Do you have Piriformis Syndrome? Dr. Cameron MacEwen of Foxboro, MA says probably NOT!
If I hear one more person tell me they have piriformis syndrome, I might just jump!!!! Seriously though, piriformis syndrome is an actual condition but according to medical research it is exceedingly rare and commonly over diagnosed by clinicians, fitness professionals, trainers, coaches, and therapists. Of course the internet would have everybody convinced that they suffer the malady. This results in patients and practitioners focusing on treating the piriformis and missing the correct diagnosis and treatment.
Piriformis syndrome was originally described by Dr. Yeoman in 1928 as a “sciatica like” symptom caused by compression of the sciatic nerve by the piriformis muscle. At the time this was an “advance” in identifying the cause of sciatica. It was theorized the the piriformis muscle compressed the sciatic nerve causing pain or abnormal sensation in the buttock, hamstring, or posterior thigh, or leg. Since then diagnostic technology (MRI, ultrasound, EMG) and the scientific method (research) have provided very little support for the frequency of the diagnosis of piriformis syndrome. M. Read (2002) states that the common theme in the literature is that piriformis syndrome is not a common problem.
I think that sciatica, gluteal and buttock pain is common and that there are many parts of the body other than the piriformis muscle that can cause it. So we ask, what is the pain generator? What is the diagnosis? What is actually causing the pain in the buttock and/or sciatic like symptoms? There are at least ten anatomical structures that alone or combined can produce the symptoms. To name just a few: spinal joint dysfunction, disc derangement, lumbar and pelvic ligaments, sacroiliac joint dysfunction, spinal stenosis, facet joint inflammation, myofascial trigger points in the thoracic and lumbar region, and postural strain. The piriformis muscle is not alone in the gluteal region either. The obturator internus and gemelli muscles, the gluteal muscles, and tensor fascia lata are all muscles that may generate pain or refer pain to the area. Knowledge and familiarity with these possible pain generators is vital in sorting out and arriving at an accurate diagnosis so that the correct treatment can be provided.
So does piriformis syndrome exist? The answer is yes, but it is just not that common and it is way over utilized as a working and treating diagnosis. What’s worse is that the proper diagnosis and treatment is missed and the patient suffers while the health care business chugs along without a care. All too often in our health care system (or business as it seems to have become), the art of sorting out and arriving at a proper diagnosis is elusive. I can’t count the number of patients I see that have undergone million dollar workups and testing without receiving an accurate diagnosis and treatment. In any case, I truly love the art of sorting out these kind of problems and providing relief. There is no greater satisfaction than relieving my patients’ pain and suffering, so I look forward to treating your buttock and leg pain, whatever is causing it.
Yours in health,
Dr. Cameron MacEwen