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Piriformis Syndrome Cheat Sheet (DRAFT) by

Presentation, management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Piriformis syndrome

- Piriformis gets hypertonic
- Hypertonic piriformis presses on proximal sciatic nerve
- Neurol­ogical ischaemia, conges­tion, local inflam­mation and radicular complaints
- Sciatic nerve can pass through the muscle instead of deep in some people
- Sciatic nerve does not innervate butt or posterior thigh (inner­vates sensation of LL and foot )
- Pain in the butt and posterior thigh thought to be because of compre­ssion of inferior gluteal vein - ischemia to posterior femoral cutaneous nerve
- Chronic cases can lead to perineural adhesions in the sciatic nerve

Risk Factors

- Morton foot (longer 2nd digit) can be a risk
- 40-60 yo
- Affects women - Q angle
- Affects people who sit on their wallets in their back pocket (hip pocket wallet)


- Trauma or develops slowly
- Strain, fall on buttocks or catching oneself from a near fall
- Repetitive microt­rauma - long distance walking, stair climbing, chronic compre­ssion
- Parest­hesia or numbness in the gluts and radiates along the sciatic nerve
- Trigger point referral into proximal thigh, SI and hip
- Aggravated by holding a position for longer than 15-20 minutes - prolonged sittin­g/s­tan­ding, hip int rot (crossed legged)
- Discomfort when walking, running, stair climbing, riding in a car or arising from a seated position
- Can be a antalgic gait
- Hypertonic piriformis and obuturator internus, TFL, obturator externus, adductor and gluteal muscles
- SI joint dysfun­ction, restri­ctions in LL and spine
- Assess arch of foot and Leg length
- Assess for externally rotated hip at rest
- PROM hip internal rot
- +ve FAIR +ve SLR
- SMR can reveal neurol­ogical changes (not proximal thigh weakness)
- Assess for other entrap­ments (gemel­i-o­btu­rator internus syndrome, ischio­femoral imping­ement syndrome, proximal hamstring syndrome


- Not usually required
- Advanced imaging to rule out other radicular complaints
- Electr­odi­agn­ostic testing
- US


- Hip pathology
- F#
- Lx compre­ssion
- Discitis
- Trocha­nteric bursitis
- Sacroi­liitis
- SI dysfun­ction
- Lx radicu­lopathy
- Spinal stenosis
- Viscer­oso­matic referred pain


- Limit activities - hill and stair climbing, walking on uneven surfaces, intense downhill runnin­g/t­wis­ting, throwing objects backward
- Avoid sitting on one foot, take breaks from standing, sitting and car rides
- Limit sustained hip ext rot and abduction
- Stretching of piriformis
- Myofascial release of gluts, obturator, tensor fascia lata, hamstring, lx erectors, hip adductors
- SMT/EMT of lx, SI, LL
- Heat/ice
- Ultrasound
- Streng­thening of abductors, adductors and gluts
- Heel lift for leg length inequality
- Muscle relaxants, steroids, trigger point inject­ions, botox for faillure to respond to con care