of delayed diagnosis and treatment.
The Bottom Line
Piriformis syndrome may be the most commonly occurring cause of sciatic-type back pain that people have never heard of. On the other hand, it may be rare.
But no one is really certain. In case a person has persistent, unexplained buttock main that extends into the leg, they should stop carrying their wallet in their back pocket, try not to sit too much, and consult their physician.
They may have a disc condition or some other common back issue. However, it is possible that they may have piriformis syndrome and prompt diagnosis can make a difference.
Board certified orthopedic surgeon Dr. Tigran Garabekyan receives patients from Los Angeles, Century City, CA, and nearby areas for orthopedic surgery.
Dr. Tigran Garabekyan is a board certified orthopedic surgeon specializing in hip preservation. To learn more about Southern California Hip Institute or to schedule a consultation, click here to contact us or call:
Century City / Los Angeles: 310.595.1030
Serving patients in Los Angeles, Beverly Hills, Santa Monica, Century City, West Hollywood, North Hollywood Encino, Sherman Oaks, Van Nuys, Burbank, Glendale and other neighboring cities in the greater Los Angeles, California area.
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