Is It Piriformis Syndrome?

Why it may not be piriformis syndrome

Dr. Cipperoni:

Hi, guys. Dr. Cipperoni here from Catalyst Health, and today I want to talk about piriformis syndrome, or what you might think may be piriformis syndrome, but it actually might be piriformis syndrome in disguise.

Let’s look at a few reasons that nerve can get pinched and why it might not actually be coming from your piriformis. So the piriformis muscle itself actually goes from the sacrum and it connects into the leg. So it crosses, it’s actually the front of the sacrum and connects into the leg. So anytime you move your leg, especially into flexion, think bringing the knee up to the chest, or if you rotate your leg inward, that will tension the piriformis muscle. Another way that does it is, if you bring your leg across the body, toward the other leg. Those are all movements that will tension that piriformis muscle. And those are all movements that can absolutely give you pain, tightness in this area.

Now, just because you’re having pain in that area, doesn’t mean that’s necessarily the source of the pain. So we want to talk about the culprit versus the victim. Piriformis syndrome is actually very overdiagnosed, because a lot of people say, “Oh, pain is coming from this area. It must be the piriformis.” And it could absolutely be the case, but more commonly, I see that the pain is actually originating in the low-back, especially when you have pain that’s radiating down the leg, that may even feel like it’s starting in the piriformis going down the leg. A lot of times that’s actually coming from the low-back, from a disc herniation, a disc bulge, or potentially some stenosis in the lower lumbar spine where you have these little foramen right here, these little holes, that can actually grow stenotic and get pressure, cause pressure on the nerve root.

And that nerve root will refer pain into that region as well. So, unfortunately piriformis syndrome, especially in runners, can be overdiagnosed or misdiagnosed, but let’s look at a few clues here. So how do you know if it’s being misdiagnosed or properly managed? Well, if your piriformis syndrome comes on when you’re sitting or when you find yourself bending forward a lot, or if you find yourself slouched in the chair for a long time, and that starts to bring on pain in this area, those movements will actually cause your disc to put pressure on the nerve in the low-back and cause that nerve to refer pain to that area. On the other end of that, if you do a lot of walking or you do a lot of activities that promote the extension of the spine, and extension, if you think just bending backwards, that’s an extension movement in spine, and those actually help your pain and your symptoms in this area.

Again, that’s another indicator that it could be more of a disc herniation or a disc bulge that’s causing your pain versus the actual piriformis itself. So if you’ve been having pain in this region, make sure that you’re getting that checked out. Make sure you’re having it properly managed, because you don’t want to be subject to a lifetime of stretching this. It feels a little bit better, and then 30 minutes later you’re stretching again because it’s still hurting. So if you want that checked out, I see a lot of this in my practice. I see a lot of it misdiagnosed in my practice. I’m located in Leucadia. We are Catalyst Health just right off of 101.