Piriformis syndrome is one of the causes of sciatica. It is caused by the piriformis muscle (a muscle in your buttocks that rotates the hip) irritating or compressing the sciatic nerve. Piriformis syndrome sometimes is called wallet sciatica or fat-wallet syndrome. Kramer (from Seinfeld) makes reference to such a problem in an episode where he says to George – ‘I don’t like to carry my wallet. My Osteopath says that it’s bad for my spine. It throws my hips off kilter.’

The pain can present as a sharp stabbing pain that can radiate from the buttocks down the leg. As the piriformis rotates your hip outwards, a patient may present with an outturned foot as this shortens the piriformis, therefore reducing the irritation or compression on the nerve.

There are numerous causes such as:

• Sacroiliac joint dysfunction  – the joint within your pelvis
• Weaknesses in the gluteal muscles, causing the piriformis to overwork
• Overuse – people doing lots of cycling or rowing
• Over pronation of the foot (foot rolling in)

Piriformis syndrome responds well to conservative treatment which can include, massage, stretching, dry needling, manipulation and/or muscle energy technique (MET) of the sacroiliac joints and lumbar spine, strengthening of the gluteal and surrounding muscles. Avoiding activities that are causing or exacerbating the symptoms are recommended.