Piriformis Syndrome is a description of a pain in the gluteal region radiating towards the thigh which believed to be related to a compression or an irritation of the sciatica nerve when passing next to the piriformis muscle at the floor of the pelvis. Many theories have stipulated that some tightness in the muscle causing this irritation and sometimes, a hypertrophic muscle in athletes can be considered as a space-occupying causing also a nerve irritation also but, in all honesty and according to my 30 years of experience, I simply do not believe that a Piriformis Syndrome does exist. In all patients that I have reviewed with regards to Piriformis Syndrome, they had been treated with a non-steroidal anti-inflammatory, physiotherapy, and sometimes a release of the piriformis muscle and almost all these patients did not improve.
With a careful analysis of the causation of their symptoms, I believe that the problem lies in the lumbar spine which is most likely related to a lateral stenosis and foraminal stenosis in the lumbar spine level causing an irritation to the sciatic nerve or in one of the nerve roots forming the sciatic nerve and this is causing this pain which does not include any significant weakness in lot of time as this is mainly because of the nerve irritation or a narrowing of mild to moderate level and did not reached a significant degree to cause weakness. From my experience of dealing with these cases, a lateral stenosis decompression with an endoscope and foraminal decompression surgery using an endoscope has recovered almost all the cases which has been attributed to a Piriformis Syndrome and this will augment my opinion that the Piriformis Syndrome does not exists.
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