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Pear muscle syndrome
Medical expert of the article
Last reviewed: 07.07.2025
Piriformis syndrome is when the piriformis muscle impinges on the sciatic nerve, causing pain.
The piriformis muscle runs from the pelvic surface of the sacrum to the superior border of the greater trochanter of the femur. During running or sitting, this muscle can press on the sciatic nerve where it emerges above the piriformis and continues above the rotator cuff muscles of the hip.
[ Symptoms of Piriformis Syndrome
Chronic, aching, dull and sharp pain, tingling, or numbness that begins in the buttocks and may radiate along the sciatic nerve down the back of the thigh, into the calf, and sometimes into the foot. The pain is usually chronic and worsens when the piriformis muscle presses on the sciatic nerve (such as when sitting on the toilet, in a car, riding a bike, or running). In contrast to the pain of piriformis syndrome, pain caused by sciatica (sciatica) is usually localized to the back, radiating along the sciatic nerve into the legs.
Diagnosis of piriformis syndrome
The diagnosis is established after a physical examination. The occurrence of pain when rotating the bent hip inward (Freiberg's symptom), abducting the affected lower limb while sitting (Pace's symptom), raising the knee a few centimeters while lying on the healthy side (Beattie's symptom), or when pressing on the buttocks at the point where the sciatic nerve crosses the piriformis muscle during a slow bend of the patient (Mirkin's test) serves as a reliable diagnostic sign. Visual examination methods are not informative, but can exclude other causes of sciatic nerve compression. Differentiating piriformis syndrome from pathological changes in the lumbar intervertebral discs is quite difficult in some cases, so it is better to consult a specialist.
What do need to examine?
Treatment of piriformis syndrome
The patient should stop running, cycling, or any other activity that causes pain for a while. Patients whose pain increases when sitting should stand up immediately or, if this is not possible, change their position to reduce the load on the affected area. Specific stretching exercises for the hamstrings and piriformis may be helpful. Surgical treatment is rarely indicated. In many cases, a cautious injection of glucocorticoids into the area where the piriformis crosses the sciatic nerve may help.