Pediatric Orthopedic surgeons  who treat Piriformis Syndrome

Piriformis Syndrome

Piriformis Syndrome happens when the sciatic nerve is compressed by the piriformis muscle, which is deeply buried in the buttock. Low back pain extending down one or both legs is associated with this condition. 

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Piriformis Syndrome Definition

Stopping persistent pain from Piriformis Syndrome takes a skilled doctor to diagnose the condition.  Hip and/or buttock discomfort on one side of the body, together with low back pain that extends down one or both legs, are the telltale signs of this condition. Piriformis syndrome is problematic since sciatica is frequently confused with it. Although the function of the sciatic nerve is affected by both illnesses, sciatica is the outcome of spinal malfunction such as a herniated disc or spinal stenosis. On the other side, piriformis syndrome happens when the sciatic nerve is compressed by the piriformis muscle, which is deeply buried in the buttock. The ability of your doctor to discern between piriformis syndrome and genuine or discogenic sciatica depends on their knowledge of the sciatic nerve’s anatomy, physiology, and link to the piriformis muscle. At Medical City Children’s Orthopedics and Spine Specialists, we are specialists in this field.

Piriformis Syndrome Anatomical Information

The piriformis muscle joins to a bony knob on the femur (thigh bone) at the outermost region of the hip from its origin at the front of the sacrum, close to the sacroiliac joint capsule. The piriformis assists in external rotation and abduction of the hip, which are technical terms for turning a hip outward and bringing a thigh out to one side when a hip is bent — like when you raise a knee and extend a leg to exit a car seat. Additionally, it provides support for standing, running, and walking. The sciatic nerve often descends on the back of the leg immediately beneath the piriformis muscle. But in certain people, the sciatic nerve travels straight through the piriformis, making them more susceptible to piriformis syndrome, also known as piriformis sciatica (as opposed to true, or discogenic, sciatica).

What Distinguishes Sciatica from Piriformis Syndrome?

Even though both illnesses affect the sciatic nerve and are occasionally connected, they are distinct. Sciatica may occur because of a herniated disc or spinal stenosis. The lower back is often where the symptoms are most prevalent, although they can also impact the leg and buttocks. Piriformis syndrome only involves one portion of the sciatic nerve in the buttock being compressed by the piriformis muscle. Though in a more localized location, it might resemble sciatica in some ways.

Causes of Piriformis Syndrome

Your child’s piriformis syndrome may have an anatomical cause. Primary piriformis syndrome is the combination of a split sciatic nerve, a split piriformis muscle, and/or an abnormal sciatic nerve route. Secondary piriformis syndrome is far more frequent and is brought on by inflammation of soft tissues, muscular spasms, or both, which compresses the nerve. Inflammation, scarring, and contractures of the piriformis muscle can result from direct trauma to the buttock. A significant incident like a vehicle accident or a tumble might have caused this. However, the piriformis muscle gradually stiffening as a result of inadequate muscular conditioning is probably the most frequent reason. Patients with piriformis syndrome frequently engage in activities like long-distance running or extended standing without properly stretching and strengthening their piriformis muscles.

Symptoms of Piriformis Syndrome

Sciatica is the primary symptom of piriformis syndrome. This is nerve discomfort, burning, numbness, pins, needles, or tingling that originates in the buttocks and travels down the back of the leg. It may feel electric-like and firing. Additionally, people may have pain or discomfort there. Due to the nerve’s position, sciatica pain is frequently located deep in the buttocks. It frequently becomes worse when you do things like:

  • sitting
  • running
  • walking
  • bending the knee completely
  • rotating the hip outwardly

Piriformis syndrome patients frequently experience persistent hip or buttock discomfort that grows worse with hip motion. Long durations of sitting or lying in postures that impose pressure on the buttocks cause pain.

The Risk Factors for Piriformis Syndrome?

There are several risk factors that might increase a person’s likelihood of developing piriformis syndrome.

  • According to some research, girls are 6:1 more likely than males to experience piriformis syndrome because of anatomical variations.
  • Anatomical variations in the sciatic nerve’s connection to the piriformis muscle may cause this condition. For example, in certain individuals, the sciatic nerve passes through the piriformis muscle, perhaps increasing the risk of sciatic nerve compression.
  • The sciatic nerve may get compressed or entrapped as a result of direct trauma or damage to the buttock region, which can result in swelling, hematoma development, or scarring.
  • Long periods of sitting can cause compression of the sciatic nerve. Due to its tendency to develop in those who frequently sit against their wallets while on a hard surface, piriformis syndrome has also been referred to as “pocket sciatica” or “fat wallet syndrome.”
  • Inflammation, spasm, and hypertrophy (enlargement) of the piriformis muscle can result from overuse or repeated motions, such as those involved in long-distance walking, jogging, cycling, or rowing. This might make sciatic nerve discomfort or entrapment more likely.

