Piriformis Syndrome Diagnosis

After years of negative test results in the search for the cause of my chronic pain, I finally found the right physician to perform the right test. Or, more accurately, I was finally referred to the right physician. In February 2012 I had a Provocative EMG. I can’t stress this next point enough…a Provocative EMG is not the same test as a Standard EMG!

Standard EMG Failure

The Standard EMG I had on June 2, 2011 showed no cause for my chronic sciatic pain. In fact, the test results were very normal. The summary results were:

“The nerve conduction study showed a normal right sural SNAP. The bilateral saphenous SNAPs were unelicitable. The right peroneal and tibial CMAPs and F wave latencies were normal. The needle study of selected muscles in the right lower extremity and lower lumbosacral paraspinal muscles was normal.

The Interpretation: Normal study. There is no definite electrophysiologic evidence of a right lower lumbosacral radiculopathy, sciatic neuropathy, myopathy, or peripheral neuropathy in this study.”

You can read my complete Standard EMG Study. I removed the physician name to protect their identity, as well as other personal information. I don’t hold them accountable for not discovering that I had Piriformis Syndrome. It was no one’s fault; it was simply not the correct test. The neurologist that ordered the Standard EMG had never heard of Piriformis Syndrome. I’m reminded of the saying, “You don’t know what you don’t know.”

Provocative EMG Success

On March 1, 2012 I had a Provocative EMG. The test lasted about twenty minutes and the results were concrete evidence that I had Piriformis Syndrome. I wrote “had” versus “have” because on July 5th, 2012 I had two surgical procedures which successfully treated my case of Piriformis Syndrome. However, had I not had a positive Provocative EMG I may not have been an ideal candidate for the surgery.

“Standard nerve conduction studies are within fairly normal limits. The motor and sensory nerve distal latencies, amplitudes, and conduction velocities are all within fairly normal limits, indicating there is no focal nerve compression or peripheral neuropathic process present. F waves are also within normal limits. Special testing of the latent responses with the hip in various stages of hip flexion and internal rotation revealed progressive prolongation of the H and F wave latencies and diminution of the H wave amplitude to significant degrees. This is consistent with sciatic nerve compression at the level of the piriformis muscle. I would also note that I have not yet seen a patient that is as flexible as Mr. Stehling have a positive provocative test.  Needle EMG parameters are all normal, indicating there is no compressive radiculopathy or plexopathy present nor any denervation associated with the sciatic nerve compression.”

You can read my complete Provocative EMG Study.  Again, I removed the physician name and other personal information. My hope is that other people suffering from Piriformis Syndrome will get a Provocative EMG  as soon as possible.

An important Note: In the event you review the Provocative EMG Study, and you’re not sure what you’re looking at I’ll break it down.  The H Wave test results are the answers I was searching for for the last five years. Many physicians and MRIs didn’t or couldn’t detect what this simple test did in a matter of a few minutes.

H Wave Results from Provocative EMG

My H Wave Test Results

About Provocative EMG

H reflex is a monosynaptic reflex elicited by percutaneous submaximal stimulation of tibial nerve and recorded from the gastroe-soleus muscle.

The first row of data shows my test results when laying flat on my back without any flexing/bending of the legs (Note: this is the only position I was in for the Standard EMG). Rows 2 and 3 show my test results when performing the stretch shown below.

Provocative EMG Stretch

Provocative EMG Stretch

H Wave Latency is the first column of data (reading left-to-right). As you can see, the latency increased when performing this stretch, meaning the nerve signal speed slowed down (due to sciatic nerve compression at the piriformis muscle level).

H Wave Amplitude is the second column. As you can see the nerve signal strength decreased by 81%. Again, this is due to my sciatic nerve being significantly compressed at the piriformis muscle level when performing this stretch.

I’m unable to offer insight into the third column…sorry but I forget the significance explained by the physician.

Disclaimer

The articles and content of this website may not be construed as personal medical advice and are provided for information only. No action should be taken based solely on the contents of this information. Readers should consult the appropriate health professionals on any matter relating to their health and well-being. The publisher of this website and its contents is not a licensed medical care provider. The information is provided with the understanding that the publisher is not engaged in the practice of medicine or any other health-care profession and does not enter into a health-care practitioner/patient relationship with its readers. The publisher is not responsible for errors or omissions.

  1. Patti
    May 12, 2014 at 11:09 pm

    Why doesn’t Dr. Hendricks website specify that he does piriformis release surgery?

  2. Patti
    May 10, 2014 at 7:50 am

    How can you be sure that your piriformis is the problem and not your sacroiliac joint? From what I’ve read, the piriformis can becomes chronically contracted as a result if sijd.

  3. Mary Jerome
    April 29, 2014 at 11:01 am

    Hi, My name is Mary, and I have suffered with Chronic pain for close to 7 years, I finally got diagnosed as having Piriformis Syndrome, I have had an injection in my piriformis, with a steroid, and that did not even fizz on my pain….Right now I am soo frusterated with not knowing what to do…I have been reading about releasing the piriformis muscle, and I do believe that is what I need….Right now I am asking my regular family doctor to send me to a back/spine doctor? and also an Orthapedic Surgeon. The wait list hear is soo crazzzy! I have been off work since middle of Dec, I just couldn’t do it anymore, putting up with the pain, tired of taking pain meds, when I am in pain every minute of the day!! Just wanting to know what kind of doctor does this release, and if I am doing the right thing, asking to get sent to those previous Specialists…..I live in Canada (Saskatchewan),

    • Patti
      May 10, 2014 at 7:46 am

      Since the piriformis injection didn’t help, have you been assessed for sacroiliac joint dysfunction?

      • Mary Jerome
        May 11, 2014 at 7:42 am

        Hi Patti,Thanks for your reply, What kind of Doctor do I need to be referred to for SJD? Maybe that is what I need to do……..:)

  4. Rodna Epley
    April 13, 2014 at 11:43 pm

    OMG I can’t believe I found you guys! I’ve been suffering for 4 to 5 years. It just seemed to come from no where. I did dance for 20 years off and on and wonder if that caused it but the symptoms came several years after I quit dancing so I don’t actually know the cause. Sucks getting old lol. I’m a 47 year old female. After getting passed around, ignored, disbelieved, misdaignosed by all kinds of doctors, several MRIs, last year I had 3, nerve testing, xrays, 5 steroid shots… and none of them showed anything or helped in the slightest, I am more the frustrated than ever to say the least, and mentally drained. My joy is hard to hold onto to say the least, although I’m basically a happy person in general.

