Piriformis Syndrome: Treatment Options

Piriformis Syndrome: Treatment Options

This video will review treatment options for piriformis syndrome. Most cases of piriformis syndrome can be managed with nonsurgical treatment. Activity modification is patient dependent. Patients affected by overuse will be encouraged to rest from aggravating activity, while those who are affected by prolonged sitting will be encouraged to move more throughout the day. Medications can be used to reduce inflammation, muscle spasm, and nerve pain. Most importantly, physical therapy and corrective exercise aim to reduce irritation at the piriformis. Stretching the muscle and strengthening surrounding hip muscles can reduce strain on the piriformis, which can ease tension from the underlying sciatic nerve.

If a patient continues to experience sciatica symptoms, injections into the piriformis muscle may be recommended. Typically guided by ultrasound, medications can be injected to numb the area, reduce inflammation, and limit muscle activity. More than 80% of patients that use nonsurgical treatment, or that combine nonsurgical treatment with injections, see improvement in their symptoms. If these treatments fail, which happens in about 7% of patients, surgery may be considered.

The goal of surgical treatment is to decompress the sciatic nerve. This can be achieved through a piriformis release, which can be performed through an open approach or an endoscopic approach, which uses a small camera and instruments through small incisions. The surgery involves cutting through the piriformis tendon to relieve tension or compression, and using small tools to free up the sciatic nerve from surrounding scar tissue. Postoperatively, patients will begin rehabilitation by limiting pressure to the region, bearing weight as tolerated, and slowly moving and strengthening the surrounding hip muscles. To summarize, most patients will successfully reduce symptoms of piriformis syndrome with nonsurgical treatment, but if surgery is necessary, sciatic nerve compression can be relieved through a piriformis tendon release.