Piriformis syndrome is a neuromuscular disorder that affects the piriformis muscle (in the hip/gluteal region near the lower back) and the sciatic nerve. A tight piriformis muscle can compress or irritate the sciatic nerve, which can cause pain in the lower back and hips as well as pain, tingling, and numbness from the buttocks down to the lower leg. When the symptoms are felt along the path that the sciatic nerve runs, they are commonly known as sciatica. Symptoms can be aggravated by sitting, walking, running, climbing stairs, and other physical activities.
Treatment of Piriformis Syndrome
There are several treatments for piriformis syndrome. Treatment usually begins with avoiding activities or positions that trigger the pain and icing and heat the sore muscle. Physical therapy may also be prescribed to reduce the nerve compression. If physical therapy and rest does not work, anti-inflammatory medications, muscle relaxants, and corticosteroid injections may be used to reduce pain. Other options are iontophoresis, which is when a mild electrical current is placed into the muscle, and botulinum toxin injections to loosen the muscle. If all else fails, surgery may be used to separate the piriformis muscle from the sciatic nerve.
The symptoms of piriformis syndrome generally are alleviated with treatment. However, nerve pain at times can be difficult to treat. If you have pain that is so severe that you cannot perform your job, you may be eligible for disability benefits.
Two Ways to Be Found Disabled
For Social Security to find you disabled, and thus eligible for disability benefits, you must be able to show that either that your medical condition matches the requirements of an official disability listing in the Social Security “blue book” or that you cannot perform any job because of the restrictions caused by your condition.
Matching a Disability Listing
For piriformis syndrome, there is no specific disability listing in the Social Security “blue book.” It would be difficult to have your condition be considered equivalent to a disability listing because the main impairment from piriformis syndrome is pain. While Social Security will consider pain in determining whether or not you can work, the disability listings require the existence of physical impairments, such as a shortening of the joint muscles or deformities. Without a physical impairment, you will not be able to meet or equal a listing.
Unable to Work Due to Medical Restrictions
You can also qualify for disability benefits by showing that you are unable to work due to medical restrictions. In determining if you can work, Social Security will have you complete a Residual Functional Capacity (RFC). The RFC assesses many different aspects of physical and mental abilities that are needed to be successful at a job. For those with piriformis syndrome, physical limitations will have the greatest impact of your ability to work, but pain can affect your mental abilities as well.
Abilities and Restrictions
Social Security will look at two different categories of physical abilities when considering if you can do your previous work. The agency will look at exertional activities required for work, including the ability to lift, carry, push, and pull items, as well as standing, walking, and sitting. Social Security will also look at nonexertional activities, including the ability to maneuver your body to crouch, stoop, or balance and to use your arms and hands to complete tasks.
For those with piriformis syndrome, pain may prevent you from being able to complete many exertional tasks; walking and standing for long periods of time will probably be the most affected by a tight piriformis. And depending on your condition, your doctor may limit you to lifting no more than 20-30 pounds, since straining your back muscles can aggravate the piriformis muscle. Depending on the level of your pain, the nonexertional activities of maneuvering your body may also be affected.
Your RFC will reflect the level of activities that you can do as well as any medical restrictions. For instance, if your doctor has limited you to sitting no more than one hour at a time or requires you to change your position each hour, your RFC will include this functional limitation.
Your mental abilities are also assessed in a RFC, including your ability to maintain concentration and attention at work and to respond properly to supervision, interact appropriately with coworkers, and handle different stresses that are present at work. The constant or intermittent pain caused by piriformis trouble may have an effect on your ability to concentrate at tasks at hand. In addition, the frequent need to change positions to prevent pain may also affect your ability to concentrate and complete a task at hand. Finally, your irritability may increase with pain, making dealing with coworkers, supervisors, and work stresses more difficult.
Ability to Perform Previous Work
With the RFC completed, Social Security will assess whether or not you can do any of your previous jobs. (Social Security will look only at your past relevant work -- substantial work you did work for income within the last 15 years.) The agency will compare the limitations from your RFC with the requirements of your previous jobs.
If Social Security finds you can't do your prior work, you aren't yet considered disabled: Social Security will look at your ability to do some kind of less demanding work. For example, if you are a manual laborer who was injured and you can no longer lift heavy items, but you can perform a job that requires only light lifting, you will not be found disabled.
Ability to Perform Other Work
For most disability applicants, the standard type of work that is used by Social Security when determining if you can do any work is sedentary work, meaning work that requires occasional walking and standing and the ability to carry no more than ten pounds. It also means work that is done eight hours per day, five days per week.
Social Security will compare your RFC against the requirements of many different types of sedentary work to see if there are any that fit within your restrictions.
For those with piriformis syndrome, the inability to sit for extended periods of time would be a major obstacle in finding sedentary work that can be done over a period of eight hours. (See our article on not being able to do sedentary work). However, keep in mind that certain types of jobs allow accommodations to be made for an individual with piriformis syndrome, such as allowing frequent breaks to walk around to alleviate pain. In such cases, a person will not be found disabled.
In addition to considering whether you can do your work with your impairment, Social Security will consider your age, education, and work experience. These vocational factors can affect the agency's decision whether you can perform any job.
As to age, those under 50 years old are consider to have no limitations due to age; those 55 and over are considered to have significant limitations on their ability to work.
As to education, the number of years in school and any special job training are considered in whether you have or could learn the job skills needed to do other work. Illiteracy and the inability to communicate effectively in English are considered significant limitations on the ability to work.
As to work experience, Social Security looks at your previous work experience to determine your ability to do work that you have never done before. For example, Social Security presumes a mechanic is able to do other mechanical-based jobs even though physical limitations prevent them from working in a garage.
Generally, those who are younger with a high education level and varied work experience will have greater difficulty showing that they are unable to do any job. For more information, see our section on how Social Security decides if your restrictions rule out working.
If piriformis syndrome is your only medical impairment and you aren't over 55, you'll probably need to hire a disability attorney to represent you in your ALJ hearing to have any chance of winning disability benefits based on piriformis syndrome.