Tightness and pain in the hips and buttock: Possible Piriformis Syndrome

Dear Ask The Doctor: I've had tightness and pain around the top of my hips and a sharp pain at the base of my right buttock for almost 2 years now. My Dr. Had an X-ray done and it didn't show anything so she gave me ibprophen and that's all. I remember when it started and what I did.....I sat on a wooden bench and crossed my legs and felt like I moved a bone over a rubber band. Nothing I do helps...I have given up jogging because it aggravates it terribly stretching the right leg hurts. Alot of people say its sciatica but the pain doesn't go any cutter than the bottom of my butt. Slalom the sides of my buttocks my husband will use his fist to massage the muscles and that makes it feel better. Thanks for any insight, Jessica

Dear Jess: According to your description, your symptoms may correspond to a Piriformis Syndrome, this condition can simulate diskogenic sciatica (radicular compression by a bulging disc), usually is caused by neuritis of the proximal sciatic nerve. The piriformis muscle can either irritate or compress the proximal sciatic nerve due to spasm and/or contracture. The Piriformis Syndrome is also referred to as pseudosciatica, wallet sciatica, and hip socket neuropathy. The pain originates in the base of the buttock and may radiate to the hip. You mentioned you sat on a very hard surface; this may have produce a trauma or blunt injury that could have caused hematoma formation and subsequent scarring between the sciatic nerve and short external rotators muscles. Nerve injury can occur with prolonged pressure on the nerve. It has been described bilateral Piriformis Syndrome due to prolonged sitting on a hard surface. Piriformis syndrome remains controversial because, in most cases, the diagnosis is clinical, and no confirmatory tests exist to support the clinical findings. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome. Approximately 50% of patients with piriformis syndrome have a history of trauma, with either a direct buttock contusion or a hip/lower back torsional injury. The remaining 50% of cases are of spontaneous onset. Diagnostic imaging of the lumbar spine (MRI) is mandatory to rule out associated diskogenic (bulging disk) and/or osteoarthritis. Usually the treatment is aimed to correct the following: tight piriformis muscle, tight hip rotator muscles, hip muscles weakness, and sacroiliac problems. The use of ultrasound previously the physical therapy session may be beneficial, and the proceed with a stretching routine for the piriformis and hip muscles, you should be provided with a home stretching program because the stretches every 2-3 hours (while awake) are critical for the treatment