Piriformis Syndrome
What is it: Irritation or compression of the sciatic nerve due to spasm of the piriformis muscle.
How does it present: Patients often present with low back or gluteal pain that may radiate down the posterior leg in the sciatic nerve distribution. They may also experience some numbness into the leg.
Common exam findings: The patient may have tenderness to palpation over the piriformis muscle in the gluteal region. Commonly patients demonstrate weakness and/or reproduction of sciatica type pain with the Piriformis Test. If a positive Straight Leg Raise is present, externally rotate the foot and repeat; resolution of sciatic type pain favors a diagnosis of piriformis syndrome.
Tests and treatment: Piriformis syndrome is a clinical diagnosis. L-S spine radigraphs and MRI may be needed to rule out other causes of the back pain including lumbar disk herniation. Treatment consists of conservative measures such as stretching and strengthening exercises and avoidance of provocative activities. Formal physical therapy may be helpful.