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What is piriformis syndrome?
ICD-10 code: G57.0
The piriformis muscle (m. piriformis) is located deep in the buttock. The sciatic nerve passes through or adjacent to it. When the muscle spasms, becomes inflamed, or hypertrophies, the nerve is compressed — producing pain that mimics sciatica.
According to research, piriformis syndrome accounts for 6–8% of all sciatica cases. It is often misdiagnosed as a disc herniation.
Symptoms
- Buttock pain that worsens when sitting
- Pain radiating down the back of the thigh
- Numbness and tingling in the leg
- Worsens when climbing stairs, squatting
- Spinal MRI — normal (no herniation!)
How regenerative treatment treats piriformis syndrome
CGF (growth factor) injection directly into the piriformis muscle and perineural space under ultrasound guidance. This relieves inflammation, restores microcirculation, and eliminates fibrotic changes in the muscle.
For chronic cases (>12 months), MFAT is added — stem cells for regeneration of damaged tissues and nerve decompression.
Good to know: diagnosis, self-help, outlook
How to tell piriformis syndrome from similar conditions
In piriformis syndrome the buttock hurts, the pain may radiate down the back of the thigh and worsens with prolonged sitting and internal rotation of the hip. Unlike a disc herniation, low back pain is mild and there are usually no neurological deficits. The sacroiliac joint and gluteal tendinopathy cause similar symptoms. The diagnosis is made on examination after ruling out other causes; the lumbar MRI usually shows no significant changes.
What you can do yourself
Stretch the gluteal muscles several times a day, strengthen the hip muscles and take breaks from prolonged sitting. A soft cushion and not keeping a wallet in the back pocket reduce pressure on the buttock. Massage and heat ease pain, but treatment is based on exercise.
Outlook and timelines
In most patients pain decreases within 4–8 weeks of regular exercise. If it persists, the physician may inject local anaesthetic into the muscle under ultrasound guidance. Surgery is very rarely needed; if there is no improvement, the diagnosis is re-checked.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Urgent surgery, not injections, is needed if there is progressive leg weakness, numbness in the groin area or bladder dysfunction.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
- Injections into the intervertebral disc carry a rare risk of disc inflammation (discitis).
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Tuakli-Wosornu YA et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R, 2016.
- Lurie JD et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the Spine Patient Outcomes Research Trial. Spine, 2014.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently asked questions
How to distinguish piriformis syndrome from a disc herniation?
Key difference: with a disc herniation, MRI shows protrusion/herniation. With piriformis syndrome, spinal MRI is normal. Diagnosis: FAIR test (pain with internal rotation of flexed hip), piriformis ultrasound, diagnostic block.
How many procedures may be needed?
The basis of treatment is exercise, not procedures. If the physician recommends an injection, one is usually enough; sometimes it is repeated after a few weeks if the first helped partly. Repeated routine courses are not needed.
Can I train with piriformis syndrome?
Yes, with adjustments: temporarily reduce uphill running, deep squats and long cycling if they worsen the pain. Gluteal stretching and hip strengthening are part of treatment. After an injection 1–2 days without intense exercise are usually recommended.
What can I do myself for piriformis syndrome?
Stretching the gluteal muscles, strengthening the hip muscles, taking breaks from prolonged sitting and not keeping a wallet in the back pocket help. Heat and massage relieve pain temporarily. If numbness and leg weakness increase, a medical examination is needed.
When is an injection into the piriformis muscle needed?
If pain persists despite exercise, the physician may inject local anaesthetic, sometimes with corticosteroid, into the muscle under ultrasound guidance. The injection reduces pain and helps confirm the diagnosis; exercise then continues. Botulinum toxin is used less often, for specific indications.
How long does treatment of piriformis syndrome take?
With regular exercise, pain eases in most people within 4–8 weeks, sometimes longer. It is important to remove the cause of overload — prolonged sitting, training errors. If there is no improvement, the physician re-checks the diagnosis: a disc herniation and the sacroiliac joint can cause similar pain.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
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