    I diagnosed my self last year after searching for my problem on the internet, watching surgeries, examining anatomy, reading every article on the subject that I could find, and paying close attention to all the symptoms of Piriformis Syndrome. Finally a pain management doctor a couple months ago agreed with me and recognized that this could be my diagnosis, now i need to convince him or someone to refer me out for a Provocative EMG test. I live in the Oklahoma City area.

    Unfortunately, I have burning, stabbing, deep, excruciating pain on BOTH sides and in BOTH buttocks, down both hamstings and now after my last steroid shots, down both calves and into my ankles and feet. I know exactly where my sciatic nerve is because i can feel it burn all day long down both legs. I can following the trail easily. My symptoms are at their worst after sitting in any kind of chair or surface… and of course i work on a computer all day! After 8 to 9 hours I’m ready to cry. I can’t lie on either side because BOTH hips are excruciatingly soar. Can’t sleep on my back, too much discomfort due to pressure on the piriformis. can’t sleep on my stomach, hurts my lower back. i do have 2 slightly bulging discs but MRIs have determined the discs are not severe enough to be middle of the buttocks, and i can pretty much tell you that direct path my piriformis takes due to the pain down the length of it. Also I have pain when i press near my hip bone on either side, in the back; basically where the piriformis would connect to the bone. Very soar. If i lay on my side for any length of time, i have to adjust so that i’m laying on the front side and not the back side. ugh! the only rest i get is standing or walking. so resting for me is painful, and relieving my pain is unrestful.

    thank you sooooo much for creating this blog and for the great information Matt (and everyone). You have given me so much hope that I too can have my life back. I’m crying just considering the possibility of feeling no pain after at least 4 years.

    Can I ask you something Matt please? Is Pirifomis release, the severing of the muscle from the bone? what happens to the muscle after that? what happened to your ability to rotate of flex your hip (hips?). Did the surgeries cause any physical limitations?

    thank you again! and may God bless you for sharing your experience and giving us hope.

    Rodna

    • April 29, 2014 at 8:26 pm

      It is the severing of the muscle tendon (at the sciatic notch for me). The muscle remained connected at the greater trochanter. Not exactly sure what happens to it, that is a good question. I actually have more flexibility now than I did before the surgery in that area. No limitations as a result of the surgery.

      Matt

      • Patti
        May 10, 2014 at 7:48 am

        I think there are several different techniques which can be used in piriformis release surgery, depending on the specific problem. It’s great to hear that one can be fully functional after the surgery!

  5. Dan
    April 11, 2014 at 9:28 pm

    Hi Matt, how many treatments of acupuncture did you try? I am a wits end and going to try it as a last resort. Hoping I just get even 1% better.

    • April 11, 2014 at 9:33 pm

      Three to five and it wasnt effective for me. Good Luck.

  6. Carol Gill
    April 6, 2014 at 1:21 am

    I want to know what type of doctor finally helped you.
    I am in Dallas TX and I went to my GP and I got muscle relaxers; went to physical therapist and just got some stretches and balance exercises which didn’t work; went to a back specialist and he did an xray and said I might be getting arthritis but I might have piriformis in my left side since I couldn’t raise my leg or lay on my side and I needed to swim. and once I hurt so bad we went to “doc in the box” and I did get a cortisone shot in my hip but it wasn’t aimed at anything particular ..and I got some relief.
    Now all of a sudden it is back full force and on todays like today after 15=20 min walking I practically fall down.

    • April 6, 2014 at 10:01 am

      An orthopedic surgeon that specialized in repairing hips.

  7. Annette Lynch
    February 1, 2014 at 3:51 pm

    Sean in Boston….I’m sure Matt can answer your medical questions better than I can but just wanted to say I am in Massachusetts as well and if you want to e mail me privately will share as much info as I can with you about our area. annettedev4962@aol.com

  8. Sean
    February 1, 2014 at 9:05 am

    Hi Matt,
    Thank you for sharing your story and providing some hope to the rest of us. I am coming up on my 3 year anniversary of undiagnosed chronic pain in my right hamstring, butt, and hip. My pain began when I felt like I pulled my right hamstring at the gym. I did 3 months of physical therapy with no relief and began feeling pain in my right buttock. I used to drive a lot for my job and would get bad pain in the buttock, hamstring, and IT band on right leg on long drives (usually after 30 minutes). Over the last three years I’ve also done three months each with a chiropractor and acupuncturist with no relief. I had an MRI of my lower back which the doc said was normal. As you said, I have constant 2/3 level pain in my right hip and leg. If I exercise, my right hamstring will feel moderately pulled. I saw a neurologist but he was unhelpful and expensive so I’ve been reluctant to go back. One unique point to my pain is that if I cross my right foot over my left knee the entire right side of my right leg and hip tense up. I do not have groin pain. I can’t sleep on my right side without hip pain. I considered steroid injections but saw a lot of people post unsuccessful stories so have not. I don’t get pain in my butt from sitting at work all day, just the ever-present dull pain in the hip and leg. I really only get the butt pain from driving or exercise. Advil doesn’t help.

    If I don’t exercise or drive the pain is tolerable and I’ve grown to accept that this may be the case for the rest of my life.

    I’d really appreciate it if you could compare your symptoms to mine and let me know if you think the provocative EMG test is worthwhile for me or if my symptoms don’t really match up to yours.

    Thank you,

    Sean in Boston

    • February 2, 2014 at 4:15 pm

      Sean, I absolutely think you should explore getting a Provocative EMG. Your symptoms sound a lot like Piriformis Syndrome.

      • Sean
        February 2, 2014 at 6:41 pm

        Thank you Matt. I am going to call the doctor Annette recommended and try and find someone close to me so I can have the test done. I can’t do it until April but will check back in to confirm my results. Thanks again, Sean.

