Piriformis syndrome can be a difficult cause of buttock pain in runners and other athletes. Often it comes on over time but occasionally it can be related to a traumatic event. Athletes will complain of pain in the buttock and occasionally pain that runs down the back of the thigh.

Tests for piriformis syndrome

A sports medicine physician can try to make the diagnosis in the office with physical exam tests. Compression of the sciatic nerve as it runs under the piriformis muscle in the buttock can recreate pain. There are many tests to stretch the piriformis that can compress the sciatic nerve and the recreate the symptoms as well. Often physical examination can be unremarkable. X-rays and even an MRI can be obtained, although these tests are often negative. A herniated disc from the lumbar spine causing sciatica is possible, so an MRI of the lumbar spine is occasionally ordered.

Treatment of piriformis syndrome

Treatment is usually nonsurgical. Rest or avoiding offending activities, anti-inflammatory medications, and physical therapy for stretching and strengthening the muscles around the hip and pelvis can all be helpful. Occasionally injections of the nerve root or other areas of the hip and pelvis can be attempted depending on the source of the symptoms. Surgery is very rarely needed.

Runners are at risk for piriformis syndrome

Return to sports

Return to sports can be difficult, as often piriformis syndrome is not quickly alleviated. If the athlete can play through the pain, there is usually no reason to hold him or her out. As it improves, the athlete can usually tolerate more activity until he or she is back to sports at the same or higher level.

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