Risk factors associated with piriformis syndrome: A systematic review

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Ida Kartini Othman
Norazlin Mohamad
Sabrilhakim Sidek
Raj Naresh Bhaskar
Chua Siew Kuan


Information regarding risk factors of piriformis syndrome (PS) among low back pain (LBP) is unclear. This manuscript aimed to determine the risk factors for PS. Searches were conducted in PubMed, Scopus and Google Scholar, as well as English language literatures, published from inception to July 2019. Secondary research, discogenic and spine related sciatica and case study were excluded. Two independent authors assessed the methodological quality used by the National Institutes of Health for observational cohort and cross-sectional studies, and appraisal tool of case series. A total of 28 studies met eligibility criteria, included 14 longitudinal cohort studies, 13 cross sectional studies, and 1 case series. High-quality studies (n=10) determined that the risk factor for PS are gender, increase of body mass index (BMI), and occupational related injury to the piriformis (e.g., prolonged sitting, driving, and hazardous manual handling). Moderate-quality studies (n=14) indicated age and previous history of LBP, whereas poor-quality studies (n=4) determined piriformis abnormality, psychological stress, and unhealthy lifestyle. Gender and strenuous activities were notable risk of PS. Early prevention of LBP may consider the modifiable factors, included increased BMI, occupational-related injury, overused of piriformis muscle, and experienced LBP.


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