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The piriformis syndrome occurs when the small muscle called piriformis compresses the sciatic nerve. The compression occurs due to spasm of the piriformis muscle. This muscle is located in the buttocks, right behind the gluteus maximus (the main extensor muscle of the hip), and it extends across the sciatic nerve, to the top of the femur (the large bone in your upper leg)  . The pain caused by this syndrome is more commonly known as sciatica.
Piriformis muscle contributes to our lower body movement by stabilising the hip joints and helping the thighs move from side to side. Thus, we can shift our weight from one foot to another and maintain balance while walking. This muscle also plays a major role in sports that involve shifting and rotating thighs.
Causes Of Piriformis Syndrome
The particular muscle can be irritated from inactivity or overuse of it. Here are some common causes of piriformis syndrome:
- Too much exercise
- Overindulgence in repetitive activities that involve legs, such as running or overstretching
- Extensive stair climbing
- Sitting for extended periods and a sedentary lifestyle
- Muscle tension and excess weight due to pregnancy
There are some common injuries that can cause this condition, such as
- a sudden twist of the hip,
- a bad fall,
- a car accident, and
- a penetrative wound might reach the muscle.
Symptoms Of Piriformis Syndrome
Signs that start with occasional pain or tingling in the buttocks, can turn to sciatica pain that extends down the length of the sciatic nerve. Pain may be triggered after sitting for a long time, running or even climbing the stairs.
Some of the common symptoms of this syndrome include
- a dull ache in the buttocks,
- numbness of the muscles in the buttocks,
- worsening pain after a prolonged period of sitting,
- pain increasing with activity, and
- pain radiating from the buttocks down the leg.
At times, the symptoms might interfere in your basic daily tasks, such as sitting at a computer, driving for a few hours or performing household chores  .
Risk Factors Of Piriformis Syndrome
People who need to sit at a desk all day or in front of a computer or television for extended periods of time are more prone to develop the signs of piriformis syndrome. If your workout regime includes regular and rigorous lower-body movements, you are at a higher risk of this syndrome.
Diagnosis Of Piriformis Syndrome
If you experience tingling pain or numbness in your buttocks lasting for more than a few weeks, you should consult a doctor as soon as possible. It is important to seek medical help even if your symptoms are recurring.
During the diagnosis process, your doctor will go through your medical records, detailed symptoms and any other potential causes of pain, such as injuries or fall. Share every bit of information regarding your medical history, no matter how insignificant it might feel.
Further procedure includes a physical exam followed by imaging tests such as an MRI scan or a CT scan. The physical exam includes checking the movements of the hip and the legs. Your doctor may put you through a range of movements to discern which positions cause you pain. It will help your doctor rule out the possibilities of other conditions. An ultrasound of the muscle may also be done to confirm the results  ,  .
Treatment Of Piriformis Syndrome
Rest, avoiding activities that trigger pain, applying ice and heat, physiotherapy are the best possible ways to deal with it. Here are the key pieces of advice for treating piriformis syndrome:
- Apply an ice pack (wrapped in a thin towel) on your skin, leave it for 15 to 20 minutes. Then use a heating pad on a low setting for about the same time. Try it every few hours to relieve the pain.
- Refrain from doing the activities and avoid certain positions that cause pain.
- Healthcare providers also recommend over-the-counter painkillers or anti-inflammatory medicines, muscle relaxants or injections in severe cases.
- You may benefit from a programme of exercises including carious stretches and exercises to reduce sciatic nerve compression.
- You can try this exercise at home. Lie flat on your back with both knees bent. Lift your left ankle and rest it against your right knee. Gently pull your right knee toward your chest and hold it for five seconds. Release your legs gently and do the same stretch on the other side. Each stretch should be for 30 seconds and repeat them for 3 to 5 times  .
Prevention Of Piriformis Syndrome
You can take the following measures to prevent the signs of this syndrome:
- Warm up and stretch well before you start off with a vigorous workout session.
- Build up the intensity of your exercise gradually.
- Avoid running or exercising on uneven surfaces.
- Make sure to change your posture every now and then so that you are not sitting or lying down for too long without any activity.
- Be extra cautious if you have been diagnosed with the syndrome already. Regularly follow the exercises learned during physical therapy.
Piriformis syndrome is usually not a severe condition. With a modified lifestyle and changed exercising habits, you can always continue leading a normal life even with this syndrome.
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-  Santamato, A., Micello, M. F., Valeno, G., Beatrice, R., Cinone, N., Baricich, A., … Ranieri, M. (2015). Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature.Toxins,7(8), 3045–3056.
-  Demirel, A., Baykara, M., Koca, T. T., & Berk, E. (2018). Ultrasound elastography findings in piriformis muscle syndrome.The Indian journal of radiology & imaging,28(4), 412–418.
-  Ro, T. H., & Edmonds, L. (2018). Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging.Journal of clinical imaging science,8, 6.