Diagnosing Piriformis Syndrome?

Our doctors will conduct a medical assessment. To assess your child’s level of discomfort, the doctor will place the injured limb in a variety of postures. Additional testing will occur if it is believed your child’s sciatica is being caused by something other than piriformis syndrome. The diagnosis of piriformis syndrome cannot be made with a computerized tomography (CT) or magnetic resonance imaging (MRI) scan. But these tests can reveal whether something else is putting pressure on your sciatic nerve.

Tips for Avoiding Piriformis Syndrome

Piriformis syndrome can sometimes stop if the patient maintains good posture and uses the correct form when engaging in physical activity. Before engaging in any physical exercise, always warm up and gradually build intensity. Avoid exercising or jogging too much on slopes or uneven surfaces. If your child has significant pain, take a break from what he or she is doing and recommend your child takes some time to relax.

Treatment Options for Piriformis Syndrome

Ice Pack or Ice Massage

Take some time to apply ice to the affected area as soon as your child gets sciatica or discomfort in his or her buttocks. Put your child in a comfortable posture lying on his or her stomach. For 20 minutes, apply an ice pack to the painful region. Repeat as often as necessary, every 2 to 4 hours. An ice massage, if feasible, might also help. Gently massage the region with a big ice cube while your child is lying on his or her stomach. To prevent having an ice burn, keep the massage to less than 10 minutes. Ice the area after the activity, not before.

Heat Therapy

Alternating between hot and cold temperatures can reduce discomfort for some people. For up to 20 minutes, while your child is lying on his or her stomach, apply a heating pad to the affected area. Avoid dozing off on a heating pad to avoid burning.

Anti-inflammatory medication

Ibuprofen and other over-the-counter anti-inflammatory drugs help alleviate discomfort and reduce swelling.


To relieve discomfort and reduce piriformis muscle spasms, electrical treatment with a transcutaneous electrical nerve stimulation device or interferential current stimulator can also help.

Stretching and Physical Therapy

Progressive muscle stretching is the key component of the most effective therapy for piriformis syndrome. In order to relax the piriformis, hamstring, and hip muscles, enhance flexibility, regain range of motion, and promote muscle healing, your doctor may have your child perform some simple stretching exercises. Additionally, a thorough physical therapy regimen that incorporates deep massages and range-of-motion exercises can lessen muscular spasms and improve blood flow to the region, promoting further recovery. Stretching and physical therapy is the most effective treatment for piriformis syndrome.

Piriformis Injections

Your doctor may occasionally provide an injection right into the piriformis muscle. Using topical anesthetics and corticosteroid creams may reduce the pain. Your doctor could suggest Botox injections in extreme situations to relax the muscle and relieve strain on the sciatic nerve. Both injections are intended to reduce discomfort sufficiently for your child to stretch the piriformis muscle and get physical treatment, leaving the muscle relaxed and extended when the injection wears off.


After treating the condition with all of the options and the pain is still persistent, your doctor may in rare instances, suggest surgery to finally stop the pain.

Piriformis Syndrome Exercises

  • Exercises that combine stretching and strengthening are crucial.
  • As soon as you feel comfortable, start piriformis stretching exercises. But only when discomfort permits.
  • Flexibility enhancement lessens strain on the nerve. It should therefore lessen discomfort.
  • Your child may also start doing exercises to build up hip muscles, particularly the piriformis. As a result, the muscle will get stronger and better able to handle any demands imposed on it in the future.
  • Using muscular energy strategies is a great approach to increasing muscle stretch.
  • It’s vital to stretch the hamstrings, groin, hip abductors, and lower back in addition to the specialized piriformis exercises.


Sciatic nerve entrapment by the piriformis muscle is known as piriformis syndrome. The condition may only last momentary or it may be ongoing and produce aches, tingling, numbness, and pain. People can treat their conditions at home or in conjunction with a doctor, depending on the severity of the ailment. Both exercises and some drugs can be helpful. In extreme situations and after every other treatment has been tried, the doctor may suggest surgery as an option. As pediatric orthopedic doctors, we are experts with piriformis syndrome.  Give us a call to make an appointment and we will help your child get back to normal without any pain. 

Call 214-556-0590 to make an appointment.

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