Piriformis syndrome is a common diagnosis for pain in the buttock. It is often attributed to issues related to the sciatic nerve but that’s not really the cause. In more than 80% of cases it has to do with some kind of trauma or repetitive motion not an anatomical difference of the piriformis muscle and sciatic nerve.
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Brief overview of the episode:
Piriformis syndrome is the literal pain in your butt. Other symptoms include low back pain, numbness, difficulty walking, pain with sitting/squatting/standing/bowel movements and tenderness. Sometimes this is called deep gluteal syndrome, extra-spinal sciatica or wallet neuritis.
The reason that the piriformis muscle is so famous is because it can have a unique arrangement with the sciatic nerve. There are 6 other muscles in this area that can also play a role and that is why primary piriformis syndrome makes up less than 15% of cases.
Secondary pirifomris syndrome is by far more common. This is usually due to some kind of trauma, muscle holding, gait patterns or other issue further down or up the kinetic chain. That will then present as pain in the buttocks.
Women are affected 6x more than men. This seems to be due to an increased q angle as this impacts the relationship between the quadratus femoris and the OS Coxae.
Most people you experience piriformis syndrome will get better with short-term activity modification and exercises. Surgery is not often recommended even in cases of primary piriformis syndrome.