  9. Annette Lynch
    January 30, 2014 at 9:28 pm

    Find someone who does the provocative EMG. If you can’t get to NYC to go see Loren Fishman, then call his office or look up in one of his books to see if he gives names of other locations/doctors who know how to do it in your area. EMG tests can show normal and there can still be a nerve problem. The provocative EMG test though is a little different and somebody who knows what to look for in your physical exam like Fishman will be able to tell right away what your issues are. I know how discouraging it is to find people who know how to deal with such an unusual problem as piriformis syndrome/sciatic nerve entrapment. Good Luck.

  10. Felicia
    January 30, 2014 at 6:49 pm

    Today, the neurologist had no idea how to do the provocative type. I showed her this link on my phone, she took offense to it, like I was trying to tell her how to do her job. So my suggestion to anyone needing this test… ASK BEFORE YOU GO if they know how to do it. If they don’t, then go somewhere else. I was certain that once I got there it would work out. It didn’t. My EMG showed normal. So now Im back to square one. This looks bad on paper. I now don’t know what to do. I did get a MRI done of lumbar today, which also wont show piriformis or S.I. joint dysfunction.

    • February 2, 2014 at 4:12 pm

      Dr. Scott Hardin’s office in Milwaukee, WI may know of a physician in your area Felicia. May be worth calling him. If you’re unable to find one, perhaps go to Dr. Hardin and have it there.

  11. laurel
    January 30, 2014 at 1:47 pm

    Thank you again Annette!

  12. Annette Lynch
    January 27, 2014 at 1:53 pm

    Dr. Fishman spent a good amount of time reviewing my history during the appointment. then he gives you a physical exam., then does the testing. After the testing he talks to you again based on the results, makes his recommendations for your next steps. He will e mail with your local Physical Therapist to make sure his protocol or recommendations are being implemented the way he wants. Dr. Hollis Potter at HSS in Manhattan will not read anyone’s MRN/MRI from another facility. You will not see Dr. Potter when you go there to have your MRI, she only reads the MRI and generates a report. I had no problem getting either of these doctors covered under my insurance which is a bluecross/blueshield PPO.

  13. laurel
    January 27, 2014 at 3:11 am

    wonder why I didn’t get notice about your reply until today; my email must be slow! Thank you for the info. It sounds like you packed a lot into one day! I live about 20 minutes from Trenton, NJ so I would probably take the train to NYC–which makes it a lot less expensive.

    That’s great that Fishman spent so much time with you; what did he do during that time/what was the goal of your visit? Besides the Provocative EMG, are there other tests Fishman runs?

    I found a place near me that does MRNs. They are not considered experimental by Medicare, so these tests would probably be covere–although I guess I would have to convince my doctor to prescribe this test for me. If I did get the test done, I could probably bring the CD to Dr. Potte ras I think she specializes in diagnostic radiology–is that correct? Or do you think there is a better way to utilize my time with her?
    Thank you again.

  14. Annette Lynch
    January 23, 2014 at 1:04 pm

    I was able to do my trips to NYC to Fishman’s and to HSS with Potter in one day. I fly from Boston though so its a short flight. Fishman spent a couple hours with me. Potter was running behind but got in and out in one day. If you do it in one day you just have to give yourself ample time to get back to the airport, etc. An MRN is Magnetic Resonance Neurography. It was a test developed by Dr. Filler in California, not that I recommend him whatsoever. The test is very useful as its able to detect and show nerve/tissue problems much more clearly than a regular MRI. If you do some google searches there are MRN places around the country in various areas. It costs a lot of money for that test and I don’t think insurance covers it, or not all of it. Dr. Potter and Dr. Fishman were both covered by my regular medical insurance, BCBS PPO, I think insurance will cover the MRI again if you check. I’ve had sometimes 3 MRI’s in one year.

  15. Felicia
    January 20, 2014 at 1:04 am

    I have severe pain in the upper butt cheek. My doctor thinks its s.i. joint, but symptoms suggest the piriformis muscle. My leg is now weak and causing me to fall. My primary doctor has ordered a normal EMG to be done, but after reading this Im going to call first thing and try to get it changed to a provocative EMG. My appt is with a neurologist. Are all neurologists capable of performing this test? The problem is determining WHAT the problem is. I have severe muscle spasms/twitches in that thigh too. did you experience this? I just hope this neurologist will agree to do this type of EMG.

    • January 22, 2014 at 1:33 pm

      Felicia I had severe twitches in my glut region not in the thigh. Dont take no for answer, find a doctor that will do the Provocative EMG.

      • Felicia
        January 22, 2014 at 3:37 pm

        I told my doctor to order the “provocative” and they told me that the neurologist office had never heard of it, but it was the receptionist they spoke with. When I get there, I plan to request it again when I meet with the actual neurologist, which is the 30th. The leg is now contracting from lack of use and the twitches are horrible. The pain is terrible in the mornings, I can barely get out of bed and I can only bear minimal weight. Thank you so much for your response.

      • Felicia
        February 1, 2014 at 10:11 pm

        the neurologist I went to didnt know how to and was offended when I tried to show this page to her so she could see. I had 3 days of where I was totally unable to walk, pain so intense I was suicidal. My husband had to carry me and I couldnt even make it to the bathroom, my husband rushed a small trashcan to me before I urinated on myself. Its better now after a steroid shot and muscle relaxers and complete rest. Im scared it will happen again. Ive never had pain that intense. I truly thought my hip was fractured and my pelvis was twisted. My leg is still weak and its hard to walk. Im still fighting my long term disability company who claims I am able to work. Now I have a negative EMG they will use against me. Im so disappointed in doctors.

