Piriformis Syndrome Treatment and Piriformis Injection

Transcript translated from Turkish (video audio remains in Turkish)

Hello everyone, I am Dr. Mehmet Levent Deniz, a specialist in brain, nerve and spine surgery. I will explain the piriformis injection that I use for piriformis syndrome, also colloquially referred to as sciatica.

The piriformis injection we use for piriformis syndrome, also colloquially known as sciatica, is performed under imaging guidance and local anaesthesia. A combination of a steroid, local anaesthetic and hypertonic sodium chloride is injected into the piriformis muscle. The aim is to reduce swelling and inflammation in the area and relax the piriformis muscle, thereby relieving pressure on the sciatic nerve.

The procedure takes 5 to 10 minutes.

I wish you all pain-free and happy days. Stay well.

What Is Piriformis Syndrome?

Piriformis syndrome is pain caused by compression of the sciatic nerve within or beneath the piriformis muscle in the buttock. The sciatic nerve leaves the lower back, passes through or immediately beneath this muscle deep in the buttock, and continues down the back of the leg.

What Causes Piriformis Syndrome?

The most common cause is a sudden, unbalanced movement or excessive strain of the piriformis muscle. The sciatic nerve becomes trapped between the muscle fibres. This clinical condition, known as piriformis syndrome, is triggered by nerve compression and is now also considered among pain conditions originating deep in the buttock (deep gluteal syndrome).

What Are the Symptoms of Piriformis Syndrome?

The most typical symptom is deep, one-sided pain felt at a specific point in the buttock.

• Local Buttock Pain: Deep, intense, one-sided pain at a specific point in the buttock. The most common findings are buttock pain, tenderness where the sciatic nerve passes through the buttock, and pain that increases with prolonged sitting [4].
• Radiating Leg Pain and Numbness: Pain may spread from the buttock into the thigh and down the back of the leg along the compressed sciatic nerve.
• Confusing Clinical Presentation: Because the pain radiates into the leg, patients and sometimes even physicians often mistake it for lumbar disc herniation. Here, however, the problem lies in the buttock muscle, not the lumbar discs.

How Is Piriformis Syndrome Diagnosed?

Piriformis syndrome is assessed through the patient’s history and examination, and diagnosed after excluding other causes such as lumbar disc herniation. A lumbar MRI must therefore be obtained. A hip MRI may sometimes be used to locate the compression, although most of the time it shows no abnormality. No single standard test definitively identifies piriformis syndrome; a clinical assessment score developed in one study helps with diagnosis [6].

How Does Piriformis Syndrome Improve?

Treatment begins with exercise and physiotherapy; patients whose pain persists receive an image-guided piriformis injection.

1. First Stage (Basic Measures): Early treatment includes brief rest, medication and exercises that stretch the piriformis muscle. In one study, half of patients (51%) improved with medication and rehabilitation [6].
2. Second Stage (Interventional Pain Treatment / Algology Procedure): For patients whose muscle spasm and pain persist despite conservative measures, we use piriformis injection [2, 3].

What Is a Piriformis Injection?

Piriformis injection is an image-guided interventional procedure into the muscle that aims to reduce mechanical and chemical pressure on the sciatic nerve.

How Does a Piriformis Injection Work?

It rapidly reduces swelling and inflammation that irritate the nerve and relaxes the contracted piriformis muscle, relieving compression of the sciatic nerve.

How Is a Piriformis Injection Performed?

The injection is performed in an operating theatre under advanced imaging guidance (fluoroscopy or ultrasound). Imaging allows the piriformis muscle to be seen clearly on screen, and a special combination of medications is injected precisely into the targeted muscle tissue.

• Duration and Anaesthesia: No extensive preparation is needed. Only the relevant area is numbed under local anaesthesia; the procedure itself takes an average of 5–10 minutes.
• Discharge: After a short rest in the clinic, our patients can walk home the same day.
• Risks: Serious complications are rare in experienced hands with imaging guidance. This targeted approach spares patients a prolonged burden of strong medication.

What Is the Success Rate of Piriformis Injection?

