A radiologist may assist in this clinical setting by injecting a small dose of medication containing a paralysing agent such as botulinum toxin under high-frequency ultrasound or CT control. This inactivates the piriformis muscle for 3 to 6 months, without resulting in leg weakness or impaired activity. Though the piriformis muscle becomes inactivated, the surrounding muscles quickly take over its role without any noticeable change in strength or gait. Such treatments may be more or less curative (with no return to pain), or may have limited timespans of effectiveness. Surgery
For rare cases with unrelenting chronic pain, surgery may be recommended. Surgical release of the piriformis muscle is often effective. Minimal access surgery using newly reported techniques has also proven successful in a large-scale formal outcome published in 2005. As with injections, the deactivated/ excised muscles role in leg movement is completely compensated for by surrounding hip muscles. Failure of piriformis syndrome treatment may be secondary to an underlying internal obturator muscle injury. Epidemiology
Piriformis syndrome (PS) data is often confused with other conditions due to differences in definitions, survey methods and whether or not occupational groups or general population are surveyed. This causes a lack of group harmony about the diagnosis and treatment of PS, affecting its epidemiology. In a study, 0.33% of 1293 patients with low back pain cited an incident for PS. A separate study showed 6% of 750 patients with the same incidence. About 6–8% of low back pain occurrences were attributed to PS, though other reports concluded about 5–36%.
To the extent that piriformis syndrome is the result of some type of trauma and not neuropathy, such secondary causes are considered preventable, especially those occurring in daily activities: according to this theory, periods of prolonged sitting, especially on hard surfaces, produce minor stress that can be relieved with bouts of standing. An individuals environment, including lifestyle factors and physical activity, determine susceptibility to trauma of any given type. Although empirical research findings on the subject have never been published, many believe that taking sensible precautions during high-impact sports and when working in physically demanding conditions may decrease the risk of experiencing piriformis syndrome, either by forestalling injury to the muscle itself or injury to the nerve root that causes it to spasm. In this vein, proper safety and padded equipment should be worn for protection during any type of regular, firm contact (i.e., American football, etc.). In the workplace, individuals are encouraged to make regular assessments of their surroundings and attempt to recognize those things in ones routine that might produce micro or macro traumas.