  16. jay amati
    January 14, 2014 at 12:07 am

    Ok will do kaydee, I contacted his office today and im getting my records together to mail to his office, then if I fall in the criteria to be seen to discuss surgery they will contact me to schedule an appointment, they said they would not be able to get me in until march or april

  17. jay amati
    January 13, 2014 at 2:26 pm

    Dr nicholaus theodore md on 3rd ave in phoenix az

    • kaydee
      January 13, 2014 at 9:11 pm

      Thanks for the info. I came across Yeddu today and made him an appointment for next week.. Let us know if you end up seeing the neurosurgeon

  18. jay amati
    January 13, 2014 at 2:23 pm

    Dr nicholaus theodore md neurosurgeon on 3rd ave in phoenix az

  19. jay amati
    January 13, 2014 at 2:20 pm

    Hey I started with desert interventional spine consultants they are off of th 60 and mcqueen, dr ajay yeddu, he acknowledges piriformis syndrome which is the first step im finding out, he thinks my pain is related to my discs so im going along with it (injections) until the injections have failed, there is another dr I. Phoenix that I am calling today that supposedly performs the piriformis release surgery, I will get back to you with his name, I have to look it up I forgot his name

  20. annette lynch
    January 13, 2014 at 11:07 am

    Laurel not sure I have the answers for you but I too have a child with special needs and its a difficult road taking care of someone completely dependent on you when you suffer like this. Like Matt suggests on this blog, I think good diagnostic testing is a must. Provocative EMG testing like what Dr. Fishman did for me in NYC is invaluable. It is what proved I had nerve entrapment. I’ve also had MRI’s with Dr. Hollis Potter at Hospital for Special Surgery in NYC and her MRI’s were the best reports I’ve ever had. I’ve never had an MRN but that is an excellent test to consider having. I too have had to travel to have all this stuff done and make arrangements for my son to be cared for. He has autism and MR and functions at a 5 yr old level @ 20 yrs of age. so I know how difficult it is to find care, travel etc. but you need to figure out what is best for you. I wish you luck.

    • laurel
      January 14, 2014 at 1:46 am

      I am considering seeing Dr. Fishman to get a Provocative EMG, as I agree diagnostic testing would be helpful. Annette, did you need several appointments with Dr. Fishman (spend several days in NYC seeing him), or were you able to get all you needed done in one meeting? Also, what is a MRN? Dr. Domb (Chicago area) suggested I get a DGemric MRI. Is anyone familiar with this test? Any other tests that would be helpful?
      I”m not sure if my insurance would cover additional MRIs with Dr. Hollis Potter–as I have had so many MRIs already: Left hip, right hip, pelvis, lumbar–although the reports I got were not very helpful; sometimes I do wonder, however, if I should get an MRI of my left thigh (femur) which measures 1/2″ larger (around) than my right thigh; I can actually feel an area on the front of my left thigh–about 4″ long, and 2″ wide–that bulges out (maybe it is just inflamed?); when I had a massage therapist work on this “bulge,” it actually caused pain in my piriformis muscle–so everything seems to be connected..
      This week I’m having a piriformis trigger injection; and should get my post delivery (after pregnancy) surgery records in the mail–since they records are so old the office had to get them out of storage.
      Thanks for all your suggestions.

  21. annette lynch
    January 6, 2014 at 10:55 pm

    Laurel, I don’t have that exact problem but my problems started many years ago when I fractured my coccyx during childbirth and spent 31 hours in labor with a vacuum extraction and a 9lb8oz baby! They should have done a c section because I really could not deliver her vaginally but they did it anyways. Nowadays they would never do that. That is when my sciatic pain started, the next day after delivery I went to get out of bed to go to the bathroom and crumpled to the floor because my leg gave out on me, the sciatic pain was horrible. Anyways, everything is connected in that area so if one thing is out of whack it has a domino effect. My pubis symphesis never healed properly after delivery (it is supposed to spread and then go back together but my pubic bones are misaligned now) due to the size of the child and the traumatic delivery. this was the beginning of my problems so I can imagine that if you have a problem with your sacrum, tailbone, or anything else, that it is going to effect your piriformis and that whole area. there aren’t that many doctors who know about this condiiton, as you’ve probably found out so I hope you find someone who knows their stuff. Don’t be afraid to seek a second opinion if this appointment doesn’t turn out how you expect. It took me several years to find doctors to help me unfortunately. I wish you luck. Keep us posted how it turns out.

    • laurel
      January 7, 2014 at 12:39 am

      Thank you for your reply; it really helped. Sometimes I think because my symptoms are unique I can’t be helped, but I guess everyone’s are unique in their own way. Also, with multiple issues I sometimes don’t know where to start.

      I also had similar issues with my labor and delivery. They vacuum extracted my daughter (who is now fourteen), at 9pm, and her shoulders ruptured the birth canal–but no one knew until 6am the next morning. I bled internally all night, finally the injury ruptured, and I began uncontrollable bleeding; Had emergency,surgery, two blood transfusions, and five days in the hospital. My hips locked after that–though I am to this day uncertain the exact nature of my injuries (as trying to get my records), and four or five years later–after a car accident–my hips unlocked, and my sciatica began. I believe it started with a small tendon tear, followed by my leg getting jammed up further into my pelvis when I tried refinishing my stairs (by kneeling).

      MRIs have shown (on left side) torn glut medius muscle tear, femur/glut tendon tear, bi-lateral hamstring tendonitis, and torn hamstring on right side. EMG was negative. Then they did the MRI with dye, and told me none of these issues exist (as if they disappeared)! I have been told nothing can be done for partially torn tendons, and muscles anyway, but I don’t think that is true. I have also been told my piriformis is very tight, and I know I can’t put any pressure on it without pain. My primary dr. thought I had torn SI joint ligaments, but–although I tried therapy for that–doesn’t resonate with me.

      Massage of my gluts/piriformis muscles feels good at the time, but then makes the pain worse, can’t do PT as the stretches they gave me caused further injury; tried lifting weights–as I believe some pelvis muscles are weaker than others (not to mention my messed up pelvic floor muscles), chiro, a zillion injections, prolotherapy, yoga, trigger point therapy etc.. If I try to squat, or lean over the sink (to brush my teeth), I feel like something in my left hip is pulling like it is stuck. I also have interstitial cystitis which further complicates things. I have trouble sleeping at night as I am convinced there are so many different things wrong with me no one can help!

      Honestly, I would call Dr. Zager–I think that was his name, but I have no idea what I would say to him; as he is not a physiologist; don’t you think I need someone who can diagnose the dysfunction of the way my body functions/moves; or just someone to diagnose the pain pattern? I do hope someone near by can help though, as travel would be really difficult for me–I am a single parent of a special needs teen with no family nearby, and I have legal and financial issues. Thank you again!

