Piriformis Syndrome of the Knee

Piriformis stretch syndrome of the knee, more commonly known as piriformis syndrome, is a neuromuscular disorder. It occurs when the sciatic nerve---which runs along the piriformis muscle---is compressed, irritated or strained by the piriformis muscle. The piriformis muscle is located in the gluteal component of the leg, along the back of the buttocks and into the knee. Patients who suffer from piriformis stretch syndrome in the knee often experience pain, numbness and tingling in the buttocks and along the border of the sciatic nerve.

Diagnosis

Although there is no definitive way to diagnose piriformis syndrome in the knee, many patients experience sciatica (a radiating pain originating in the posterior thigh and knee) and tenderness of the sciatic notch, a small sac above the right hip bone. A medical imaging technique called magnetic resonance neurography is also used to show irritation where the nerve passes beneath the piriformis muscle. Image-guided injections carried out in an open MRI scanner may also assist in diagnosing the condition, since they enable the piriformis muscle to relax and test the muscle's reaction.

Holistic Treatment

Patients with piriformis syndrome often find relief in massages and stretching exercises that reduce strain on the piriformis and strengthen the core muscles. Patients should avoid strenuous activities, including bicycling and running, and physical therapy is recommended. Many patients find comfort in applying heat and ice to the exterior of the muscle; ice may help reduce the onset of pain after strenuous activity, while heat may help to calm prolonged aching in muscles. Custom shoes may help prevent the injury from recurring. Posture correction may also help in reducing use of the piriformis muscle while allowing the muscle to relax and heal.

Medical Treatment

Many physicians believe anti-inflammatory drugs and corticosteroid injections to be the most effective way to treat a severe case of piriformis syndrome. Physicians may also prescribe the use of an ultrasound, which provides a deeper level of heat than heating packs can deliver. In a 2005 study, scientists reported that minimal-access surgery, used primarily for patients with severe piriformis syndrome, has been widely successful in the treatment of the syndrome.

Expert Insight

More than 15 percent of the population has a sciatic nerve that passes through the piriformis muscle rather than below it. Recent studies have concluded that these patients have a greater chance of developing piriformis syndrome, though some scientists dispute these claims, citing insufficient evidence. Failure to treat piriformis syndrome may result in an obturator internus muscle injury, so it is essential to report any incidences of radiating pain down the back of your leg to a doctor immediately.

Prevention/Solution

People who run, bike or complete forward-moving activities often are more likely to develop piriformis syndrome if they do not complete the proper stretches. Lateral stretching and strengthening exercises assist in elongating the muscle and making it more flexible. Scientists also believe that inactive gluteal muscles may increase the likelihood of developing piriformis syndrome; these muscles are essential to hip extension and the external rotation of the femur.