This tiny muscle (Piriformis) is a common cause of lower back pain (and you’re probably not even aware of it)

What is piriformis syndrome?

Piriformis syndrome is a condition characterised by the irritation or inflammation of the sciatic nerve by the piriformis muscle. If the piriformis muscle tightens or spasms, it can impinge on the sciatic nerve, leading to symptoms like one-sided back or buttock pain with or without referral down the leg.

What does piriformis syndrome feel like?

If you’re wondering if your back pain might be a piriformis issue, your best bet is to get checked out by your GP or a pain specialist. The syndrome manifests as a sharp stabbing pain in the base of the lower back or the buttock; however, it can feel different for everyone – with pain severity spanning from a dull ache to a sharp, shooting sensation.

Piriformis syndrome most commonly presents with pain, tingling or numbness in the lower back, bottom area that may radiate down the back of the leg. Patients often describe discomfort while sitting for extended periods, walking or climbing stairs.

How to manage piriformis syndrome?

Core and hip strengthening exercises are going to be key to recovery- staying active in a way that strengthens and rebalances the body is crucial. The piriformis is supposed to be part of an ecosystem of muscles that support the movement of your glutes. When you’ve developed piriformis syndrome, however, the piriformis acts in isolation.

Using a foam roller:

A foam roller is a really cost-effective and an easy thing to buy. Foam rolling is worth doing because it loosens tight muscles – including the piriformis.

Moves for building a stronger piriformis

Single-leg deadlift

• Stand with your feet shoulder-width apart and hold a dumbbell in your right hand. Place your left hand on your hip or extend it out to your left.
• Keeping your back straight, send your hips back, as though you are trying to get them to touch a wall behind you. Allow your arm to lower down towards your feet.
• Make sure your hips stay in alignment by pushing your left hip forwards and engaging your core.
• Press through your heels to come back to the starting position.

Single-leg glute bridge

• Beginning in the same position as before, tuck your left knee in towards your chest and hold onto it with your right hand. Place your left hand behind your head.
• Keeping your tailbone tucked, press through your right heel to lift into a bridge position. Remember to squeeze your glutes at the top.
• Slowly lower back down.

Three-legged dog hip circles

• Standing with feet hip-width apart, bend from the hips and start to walk your hands forward.
• With your bum in the air, hand flat on the floor, bend your right knee and raise into the air.
• Working from the hip, start to circle that knee in one direction and then reverse.
• Bring that foot back onto the ground and repeat on the left hand side.

When Rehabilitation Falls Short: Ultrasound-Guided Injections for Piriformis Syndrome

While rehabilitative strategies such as physiotherapy, stretching, and activity modification form the cornerstone of piriformis syndrome management, some patients may continue to experience persistent sciatic-type pain despite conservative measures. In such cases, targeted interventions like piriformis muscle injections can be highly valuable.

Ultrasound-Guided Steroid Injections for Piriformis Syndrome

A piriformis injection using a combination of local anaesthetic and corticosteroid can serve both diagnostic and therapeutic purposes. The local anaesthetic helps confirm the diagnosis by temporarily relieving the pain if the piriformis muscle is indeed the source, while the steroid component helps reduce inflammation and irritation of the sciatic nerve as it passes near or through the muscle. Studies have shown variable but often meaningful relief following steroid injections, particularly in patients with clearly localised symptoms and positive response to physical examination tests.

Ultrasound-Guided Botox for Piriformis Syndrome

For patients who do not achieve sustained benefit from steroid injections or who suffer from significant muscle spasm contributing to nerve compression, botulinum toxin (Botox) injections into the piriformis muscle represent an effective alternative. Botox works by inducing temporary chemodenervation, leading to relaxation of the hypertonic muscle and reducing sciatic nerve entrapment. Several clinical studies and case series have reported significant improvements in pain, function, and quality of life following botulinum toxin injections for piriformis syndrome, especially in chronic or refractory cases. The onset of relief typically occurs within a few days to weeks, with effects lasting several months.

Expertise at Pain Spa

Dr. Krishna has substantial expertise in performing both corticosteroid and botulinum toxin injections for piriformis syndrome under high-resolution ultrasound guidance. Ultrasound enables precise visualisation of the piriformis muscle and surrounding structures, ensuring accurate needle placement and minimising risks. His experience in interventional pain management and musculoskeletal ultrasound significantly enhances treatment accuracy and improves clinical outcomes for patients suffering from this complex and often underdiagnosed condition.

Please contact Pain Spa at clinic@painspa.co.uk or via our website www.painspa.co.uk. to arrange a consultation or if you have any further questions.