When it comes to diagnosing piriformis syndrome, there are many physical findings that can promote the diagnosis. The common symptoms of piriformis syndrome include pain in the buttock with or without radiation in the distribution of the ipsilateral sciatic nerve (down the posterior aspect of the leg). More often than not patients will complain of pain that worsens with sitting or standing from a sitting position along with increased pain when lifting or flexing forward at the waist. Advanced piriformis syndrome may cause weakness in the ipsilateral gluteal and lower extremity muscles. It is often difficult to distinguish piriformis syndrome from lumbar radiculopathy. Generally speaking, patients with lumbar radiculopathy have back pain with associated motor, sensory, and reflex changes, whereas those with piriformis syndrome lack reflex changes. Plain films are an initial imaging modality that is often performed to rule out any bony abnormalities. Magnetic resonance imaging (MRI) is often next in line to detect a herniated disc or spinal stenosis. Physical examination still remains of utmost importance. There are a handful of provocative maneuvers that can point toward a diagnosis of piriformis syndrome. These include the following:

The treatment options for piriformis syndrome are extensive, ranging from conservative medical management to interventional injection techniques. Initial treatment usually begins with a combination of nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2) inhibitors and physical therapy. Sleeping with a pillow between the legs may also help to alleviate the pain as well.

The above exercises (Fig 5.4) have been shown to be effective in strengthening the piriformis muscle and relieving the pain of piriformis syndrome and are explained as follows: