Pyramidal Syndrome: what causes it?

Pain in the thighs and buttocks can be an indicator of pyramidal syndrome. Undoubtedly, it's a condition that we can't ignore.
Pyramidal Syndrome: what causes it?

Last update: 16 February, 2019

A compression or impingement of the sciatic nerve causes pyramidal syndrome, also known as piriformis syndrome. Pain, tingling and numbness are the main symptoms. Find out more about this condition in the following article.

What is pyramidal syndrome?

Firstly, we have to talk about the pyramidalis muscle: a flat muscle, shaped like a pyramid (hence the name). This muscle is connected to the gluteal region, the anterior surface of the sacrum and the sciatic notch. The sciatic nerve is intimately related to the pyramidal, as it runs through it in its entirety.

This syndrome occurs when the piriformis muscle compresses or clamps the sciatic nerve. One of the leading causes of pyramidal syndrome is an injury in the gluteus, but it can also appear because of anatomical variations in the pyramidalis muscle, injuries from overtraining or strain.

Research has confirmed that pyramidal syndrome can originate from hypotrophy or a loss in muscle volume. This happens when a person suffers from an illness or performs exercises which are too intense.

Even weightlifters may suffer from pyramidal syndrome. This is due to an increase in muscle volume surrounding the pyramidal muscle which leads to higher pressure in that area.

In turn, certain anomalies such as the presence of tumors, aneurysm of the inferior gluteal artery or variations in the sciatic nerve can contribute to the compression of the nerve against the pyramidalis muscle.

What are the symptoms of pyramidal syndrome?

The warning signs of the onset of pyramidal syndrome are a slight tingling or numbness in the buttocks and upper posterior thigh. Then, this turns into pain, which extends to the lower thigh or, the lower part of the leg.

There may also be some pain in the upper part of the foot (the instep) or in the waist. Because of this, the person may walk with a limp and a stooped back. You can also experience weakness in the leg, along with a stinging or burning sensation.

Symptoms of pyramidal syndrome can often be confused with other pathologies related to the sciatic nerve.

Is there treatment for pyramidal syndrome?

In many cases, diagnosis of this syndrome comes after ruling out other pathologies. Among these other pathologies are, lumbar spinal stenosis, lumbar disc disease or a pelvic problem- since the symptoms are similar.

Often, it’s difficult to make a diagnosis, although in recent times nuclear magnetic resonance is implemented, and is usually quite precise. Another option may be a magnetic resonance neurography, which scans the peripheral nerves to visualizes their general state.

Treatment for pyramidal syndrome may include rest, taking non-steroidal anti-inflammatory drugs or muscle relaxants, and physical therapy. Among the main therapeutical methods, we can try passive kinesitherapy exercises, active muscle stretching, and post-isometric relaxation. Patients are also recommended to swim or become involved in water therapies to improve this condition.

Other ways to treat it

Besides the methods mentioned above, there are some exercises you can do at home. These include stretching the thigh and buttocks before getting out of bed. Massages performed by a professional can also help.

If it hurts a lot, lay on your back on the bed and put a tennis ball or ping pong ball on the affected area. Then, use your body weight to move the ball back and forth and from side to side.

Another way to relieve pain is to apply a bag of warm water, or also take some analgesic medication.

In more severe cases, the doctor may recommend botulinum toxin injections or corticosteroids, to decrease muscle spasms in that area. If none of the solutions presented above work, you may have to resort to surgical intervention as a last resort

The pyramidal syndrome is more common than we think; and, as it affects the sciatic nerve, we can’t downplay it. If you feel pain, tingling or numbness in your legs, thighs or buttocks, it’s necessary to consult a doctor.


All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Gutiérrez Mendoza, I., López Almejo, L., Clifton Correa, J. F., & Navarro Becerra, E. (2014). Síndrome del piramidal (piriforme). Medigraphic.
  • Mendoza, I., Almejo, L., Correa, J., & Becerra, E. (2014). Síndrome del piramidal. Orthotips10(2), 85–92.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.