Myofascial trigger point distribution in the lumbopelvic – gluteal – thigh complex in patients with piriformis syndrome: a controlled cross – sectional study

Background Piriformis Syndrome (PS) is a neuromuscular condition characterized by pain in the gluteal region, often associated with irritation or compression of the sciatic nerve. Although traditionally considered a localized disorder, recent evidence suggests that myofascial dysfunction, particularly the presence of myofascial trigger points (MTrPs), may contribute to a more widespread clinical presentation.Objective This study aimed to evaluate the presence and anatomical distribution of MTrPs in the lumbopelvic, gluteal, and thigh muscles in patients with PS, and to determine whether PS represents an isolated muscular disorder or a broader neuromyofascial involvement by comparison with healthy controls.Methods This single-center, cross-sectional controlled study included 80 patients with PS and 80 age- and sex-matched healthy controls. MTrPs were assessed by standardized physical examination. Pain intensity was evaluated using the Visual Analog Scale (VAS). Group comparisons were performed using appropriate statistical tests (p < .05).Results MTrPs were significantly more prevalent in the PS group than in controls. The highest prevalence was observed in the gluteus medius (80.0% vs. 5.0%, p < .001), gluteus minimus (75.0% vs. 5.0%, p < .001), biceps femoris (71.3% vs. 6.3%, p < .001), and semitendinosus (68.8% vs. 0.0%, p < .001). In the lumbopelvic region, MTrPs were also more frequent in the internal oblique (45.0% vs. 0.0%, p < .001), erector spinae (50.0% vs. 10.0%, p = .016), and quadratus lumborum (50.0% vs. 0.0%, p < .001).Conclusion PS appears to represent a widespread neuromyofascial disorder rather than an isolated sciatic nerve compression syndrome. Systematic evaluation of MTrPs may improve diagnostic accuracy and guide more comprehensive treatment strategies.