This article is divided into several pages for easier reading:
- Part 01: Introduction and Defining the Terms.
- Part 02: What is Piriformis Syndrome?
- Part 03: Anatomy of the Gluteal Region.
- Part 04: What can cause Piriformis Syndrome?
- Part 05: Who can be Affected by Piriformis Syndrome?
- Part 06: Prevalence and Risk Factors.
- Part 07: What are the Symptoms?
- Part 08: How is Piriformis Syndrome Diagnosed?
- Part 09: Differential Diagnosis for Piriformis Syndrome.
- Part 10: Treatment.
- Part 11: What is the Prognosis or Outlook?
- Part 12: References and Bibliography.
7.0 What are the Symptoms?
In general, patients will present with:
- “Gluteal pain is reported to be observed in 97.9% of cases.” (Jankovic, Peng & van Zundert, 2013, p.1005).
- Acute tenderness and sciatica-like pain in the buttock, in the posterior hip or lower back, and even the calf or foot. Pain and paraesthesia was reported (Jankovic, Peng & van Zundert, 2013, p.1005):
- In 81.9% of cases in the back, groin, perineum, buttocks, hip, and back of thigh.
- In 59% of cases in the calf.
- Between 59% and 18.1% of cases in the foot, rectum (during defecation), and coccyx.
- In 18.1% of cases low back pain is reported.
- Pain that radiates into the thigh or lower leg, and there may be an intolerance to sitting on the affected side.
- Pain when rising from seated or squatting position (Boyajian-O’Neill, 2008).
- Increased pain after prolonged sitting (more than 15-20 minutes (Boyajian-O’Neill, 2008)), walking, or running.
- Reduced range of motion of the hip joint (hypomobility).
- Pain that can be aggravated by activity (e.g. walking up stairs or inclines) or standing, and is often relieved on lying down.
- Associated numbness or paraesthesia radiating distally in the distribution of the sciatic nerve.
- A tight piriformis muscle may compress the sciatic nerve. This nerve impingement may result from overuse or hypertrophy of the piriformis muscle. Nerve impingement may cause features such as radicular pain, tingling, numbness, and/or weakness of the lower extremity.
- Localised gluteal muscle spasms.
- Difficulty walking such as antalgic gait or foot drop (Boyajian-O’Neill, 2008).
- Headache and/or neck pain (Boyajian-O’Neill, 2008).
- Abdominal, pelvic, and inguinal pain (Boyajian-O’Neill, 2008).
- Dyspareunia (difficult or painful sexual intercourse) in women (Boyajian-O’Neill, 2008).
- Pain with bowel movements (Boyajian-O’Neill, 2008).
Pain is usually felt unilaterally (e.g. one leg), rather than bilaterally (e.g. both legs), although it can manifest bilaterally (Zeren et al., 2015).
7.1 Short versus Long Piriformis Muscle
When diagnosing Piriformis syndrome, Horschig (2017) states it is important to differentiate between those who have a short versus a long Piriformis muscle (Table 1), as the treatment options vary between the two.
|Table 1: Differentiating between a short and long piriformis muscle|
|Short Piriformis Muscle||Long Piriformis Muscle|
|Glute pain with or without radiating pain down the posterior thigh|
|Pain often increases with prolonged sitting||Pain often decreases with sitting|
|Limited medial or internal rotation on affected hip|
|Painful when pressing deep into glute|
|Responds well to stretching & soft tissue mobilisation||Responds well to strengthening & movement re-education|
|Strengthening in a shortened position can recreate symptoms||Associated with poor movement (kne collapse and/or anterior pelvic tilt)|
|Return to Part 06||Continue on to Part 08|