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Piriformis Syndrome

Piriformis Syndrome Pain Management in Knoxville, TN

The American Chiropractic Association reports that 31 million Americans are experiencing lower back pain at any given time. Some of that pain might be caused by a somewhat elusive disorder called piriformis syndrome, which has been treated effectively for years at Knoxville Omega Pain Management. You may have heard of sciatica – a condition in which the sciatic nerve gets compressed in the spine, causing pain in the lower back, buttocks, and legs. In 1934, two orthopedic doctors Albert Freiberg and Theodore Vinke described a similar condition, later named piriformis syndrome, in which the same nerve is affected but the compression site is in the buttock area instead of the spine. Due to the similarity of the symptoms and lower prevalence, it often gets mistaken for sciatica, making the treatment less effective. In this article, we will discuss the symptoms, causes, and treatment options for this disease and explore its differences and similarities with other conditions.

What is piriformis syndrome?

Piriformis is a muscle in the buttock that diagonally connects the bottom of the spine to the top of the hip bone. It is responsible for rotating the hip in and out and provides balance during walking or running. The biggest nerve in the human body – the sciatic nerve – runs behind the piriformis muscle. When the muscle is inflamed, injured, or swollen from excess contraction it can entrap the sciatic nerve behind it and cause pain and other symptoms. Because the sciatic nerve originates in the lower back and travels through the buttock down the leg, these are the areas primarily affected by this condition.

What causes piriformis muscle?

The causes of piriformis syndrome are not always clear but are presumed to be:
  • Injury to the buttock or hip area as a result of a car accident or a fall
  • Overuse of the piriformis muscle, usually observed in athletes
  • Prolonged sitting (office workers, taxi drivers)
  • Anatomic anomalies (sciatic nerve traveling through the muscle rather than behind it or branching into smaller nerves at a higher point than normal)
These events can result in inflammation, spasm, or gradual contraction of the piriformis muscle, which in turn compresses and irritates the sciatic nerve.

How common is piriformis muscle?

Piriformis syndrome is not a very common condition and by various estimates accounts for 0.3 to 6% of all lower back pain. According to a 2008 review published in the Journal of Osteopathic Medicine, it typically occurs in your 40s and 50s, more commonly affecting women than men. Having had piriformis syndrome in the past increases the risk of having it again in the future. This disorder is thought to be underdiagnosed as it is often confused with other conditions that have similar symptoms.

What are the symptoms of piriformis syndrome?

The main symptoms of piriformis syndrome are pain and tenderness in the buttock, hip, thigh, and lower back. It can also cause numbness, tingling, and burning sensations in these areas. It tends to happen on one side of the body, although it is possible to have it on both sides. The pain usually gets worse after prolonged sitting or walking but improves when you lie down. Walking up the stairs can exacerbate the pain as well. The symptoms are very similar to another condition called sciatica. Sciatica is also caused by a compression of the sciatic nerve but at a different location: the nerve root in the spine. To successfully treat piriformis syndrome, it’s important to differentiate these disorders, which can sometimes be challenging.

How is piriformis syndrome diagnosed?

There is currently no specific test to diagnose piriformis syndrome. A doctor will take the patient’s medical history and ask about the symptoms and any recent injuries. After this, he or she will perform a physical exam with the intention of identifying the source of the pain. It will involve moving, rotating, and pressing on different parts of the leg, buttock, and lower back to see which positions reproduce the painful or tingling sensations. Imaging techniques such as X-ray, CT, and MRI scans might be helpful in ruling out other conditions. If no other causes of pain can be found and the physical exam indicates sciatic nerve compression near the piriformis muscle, piriformis syndrome is diagnosed. An anesthetic injection into the piriformis muscle can help confirm the diagnosis if it results in pain relief.

How is piriformis syndrome treated?

In many cases, piriformis syndrome improves within days or weeks with minimal treatment, such as over-the-counter medications (Ibuprofen, Naproxen) and hot and cold compresses to reduce inflammation and relieve pain. If the pain doesn’t improve after a few days, physical therapy could be beneficial. Stretching exercises will increase muscle flexibility and strength, easing the symptoms. In more severe cases, further treatment might be necessary. There are several types of injections that can help with pain from piriformis syndrome:
  • Trigger point injections – injecting a local anesthetic into the muscle knots to help relax the muscle and relieve the pain
  • Steroid injections – injecting a corticosteroid and an anesthetic into the affected area to reduce pain and inflammation
  • Botox injections – injecting Botox into the muscle to temporarily paralyze it which helps reduce the pain.
The injections act as a way to allow the patient to engage in physical therapy so that by the time the effect of the injection wears off, the muscle is strengthened, stretched, and relaxed. This greatly increases the chances of full recovery. Transcutaneous electrical nerve stimulation (TENS) is another method of easing pain that works by sending electrical changes to the muscle through the skin. Very rarely, a surgical procedure that involves cutting the piriformis muscle might be recommended to decompress the sciatic nerve. Surrounding hip muscles can usually fully compensate for the deactivated piriformis muscle.


Piriformis syndrome is a challenging disorder to diagnose due to a lack of certainty of the exact cause, an absence of a specific diagnostic test, and similarity to other more common conditions. Nonetheless, a doctor with a solid understanding of the role of the piriformis muscle and its relation to the sciatic nerve will be able to explore this possibility and take necessary action to diagnose and treat this condition to help you achieve full recovery.

Piriformis syndrome treatment in Knoxville, TN

If you’re suffering from piriformis syndrome or other sciatica pain, it’s important to have your treatment supervised by comprehensive pain specialists. Omega Pain Management is where to turn for comprehensive pain management Knoxville TN for piriformis syndrome. Depending on the severity of your pain and other symptoms, a number of treatment options may be available. Our Knoxville piriformis syndrome specialist will take you through a series of tests and you’ll be given a treatment plan that’s tailored to your individual needs. Conta ct Dr. Igor Smelyansky. Phone (865) 337-5137.


Boyajian-O’Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008 Nov;108(11):657-64. doi: 10.7556/jaoa.2008.108.11.657. PMID: 19011229.

Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010 Dec;19(12):2095-109. doi: 10.1007/s00586-010-1504-9. Epub 2010 Jul 3. PMID: 20596735; PMCID: PMC2997212.