# Severe, Unremitting Piriformis Syndrome Following Yoga and Pilates: A Case Report

## TL;DR

A 60-year-old woman with severe anxiety developed persistent piriformis syndrome after yoga and Pilates, which improved only after adjusting psychiatric medications.

## Contribution

This case highlights the role of psychiatric medication in managing piriformis syndrome linked to psychological factors.

## Key findings

- The patient's pain improved after increasing duloxetine and adding amitriptyline.
- Sport-related pain exacerbations ceased with the medication regimen.
- Psychological factors may influence piriformis syndrome and require holistic treatment.

## Abstract

Piriformis syndrome (PS) is caused by entrapment of the sciatic nerve due to spasm of the piriformis muscle, resulting in debilitating pain and discomfort. It is challenging to diagnose clinically, particularly when influenced by unusual triggers such as yoga or Pilates. Although anatomical factors and physical strain are commonly attributed to the etiology of the condition, studies have shown that psychological or environmental influences may contribute to the development and persistence of symptoms. This case report explores the atypical management of severe PS and the use of an integrated approach to sport-related pain exacerbations. We report a 60-year-old woman with a history of severe anxiety disorder who developed PS following yoga and Pilates sessions. The patient’s pain remained severe and unremitting despite receiving standard therapy. She began to show clinical improvement only after her duloxetine dose was increased back to 60 mg and amitriptyline was added, with full pain recovery occurring three weeks thereafter. By prioritizing this integrated approach, the patient noted a rapid reduction in pain intensity and an improvement in overall symptoms. She continued to improve on the medication regimen with no recurrence of sport-related pain exacerbations. The use of psychiatric medication for pain management in patients with PS or other sport-related injuries must be investigated further. This case underlines the importance of addressing holistic factors in managing musculoskeletal pain syndromes.