  22. Annette Lynch
    January 1, 2014 at 4:08 pm

    Laurel, I went to NYC to have the testing done by Dr. Fishman. He is a very nice doctor and it was worth the trip since none of my issues showed up on regular MRI’s. You are on the East Coast so you do have options. I would make a trip to see him if you can’t find anybody to take you on. There is Dr. Belzberg and Johns Hopkins, Dr. Lee Dellon at Johns Hopkins, and Dr. Eric Williams at Johns HOpkins who all do the surgery for this condition. Dr. Zager whom I referred you to before has written a lot of research papers/articles on it and does do surgery on people with very complex nerve conditions. When I went to see Dr. Fishman for testing and evaluation it was all covered by insurance. He will most likely recommend a very specific physical therapy protocol for you to try before you try surgery. Dr. Fishman has written two books on sciatic nerve pain if you google his name on amazon, you will see his books. He talks about his test (which he invented) and piriformis in both books, though not entirely. He may be able to recommend a doctor in your area……he couldn’t recommend anyone for me up in Boston. I’m sure he’s heard of all the names I mentioned above. The most likely scenario is you will have to travel to see a specialist……they are few and far between like Matt says….not too many doctors even know about these conditions. With the exception of Dellon, they all take insurance so hopefully you will find one who will take you. Good luck.

    • laurel
      January 6, 2014 at 9:27 pm

      Thank you for all the info; I did receive the name of a doctor about an hour away who does surgery to release the piriformis muscle. Right now I am trying to get my records together to go to a consultation.

      I do not know if my symptoms are consistent with PS though: Have you (or anyone else) experienced their sacrum being pulled out of place by their piriformis (or other muscles attached to the hip/femur)? I can feel it bulging out on one side. It keep getting stuck. This is making me quite anxious; I have this fear (irrational–I hope) that I will fold over to one side! My chiropractor gave me an adjustment, but the next day my sacrum returned to the same (dysfunctional) position!

      I also think my left leg (which is where my problem is) is shorter than my right one; due to compressed muscles, and a torn glut tendon. I did read some place that if your piriformis muscle is causing you problems–and is not properly treated–your gluts will soon have issues; I would think the entire pelvis area would suffer from these imbalances.

  23. laurel adelman
    January 1, 2014 at 2:03 am

    I will certainly try this also!

  24. laurel adelman
    January 1, 2014 at 2:00 am

    Don’t know what CT is, but the injection is going to be done with x-ray and dye–in an operating room. Does that sound right? Thanks!

  25. laurel adelman
    January 1, 2014 at 1:26 am

    Thank you. I will follow up. I am scheduled to have a piriformis injection in a couple of weeks so at least that is some what of a diagnostic tool. Thanks again.

    • January 1, 2014 at 1:35 am

      I recommend the injection being done by CT to ensure it goes into the muscle for sure.

  26. laurel adelman
    January 1, 2014 at 1:08 am

    Thanks for the name of the doc in Philly. I went to another dr. this week, and asked about the provocative EMG, and he looked at me like I had three heads! When I asked for a referral–to a dr. who could do the surgery Matt had, my doctor–who specializes in pain management–was clueless.

    • January 1, 2014 at 1:19 am

      Laurel,

      I wish that I could say I’m surprised by your pain doctor’s reaction, but I experienced the exact same thing myself several times over the course of my five year search for a definitive diagnosis and treatment. I’m going to be very straight forward with you because I wish I would have had someone like me to do the same. You do not have many options to get a clear diagnosis or treatment. But, there is hope so don’t give up. A provocative EMG is also called FAIR test. You can research it. It was perfected by Dr. Loren Fishman in New York. Perhaps contact him to find out if he or someone he knows of can perform the test on you. Likewise, perhaps he can also recommend a surgeon that can perform a piriformis tendon release.

      Matt

  27. Annette Lynch
    December 31, 2013 at 9:15 am

    http://www.pennmedicine.org/wagform/MainPage.aspx?config=provider&P=PP&ID=1894
    Someone just said on your blog they are from the PA area….I found this doc online. He has written and done a lot of research on complex nerve cases. Not sure if he can help but thought I’d pass the name along. good Luck.

  28. jay amati
    December 30, 2013 at 8:08 pm

    Laurel, I went the route of googling “piriformis syndrome” followed by the state you live in, I live in tucson ax and I found a pain mngmt dr in phoenix that discusses piriformis syndrome on his website, this at least got me to a doctor that acknowledges piriformis syndrome, that was half the battle was finding a doctor that believes in it, I could not find one in tucson

    • kaydee
      January 13, 2014 at 9:03 am

      Hi Jay,
      Trying to find help for my husband. We are in Mesa. Did you find someone in AZ to help you with your piriformis issue?

  29. laurel adelman
    December 28, 2013 at 2:48 pm

    I am having trouble finding a doctor to help me. any suggestions? Been in pain for five years, but the last year has been unbearable. Don’t know where to turn. Live in the Philadelphia area. Already been to two orthopedic surgeons, had PT, prolotherapy, numerous injections, chiropractic therapy, EMG, MRI hip, pelvic, lumbar, thoracic, etc. the same ordeal you went through. Can’t seem to find anyone who can diagnosis/treat me–so I can get a provocative EMG, and surgery if needed. It spounds as if you were refered to the right doctor, but I had not been; so how would you suggest finding the right doctor–any online sources you can suggest, or someone I can contact? One leg is beginning to lose sensation–due to lack of blood circulation from tight muscles. Can’t take much more of this.

    • December 31, 2013 at 9:27 pm

      Laurel,

      I recommend getting a provocative EMG from Dr. Scott Hardin at St. Luke’s in Milwaukee, WI. If he finds that you have compression at the level of the piriformis muscle you can then take the next step which would be to get an actual steroid injection into the muscle itself. If the injection provides you even a day or two of relief you know you are on the right track, and may likely be a candidate for surgery. The only surgeon I can recommend for this procedure is Dr. John Heinrich in Milwaukee, WI. Goof Luck.

      Matt

  30. jessica
    November 27, 2013 at 10:51 pm

    For those that have had a regular EMG out there, did you have increased discomfort in the affected body part for a few days after ? I didn’t have a piriformis EMG but one for the LCFN in my anterior thigh (which was abnormal) and it was a very unpleasant experience to say the least ! Just wondering if this is common ?

    • November 28, 2013 at 8:18 am

      Jessica I do remember the painful experience of the traditional EMG. But I don’t recall how I felt the days following it. I can tell you that the Provocative EMG was not as painful an experience and I didnt experience any other new pain as a result of it for the days immediately after.

