Piriformis syndrome can be classified by cause and course:

1. Primary piriformis syndrome:
   Arises from anatomical anomalies, such as an unusual position of the sciatic nerve in relation to the piriformis muscle.
2. Secondary piriformis syndrome:
   Develops due to external factors such as trauma, overuse, or poor posture.
3. Acute piriformis syndrome:
   Sudden onset of symptoms, often after injuries or intense exertion.
4. Chronic piriformis syndrome:
   Longer-lasting symptoms, often associated with degenerative changes or persistent improper loading.

Piriformis syndrome has diverse causes, which can be mechanical or neurological in nature:

• Overuse:
  • Repetitive movements, such as running or cycling, place strain on the piriformis muscle.
• Postural misalignments:
  • Pelvic asymmetries or poor sitting posture can place sustained strain on the muscle.
• Trauma:
  • Injuries such as falls onto the buttocks or whiplash can lead to tension and irritation.
• Anatomical anomalies:
  • Variations in the course of the sciatic nerve can increase the risk.
• Muscular imbalances:
  • An imbalance between the hip and gluteal musculature impairs the function of the piriformis muscle.
• Scar formation:
  • After surgeries or injuries, adhesions can affect the muscle and the nerve.

The symptoms of piriformis syndrome are characteristic but can vary individually:

• Buttock pain:
  Localized pain in the buttock area that often increases when sitting or walking.
• Radiating pain:
  Pain along the sciatic nerve that can radiate into the leg down to the foot.
• Tenderness to pressure:
  Pain when pressure is applied to the piriformis muscle, often noticeable on palpation.
• Restricted movement:
  Limited hip mobility, especially with external rotation.
• Tingling or numbness:
  Neurological symptoms such as paresthesias in the affected leg.
• Worsening of symptoms:
  Pain increases with activities such as climbing stairs, sitting, or prolonged walking.

The diagnosis is based on medical history, clinical examination, and imaging procedures:

1. Medical history:
   Taking the medical history, description of symptoms, and analysis of possible stress factors.
2. Clinical examination:
   • Tests such as the FAIR test (flexion, adduction, internal rotation) or the Lasègue test to provoke pain.
   • Palpation of the piriformis muscle to assess pressure tenderness.
3. Imaging procedures:
   • MRI: Exclusion of other causes such as herniated discs or tumors.
   • Ultrasound: Visualization of muscle and nerve damage.
   • EMG (electromyography): Assessment of nerve function to confirm the diagnosis.

Conservative therapy

In most cases, piriformis syndrome can be successfully treated without surgery:

• Physiotherapy:
  • Stretching exercises and massages to relax the piriformis muscle.
  • Strengthening exercises for the surrounding muscles.
• Manual therapy:
  • Mobilization of the pelvis and hip to reduce muscle tension.
• Cold and heat applications:
  • Relief of pain and promotion of blood circulation.
• Medication therapy:
  • NSAIDs to relieve pain and reduce inflammation.
  • Muscle relaxants to relax the piriformis muscle.
• Injections:
  • Local anesthetics or cortisone injections to reduce symptoms.

Surgical therapy

In therapy-resistant or chronic cases, surgery may be necessary:

• Release of the piriformis muscle:
  • Surgical loosening of the muscle to relieve the sciatic nerve.
• Removal of scar tissue:
  • Removal of adhesions that irritate the nerve.

The following measures are helpful for preventing piriformis syndrome:

1. Regular stretching exercises: Promote flexibility of the piriformis muscle and the surrounding structures.
2. Strengthening the hip muscles: Strengthen the gluteal and pelvic muscles to stabilize the hip.
3. Avoiding poor posture: Ergonomic sitting positions and regular breaks during sedentary work.
4. Low-impact exercise: Prefer joint-friendly activities such as swimming or yoga.
5. Early detection: Timely medical evaluation at the first signs of pain or restricted movement.