Piriformis syndrome is difficult to diagnose because its symptoms are generally the same as the more common lumbar radiculopathy (numbness in the leg caused by low back pain). Both conditions are caused by the compression of the sciatic nerve. The only difference is where the sciatic nerve is being compressed. Piriformis syndrome is far more rare than low back pain, and most primary care physicians are not given much training in this syndrome. Instead, consider seeing an orthopedist, a specialist in physical medicine, or an osteopathic physician. You may need to see your primary care physician first to ask for a referral to a specialist. Your doctor may need to conduct an extensive physical exam and perform tests before reaching a diagnosis. Some tests, such as a MRI, CT scan, or nerve conduction study, may be used to rule out other conditions such as a herniated disc. To determine if you have piriformis syndrome, your doctor will begin by evaluating your range of motion by asking you to perform several exercises including straight leg raises and leg rotations. There are a number of other tests that can indicate the presence of piriformis syndrome, including:   The Lasègue sign: Your doctor will ask you to lie on your back, flex your hip at a 90 degree angle, and extend your knee straight out. A positive Lasègue sign means that pressure on the piriformis muscle while you are in this position causes you pain.    The Freiberg Sign: In this test, your doctor will internally rotate and lift your leg while you lie flat on your back. Pain in your buttocks when doing this movement may indicate piriformis syndrome.   The Pace Sign: In this test, you will lie on the unaffected side. Your doctor will flex your hip and knee, then rotate your hip while press down on your knee. If you feel pain, you may have piriformis syndrome.  Your doctor may also “palpate” (examine with the fingers) your greater sciatic notch, a notch in one of your pelvic bones through which the piriformis muscle passes. Your doctor will likely test your affected leg for sensory changes or a loss of sensation. For example, your doctor may lightly touch your affected leg or use an implement to cause a sensation. The affected leg will have noticeably less sensation than the unaffected leg. Your doctor should check your muscle strength and size. Your affected leg will be weaker and may be shorter than your unaffected leg.   Your doctor can also palpate your gluteus (the largest muscle in your buttocks) to determine the condition of the piriformis muscle. When the muscle is very tight and contracted, it can feel like a sausage. Your doctor will also check the amount of pain you experience from pressure on your gluteus muscle. If you experience pain or tenderness deep in the buttocks or hip region, this is a sign that your piriformis muscle is contracted. Your doctor will likely check for gluteal atrophy (shrinkage of the muscle). In chronic cases of piriformis syndrome, the muscle begins to wither and shrink. This can be seen in visual asymmetry, where the affected buttock is smaller than the unaffected buttock. While doctors can check for signs by performing physical tests, there are currently no diagnostic tests that can fully diagnose piriformis syndrome. Because of this, your doctor may order a computed tomography scan (CAT scan or CT scan) and/or Magnetic Resonance Imaging (MRI) to determine whether something else is compressing your sciatic nerve.  A CT scan uses computer processes with x-rays to create 3D views of the inside of your body. This is achieved by taking cross-section views of your spine. A CT scan may help identify whether there are abnormalities near the piriformis muscle and can track any arthritic changes.  An MRI uses radio waves and strong magnetic fields to create images of the inside of your body. An MRI can rule out other causes of low back pain or sciatic nerve pain. Electromyography tests the reaction of muscles when they are stimulated with electricity. This method is often used when a doctor is trying to figure out whether you have piriformis syndrome or a herniated disc. If you have piriformis syndrome, the muscles around your piriformis will react normally to electromyography. On the other hand, your piriformis muscle and gluteus maximus will react abnormally to the electricity. If you have a herniated disc, all of the muscles in the area may react abnormally. Electromyography tests have two components:  A nerve conduction study will use electrodes taped to your skin to evaluate your motor neurons. A needle electrode exam will use a small needle inserted into your muscles to evaluate your muscles’ electrical activity.

Summary: Consider seeing a specialist. Be aware that there is no definitive test for piriformis syndrome. Have your doctor conduct diagnostic tests. Check for sensory changes. Have your doctor examine your muscles. Request a CT scan or an MRI. Talk to your doctor about an electromyography study.


Measure and mark your paper with a ruler and pencil. Then, use a sharp pair of scissors to cut out the strips. The paper should look like long, thin strips of ribbon. Don’t worry if the strips seem too long for a bookmark. You will be weaving them together so your finished bookmark will be about half as long as the individual strips are now.

Summary: Cut out 4 0.25 by 11 in (0.64 by 27.94 cm) strips of paper.


Tea pouches can be purchased from health food stores and tea stockists.   The tea is now ready to serve.
Summary: Fill a tea pouch with dried raspberry leaves. Put the tea pouch containing raspberry leaves in 1 cup of boiling water. Let the pouch sit for 5 minutes. Take out the tea pouch.