  31. jay amati
    November 26, 2013 at 9:12 pm

    Hey matt, I have throbbing in my lower back and legs every night, I can feel my heartbeat through there, is this something you experienced too? Could you possibly explain briefly whats going on? I think I know but I would like to hear it ftom someone with experience?Matt how are you feeling now after your surgeries? Thanks again for your help-jay

    • November 28, 2013 at 8:21 am

      Jay I remember feeling my heartbeat through my lower extremities on many occasions. I am now cured from Piriformis Syndrome chronic pain. Please read my other posts about recovery and physical therapy.

      • Jay Amati
        December 16, 2013 at 3:14 pm

        Hey matt, I recently discussed the piriformis muscle with my physical therapist, she did some piriformis tests on me for example, laid on my back, brought one leg up knee raisef but foor still on the table, she pushed on my leg, asked me to push back I did push back without pain and she said its not piriformis syndrome, is this accurate? On Nov 28, 2013 6:21 AM, “Piriformis Syndrome” wrote:

        > mstehling commented: “Jay I remember feeling my heartbeat through my > lower extremities on many occasions. I am now cured from Piriformis > Syndrome chronic pain. Please read my other posts about recovery and > physical therapy.”

      • December 16, 2013 at 3:49 pm

        That test is useless IMO.

  32. jay amati
    November 26, 2013 at 8:42 pm

    Hey matt I scheduled an appointment today with a spprts medicine dr, my appointmemt is dec 27, thats the soonestthey could get me in, now for the interventional radiologist can I self refer or do I have to be referred by a doctor,

    • November 28, 2013 at 8:12 am

      I didn’t get a referral.

  33. Lina
    November 26, 2013 at 3:20 pm

    I think find the right surgeon is the arduous part, Where could I find Dr. Hardin and Dr. Heinrich.

    • November 28, 2013 at 8:11 am

      Both physicians are located in Milwaukee, Wisconsin. You can find their contact info online. Good luck Lina. Keep me posted.

  34. jay amati
    November 25, 2013 at 9:09 pm

    I am so sorry that you, and anyone else has had to go through this struggle, its inhumane, I have already found an interventional radiologist and sports medicine md I will be contacting tomorrow, thanks again matt you are doing a great service

  35. jay amati
    November 25, 2013 at 9:01 pm

    Matt thanks alot man you are giving me hope, I swear if I ever get rid of this pain I am going to cry, a happy cry, I am having so much trouble finding doctors that believe in PS, and my doctors are messing up my codes and united healthcare doesnt even want to cover my tens unit because of codes, I have heard before if a doctor knows what he is doing you wont have problems with insurance, I am in tucson az and I will continue to search for a doctor with good intentions, who is sincere in wanting to save my life, you had the same battle right?

    • November 25, 2013 at 9:06 pm

      It took me five years to find Dr. Hardin and Dr. Heinrich. I didn’t bother getting my TENS Unit covered by insurance, I just bought one from Amazon for around $100.

  36. jay amati
    November 25, 2013 at 8:30 pm

    the treatments I received for the L5 S1 herniation were steroid injections,physical therapy, inversion, pain medication, electrical stimulation. My 2nd mri showed my disc had actually backed off from yhe nerve area thanks to the inversion I am assuming, but my pain had become alot worse, it had become a 9 on a 1-10. It made no sense so I started researching what else it could be and found my symptoms matched PS, I cant sit more than 5 minutes, I cant stand still, I have to keep moving or the pain sets in,

  37. jay amati
    November 25, 2013 at 7:24 pm

    Matt thanks for dedicating time to help other sufferers of PS, my doctors do not want to say its PS, one said it doesnt exist(my pain mngmt doctor), another said PS was overdiagnosed in the 70’s before MRI and that PS was not talked about anymore among surgeons, I feel hopeless, I am pretty sure united healthcare doesnt cover anything regarding PS, the only hope I have right now is to save up $15000 dollars and go to belgium to have the surgery performed by dr dieter mortier, in the us without insurance covering it will cost me $40000 -$50000. What insurance did you have? Who performed your surgery? Where do I get an provacative EMG and who if anyone has to order it? I have already done 2 mri’s because my doctors insisted it was my L5 s1 disc which was 5 mm herniated, but after treatment for that(no surgery) I am in a lot of pain

    • November 25, 2013 at 8:44 pm

      Jay,

      I had to calm down after reading your post. I get very emotional (in a bad way) when people who are suffering tell me that physicians (ESPECIALLY PAIN MANAGEMENT PHYSICIANS) claim that Piriformis Syndrome doesn’t exist. Please trust me, physicians do still talk about it, in fact, I had three tell me that I had a classic case of it. I can sort of understand if a physician doesn’t know about it, but for a physician to actually know what it is and then claim that it isn’t real is disgusting. I HAVE YET TO MEET ANYONE WHO HAS/HAD PIRIFORMIS SYNDROME THAT HAD IT DIAGNOSED FROM AN MRI. It DOESN’T present itself in an MRIs.

      You need to have two things done to get a definitive diagnosis for Piriformis Syndrome. First, get a CT-guided steroid injection into your piriformis muscle. If this temporarily relieves the pain (even for one day) it is a good sign that your piriformis muscle is suspect. I had an Interventional Radiologist do this. Next, get a Provocative EMG. The test results will show whether or not you have compression of the sciatic nerve at the piriformis muscle level. I had a Sports Medicine physician do this.

      United Healthcare does cover Endoscopic Piriformis Tendon Release and Sciatic Nerve Neurolysis, as well as a micro-bursectomy of the greater trochanter. I know this because I have United Health Care. The procedure will be “Uncategorized” meaning that it doesn’t have a code assigned to it. But, it was covered. The surgery was about $20,000 total and I only paid about $5,000 of that since the surgeon wasn’t a “preferred (Tier A) surgeon” in my plan.

      I got my Provocative EMG at St. Luke’s in Milwaukee, WI by Dr. Scott Hardin (I had an orthopedic doctor refer me to him). I had my surgery at the Milwaukee Orthopedic Hospital in Milwaukee, WI by Dr. John Heinrich (who has done well over 100 of these surgeries).