Yes: among patients with piriformis syndrome who had a positive diagnostic test, 79% reported at least a 50% reduction in pain with injection and physiotherapy; average improvement was 71% [1]. A study in Turkey found that local anaesthetic injection into the piriformis muscle significantly reduced pain [2]. A combination of local anaesthetic and cortisone was found most effective [3]. This ultrasound- or fluoroscopy-guided procedure relieves spasm and pressure exerted by the piriformis muscle on the sciatic nerve; for buttock pain confused with disc herniation, it has both therapeutic and diagnostic value [1, 2, 7]. Relieving muscle spasm also improves the patient’s ability to participate in physiotherapy [1].

What Are the Risks and Side Effects of Piriformis Injection?

Ultrasound- or fluoroscopy-guided piriformis injection is an interventional procedure with a low complication rate. Outcomes are similar with both guidance methods; in each, the needle is advanced under imaging for a controlled procedure [5]. The most common side effects are temporary fullness, tenderness or muscle aching at the injection site for a few days; these resolve on their own [2, 5]. Serious complications such as infection, bleeding and nerve injury are rare when the procedure is performed under sterile conditions with imaging guidance.

🩺 Physician’s Insight & Clinical Experience

“Many patients come to my clinic saying, ‘Doctor, my leg hurts terribly; my disc must have ruptured.’ After neurological examination and MRI, I often find no lumbar herniation and identify the piriformis muscle in the buttock as the cause. I first direct patients towards conservative treatments. When physiotherapy and exercise do not provide relief, I aim to support treatment by entering the muscle under imaging guidance and relieving the spasm with an injection. My clinical observation, however, is that injection alone cannot achieve complete success in this condition: the patient must follow an appropriate exercise programme.”

Frequently Asked Questions

Is Piriformis Syndrome the Same as Sciatica?

No. Sciatica describes pain and numbness along the sciatic nerve; piriformis syndrome is one of the leading non-spinal causes of this presentation. The most common cause of sciatic pain is lumbar disc herniation.

What Is the Success Rate of Piriformis Injection?

Of patients with a positive diagnostic test, 79% reported at least a 50% reduction in pain with injection plus physiotherapy [1]; studies in Turkey and abroad confirm the injection’s effectiveness [2, 3].

Does Piriformis Injection Have Risks or Side Effects?

Yes, but they are low: the most common effect is temporary fullness or muscle aching at the injection site for a few days; serious complications are rare [2, 5].

What Should People with Piriformis Syndrome Watch For, and Which Exercises Should They Do?

Avoid prolonged sitting on hard surfaces, carrying a wallet in the back pocket and strenuous uphill running. Piriformis stretches, drawing a crossed leg towards the chest, are a fundamental part of treatment.

Which Specialist Performs Piriformis Injections in Istanbul?

One of the physicians performing piriformis injections in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does a Piriformis Injection Cost?

A definite fee can only be determined after examination and review of imaging; treatment costs vary according to the patient and hospital conditions.

References

1. Fishman LM, Dombi GW, Michaelsen C, et al. Piriformis syndrome: diagnosis, treatment, and outcome — a 10-year study. Arch Phys Med Rehabil. 2002;83(3):295-301. PMID: 11887107.
2. Misirlioglu TO, Akgun K, Palamar D, Erden MG, Erbilir T. Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain Physician. 2015;18(2):163-171. PMID: 25794202.
3. Hilal FM, Bashawyah A, Allam AE, et al. Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis. Pain Physician. 2022;25(5):325-337. PMID: 35901473.
4. Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010;19(12):2095-2109. PMID: 20596735.
5. Fowler IM, Tucker AA, Weimerskirch BP, Moran TJ, Mendez RJ. A randomized comparison of the efficacy of 2 techniques for piriformis muscle injection: ultrasound-guided versus nerve stimulator with fluoroscopic guidance. Reg Anesth Pain Med. 2014;39(2):126-132. PMID: 24509422.
6. Michel F, Decavel P, Toussirot E, et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med. 2013;56(5):371-383. PMID: 23684470.
7. Li S, Sun Y, Zhang Q, Zhang W, Qin X. Analysis of the Effectiveness of Injection-Based Minimally Invasive Treatment for Piriformis Syndrome: Clinical Outcomes and Anatomical Correlates. Curr Pain Headache Rep. 2026;30(1):84. PMID: 42406261.

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.