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Piriformis syndrome is often left undiagnosed and mistaken with other pains due to similar symptoms with back pain, quadriceps pain, lower leg pain, and buttock pain. These symptoms include tenderness, tingling and numbness initiating in low back and buttock area and then radiating down to the thigh and to the leg. [ 72 ]
Common symptoms include lower back pain, buttocks pain, sciatic leg pain, groin pain, hip pain (for explanation of leg, groin, and hip pain, see referred pain), urinary frequency, and "transient numbness, prickling, or tingling".
The piriformis muscle sits over the top of the sciatic nerve, so if the muscle becomes irritated, it can press down on the sciatic nerve and cause glute pain, along with radiating pain down the leg.
Piriformis syndrome occurs when the piriformis irritates the sciatic nerve, which comes into the gluteal region beneath the muscle, causing pain in the buttocks and referred pain along the sciatic nerve. [8] This referred pain is known as sciatica. Seventeen percent of the population has their sciatic nerve coursing through the piriformis muscle.
The most common symptoms are localized unilateral low back pain, though up to anywhere between 40 and 82% of patients may complain of leg symptoms – pain or dysethesia. [ 5 ] [ 11 ] [ 12 ] The onset of pain can vary, with some patients report sudden onset of pain with a known inciting incident. [ 13 ]
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For example, sitting pain is associated with sciatic nerve entrapment under the piriformis, but pain lateral to the ischium when walking is associated with ischiofemoral impingement. [1] The core of the physical examination is palpation and stretch/activation tests of the external hip rotators.
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