      I was also diagnosed many years ago with a disc problem in my L4/L5 as well because I had a slight bulge in a disc that presented itself in an MRI. THE SLIGHT DISC BULGE HAD NOTHING TO DO WITH MY SCIATIC NERVE PAIN.

      Good Luck & Keep Me Posted,

      Matt

  38. Daniel
    November 21, 2013 at 11:27 am

    Hi Matt. I really enjoy your site and thank you for taking the time to put this out there for others. That’s something most people would not do, but then again most people probably don’t go through having PS. I was curious as to the symptoms, I started having what seems to be like PS about 2 years ago (I’m 27) after going through physical therapy for my hips. They had me perform a lot of external rotation exercises and gluteal strengthening. After that and since then I’ve had intense burning, stiffness, weakness, numbness from my glutes through my legs and to my feet. I’ve tried various alternative and conservative therapies except for injections and surgery although at this point with the lack of mobility and sleep I’d let them cut me open right now. Just curious though, were your leg muscles extremely stiff (hamstrings, groin, calves)? Mine seem to be bar tight. I notice that my legs seem to cave in quite a bit every since I started (excessive internal rotation and adduction), if I am not conscious of my gait it would appear as if I had cerebral palsy. I’ve been checked out by all sorts of specialists and docs and everything is negative. The provocative EMG test is interesting and am about frustrated that none of my doctors have ever considered that. Unfortunately I do not live in your neck of the woods or else I would go to the doctor you are recommending. I live in the San Francisco bay area and am going to be going to the UCSF pain management center, I can only hope they’ll have some idea of what is going on. Lastly, I see talk about obtruator internus pain (another external rotator), how do doctors decipher which tiny little intrinsic muscle is the problem? Would that be through the P EMG? Thanks Matt. Hope you are still feeling better.

    • November 22, 2013 at 10:00 pm

      Daniel,

      Your symptoms are complicated. In my opinion I think you need to do two things. First, get the Provocative EMG. It will probably take you some effort to find someone that does it, but be stubborn and call around. Dont go to a physician that hasnt performed this exact test many times, because it is too important to be a guinea pig. One through I have is that you could call Dr. Scott Hardin’s office in Milwaukee to simply just ask him if he knows of anyone in your area that he recommends for this test. Second, is to get a steroid injection in your piriformis muscle under CT guidance. If you get relief even for one day that is a good indicator that the piriformis is the culprit.

      As for you other questions, I don’t recall recall intense stiffness. However, this doesnt mean that you dont have piriformis syndrome. One theory I have is that you could overcompensating for the muscle problem, and it is causing ill effects on your other muscles. I admit I’m simply taking a wild ass guess here. Note: Paid physicians took wild ass guesses when diagnosing me for years, so what’s the harm in me offering some thoughts, right?

      Please keep me posted, and I wish you the very best. Don’t give up your search for answers. You’re way too young to thrown in the towel and become dependent on pain medicine. Be very careful about pain management treatment. For me, pain management treatment helped for a while, but it wasn’t the answer I needed.

      Matt

  39. Jason Simpson
    August 26, 2013 at 9:54 pm

    My name is Jason and Ive been dealing with this crap since 99. While in the Marine Corps it was hard to march with a loaded pack but I just had to suck it up. My pain got super intense in 04 and has gradually increased since then. Im on all kinds of narcotics and nerve pill and I feel like dying. I had to get out of the gym 4 years ago and my life went down hill. Its really killed my self esteem. Ive been to every doctor in town and had to convince and then prove by process of elimination that its not a dang disc or a joint or anything else. Ive had 4 spinal punctures in the journey to good health 3 steroid injections and a mylogram. Steroids gave me the worst acid reflux ever! These doctors only know how to treat the symptoms it seems. which means pills pills pills! Now I have an addiction because they don’t want to admit that I did my own research and I was right! A general practice doctor told me what my problem was in the first 10 minutes but it seems the other specialist don’t believe it. They don’t even know what it is. They just pass me around and charge the crap out of my insurance and me it seems. Im frustrated as all heck and Im lost as to what to do now. Im going to as for a provocative EMG because of this page. Thank you! The last pain management doctor was going to try to stick me in the spine again and inject something into my vertebrae to block the pain. I told him that wasn’t the right thing and he said “No No, its not PS” and that was it. I didn’t get the procedure needless to say. Whats with these people? Im thinking of writing my senator and voicing my concerns. It couldn’t hurt right? lol Thanks for the info but. Ill try to keep you guys posted.

  40. Debbie
    August 18, 2013 at 5:07 pm

    Matt, Thank you so much for sharing your experiences. I am going on six years of dealing with this pain. It is so hard to find a doctor who will listen. I finally flew to New York from California for a provocative EMG. Problem is I can’t even get my pain management doctor to recognize the results of the EMG Which showed severe entrapment. Does anyone know of a doctor in California Other than that one in Los Angeles that has such terrible reviews(it’s a shame). I finally talked to my pain management doctor into giving me Botox injections But he only does 15 units and doesn’t really make an effort because he doesn’t believe in it. Has told me several times it’s in my head and suggested biofeedback. I’m sitting here right now visiting in beautiful San Diego but was not able to go out and enjoy myself. Please help.

  41. June 27, 2013 at 4:45 pm

    I know you have posted some information, Matt, on recovery after surgery. I wondered if there is anything more you or others could post regarding experiences 1 month out with pain after piriformis surgery, what you could/ couldn’t do regarding things like walking, sitting, driving? I know many of us have some differences in the exact procedures and issues addressed, but it would be helpful to have an understanding of what others could do one month post-op and what things took more time to be able to do. Thanks for any input!

    • June 27, 2013 at 8:44 pm

      I recommend asking your doctor if he/she feels you are ready to start physical therapy and to start walking for exercise. Personally I was driving in my third week post-surgery.

      The most painful thing I experienced one month post-surgery was laying on my right hip. I couldn’t do it for more 15 minutes without HAVING to get off my hip. The second most painful thing was applying moderate pressure (using my fingers or fist) to my IT band. It was very sharp, stabbing pain (not the dull achy pain like PS). The ONLY way for me to stop the pain was to have my physical therapist massage my IT band and hip. I don’t recommend trying this yourself unless you know what you’re doing.

