Sports Medicine: Piriformis Syndrome

Piriformis (pee-ruh-for-muhs) syndrome is a rare condition in the back of the hip, causing pain and sometimes loss of feeling in the back of the thigh. Pain often goes down to the bottom of the foot. The piriformis muscle travels from the pelvis to the outer hip and helps rotate the hip, allowing the thigh, foot, and knee to point out. The sciatic nerve passes the hip between this muscle and other muscles of the hip. Piriformis syndrome occurs when the piriformis muscle tightens up, sometimes pushing on the sciatic nerve.

Signs and Symptoms

  • Tingling, burning, or numbness from the back of the thigh to the knee, and sometimes the bottom of the foot
  • Pain in the hip or groin, mid-buttock, or back of the thigh often to the knee
  • Pain gets better by lying flat on the back
  • The buttock area can often be tender
  • The leg can feel heavy or tired
  • Pain gets worse with running, jumping, long walks, walking upstairs or hills, or sitting for long periods

Increased Risk

  • Sports involving running, jumping, or long walks
  • Poor physical conditioning (decreased strength and flexibility)

Treatment

  • Medicine
    • Anti-inflammatory medicines like (Motrin® or Advil®) or naproxen (Aleve®) may be recommended. Take these as directed by your doctor or health care provider.
    • Other minor pain relievers like acetaminophen (Tylenol®) may be taken.
  • Use of cold and heat
    • Cold should be applied for 10 to 15 minutes every 2 to 3 hours and after any activity that makes symptoms worse. Use ice packs or an ice massage and raise the foot and ankle at or above heart level to reduce swelling.
    • Heat may be used before doing stretching and strengthening activities ordered by your doctor, health care provider, or athletic trainer. Use a heat pack or a warm soak. Apply for 10 to 15 minutes.
  • Rest
    • Decreasing or stopping painful activity may be necessary to allow the injury to heal.
  • Exercises
    • Exercises to stretch and improve strength and flexibility of the hip and leg muscles are helpful. These can be done at home, but often a referral to a physical therapist or athletic trainer may be advised by your doctor or health care provider along with a slow return to sports.
  • Injection
    • An injection with a steroid given in the area where the nerve is being pinched may help swelling and pinching.
  • Surgery
    • If other treatments fail, surgery may be needed to free the pinched nerve by cutting the muscle or tendon where the nerve is being pinched.

How to Prevent

  • Do correct warm-up and cool down before and after practice or competition.
  • Maintain proper conditioning, strength, hip flexibility, endurance, and cardiovascular fitness.

When to Call the Doctor

Call your doctor, health care provider, or the Sports Medicine team at (614) 355-6000 if:

  • Symptoms get worse or do not improve in 2 weeks, even with treatment.
  • New, unexplained symptoms develop.

 

Sports Medicine: Piriformis Syndrome (PDF)

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