Piriformis syndrome is a relatively unusual neuromuscular disorder, which manifests every time the piriformis muscle compresses the sciatic nerve with its trajectory normally underneath the piriformis muscle. For a percentage between 7-16% of the population, the sciatic nerve has its route through the piriformis muscle, these people being thus prone to the development of sciatica. The sciatic nerve is a long and thick nerve that starts at the L3-L4 level of the lumbar, descends through the buttock region along the piriformis muscle and behind the knee, where it divides into smaller branches that end in the legs. Compression of the sciatic nerve can be caused by several factors including contracture (spasm) of the piriformis muscle, leading to sciatica. Sciatica manifests with pain, tingling and numbness in the buttock region and along the thigh. Movements such as sitting, stretching, climbing stairs and squats usually increase pain.

The piriformis muscle is a pear-shaped muscle located in the buttock region, which has its origin on the anterior part of the sacrum, protrudes from the pelvic region and runs diagonally to the upper part of the large trochanter of the femur where it is inserted. The piriformis muscle is an important component of the movement of the lower part of the body because it helps to stabilize the hip joint, rotation and to abduction (lateral movement) of the thigh, to maintain balance and to transfer the weight from one leg to the other. Essentially the piriformis muscle is used in all movements involving the hips and legs.

The piriformis syndrome is quite difficult to diagnose and most of the time the diagnosis is established based on a physical examination but also after the exclusion of other factors that can cause compression of the sciatic nerve. Also, for diagnosis the massage of the piriformis muscle is applied and if it causes pain on the back of the foot, it may be the piriformis syndrome.

1. Rest, avoid activities that cause pain, whether it is sitting in a chair or moving. Adopt a position that causes the least discomfort.

2. Topically applied ice, in sessions of 5-10 minutes 3-5 times a day, helps reduce pain and inflammation. Always apply a towel between the ice and the area on which it is applied.

3. Physical therapy, through specific exercise programs that have as objective the reduction of the compression of the sciatic nerve, combined with manual therapy and physiotherapy is the most effective way of treating piriformis syndrome.
Deep massage of the buttock muscles significantly relieves the symptoms.

4. Acupuncture can be used in cases where the pain takes more time to decrease.

5. Drug treatment
In addition to the classic anti-inflammatories, which can be taken for relatively short durations of time, 10-14 days, corticosteroid injections are also used, around the buttock, which have a stronger anti-inflammatory effect, as well as botulinum toxin injections that have the effect of reducing the spasm (contracture) of the piriformis muscle.

ADVICE:

➢ Before any sports activity, an appropriate warm-up is indicated. Avoid running on uneven surfaces

➢ The intensity of physical effort is gradually increased

➢ Maintaining a correct posture is indicated, both at rest and during daily or sports activities

➢ If an activity causes pain, it will be interrupted until the pain disappears.