      Matt

  42. tina
    April 4, 2013 at 6:46 am

    Hi again Matt!
    So glad to hear how well you’re doing. It makes me feel like there is hope for resolution of this condition.
    I’ve had bad PS for almost 18 months now. It’s really bad on my Left side but now I’m starting to feel it on my right side. I live in Connecticut and I’m hoping to get in with a really good hip surgeon soon. I’m trying to see whom in CT does Provocative EMG’s. The surgeon I’m trying to get in with does a lot of hip replacements as well as hip arthroscopys. He’s a big UCONN team doctor so he’s familiar with a lot of various sport injuries. His website states for Gluteal issues he does an “open” surgery. I’ve just had my records sent to him being his office won’t schedule me until he’s reviewed my current notes. So, my fingers are crossed that I get a call soon for an appointment. I’m not giving up and know that there is someone out there that can fix this for me. I will definitely come back and post info I obtain from this ortho doc. to share with everyone…. thanks again for creating this site, it’s GREAT!!!…. tina

    • April 4, 2013 at 5:06 pm

      The treatment I had to cure me can not be accomplished by an open surgery so please be careful. Endoscopic surgery is what I had. You can read more about it in my blog.

    • jessica
      May 11, 2013 at 10:24 pm

      Look up Dr. Hal Martin in Dallas or Dr. Thomas Byrd in Nashville. You want someone who does LOTS of arthroscopy and not necessarily replacements. Depending on your age, you want to make sure you are seeing a hip preservation center for the long-run. Just my 2cents and experience of dealing with no true diagnosis for over 18 months.

      • tina
        May 18, 2013 at 5:21 pm

        thanks Jessica, I hope all goes well with you and your visit with Dr Martin. Please keep us posted. I’ve had this issues basically as long as you have. I’m 42, so close to the same age as you. It makes you feel like your 90. Dr. Joyce, the ortho doc I’m currently seeng, does a lot of arthscopic surgeries too….. Tina

    • Helaine
      September 2, 2013 at 1:13 pm

      Hi Tina. My name is Helaine I live in Connecticut as well. I’m wondering if you were able to find someone to do the Provocative EMG. I believe I have either Sacroiliac Joint Dysfunction or Priformis Syndrome but can’t get anyone to give me a definitive diagonosis and my quality of life is nowhere. I am currently doing Prolotherapy and praying for a miracle.

    • Jaime
      April 9, 2014 at 12:55 pm

      Hi, Im Jaime. Im glad I came across this blog. It all started 11 months ago. I was running, training for a 5K…..when something happened and my right hip was KILLING me, and I had the numbness/tingling in my foot. After 2 months of doing nothing and just expecting it to get better I finally went to PT and they told me it was my back, not my hip causing the pain. A month of PT did nothing to ease the pain I was having in my hip. So I decided to see a chirpractor. Its been 6 months with the chirpractor and even tho he has helped reduce the pain in my hip tremendously, the numbess/tingly in my leg/foot has all of a sudden intensified. Its really bad. Finally went and saw an Ortho that specializes in hips….he said it wasn’t my hip, it was my spine, and sent me to get an MRI ( because for some reason no one would give it to me before).

      MRI results came back, the spine specialists said its fine. Absolutly nothing wrong with my spine. No disc problems whatsoever. I don’t think the guy believes me about my pain in the hip area, (even tho much better, still there) and the numbess/tingly in foot.
      He even went to say it could be someting in my hip. I told him that the hip specialist sent me to him! A spine specialits. ugh….exhausting.

      So now he’s sending me to get an EMG…..and said I should probably stop seeing the chiro. But the chiro has been the only one to have helped me so far!
      Im so done with this injury. I have 3 young kids and I work part time…..this is totally sucking.

      This annoying spine guy never mentioned Piriformis Syndrome….so only ordered me a standard EMG. Which I am realizing now probably won’t show anything.

      Anyway, my husband was the one who thought maybe I have this PS thing?
      I have been soing piriformis stretching for the past year.

      Tina, I came across your blog and saw that you live in CT. I also live in CT.
      For the past year: its your hip, no its your spine, no its your hip, its your spine…..why hasn’t anyone diagnosed me with Piriformis Syndrome? Especially when the hip & spine look apparently fine.

      So first, can you tell me who diagnosed you with this PS? And can you tell me if you found someone that does the Provocative EMGs?

      My case seems a litte different since its always been my hip that’s bothering me, and not so much the buttocks. And I know I am not as bad as some…..but still, Ive been popping Ibuprofen like candy on a daliy basis. Which isn’t good either.

      I ust dont want to live like this for the rest of my life ( Im 37 ).
      I just want to be normal again.

      Seeing a blog like this give me hope…..Im thinking acupuncture next if these Ortho people wont help me.

      Please let me know when you can.

      Thanks!
      Jaime

      PS, Matt, its great you found a treatment that worked for you!
      If I hear one more person tell me its in my head……errr

  43. tina
    April 3, 2013 at 8:28 am

    Matt, so glad to hear you’re doing so well. I agree with you that surgery is probably the best long-term treatment option. This blog is great!!!

    • April 3, 2013 at 8:57 am

      Tina,

      Thank you so much for the kind words. I’m sitting here at work (which I do five days a week for eight hours a day) and I am pain free. All of the credit is due to Dr. Scott Hardin for proving that I had Piriformis Syndrome using a Provocative EMG test, and to Dr. John Heinrich for his meticulous surgical skills in releasing the muscle, and lastly due to my physical therapist Beth. These three people gave me my life back, gave my wife her husband back, and gave my kids their daddy back.

  44. Matt
    March 7, 2013 at 7:59 pm

    Matt: Is there any way you could give me the name of the physician who performed your provocative emg? I’m having difficulty finding one willing to perform one or who even believes in piriformis syndrome. I frequently travel to WI and would like to visit the one who diagnosed you. Thanks for your help and all of the information.

    • March 7, 2013 at 8:02 pm

      His name is Dr. Scott Hardin at St. Luke’s Medical Center in Milwaukee, WI. He is truly amazing.

  45. katbunker
    July 27, 2012 at 2:38 am

    This blog is brilliant. I will use it to help evaluate the treatment I get and what the docs say. Thank you !

  46. Annette Lynch
    July 25, 2012 at 11:48 pm

    Finally, a website that gives people suffering with PS guidance and information that is all up to date and accurate.

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