Piriformis Syndrome

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Piriformis syndrome is a common cause of buttock and lateral hip pain – this is due to where it is located on the buttock.

But what’s it all about?

Piriformis syndrome happens when the piriformis muscle can over tighten and cause pain – this can stem from the muscle itself but also it can compress the sciatic nerve which can make it an entirely more painful experience.

Runners commonly suffer from this issue which causes tightness and pain in a small muscle within the buttock.

You don’t have to be a runner to get this issue – people of all ages and activity levels can fall victim to this problem.

If you have had piriformis syndrome or know someone who has – then this guide will be helpful as it can address some of the anatomy, causes, symptoms and even handy treatment and rehab which is essential for reducing the problems caused by piriformis syndrome.

 

General Anatomy

 

There aren’t too many parts of the body involved with piriformis syndrome apart from the muscle and nerve. It does have a larger effect on the body however. The buttock and glute muscles are responsible for movement of the back and also the knee. If there is a pain or compromised tissue at the piriformis it can weaken other areas and even cause pain to develop in other movement and functions.

 

Piriformis Muscle 

 

Small in nature and flat/strap like. This muscle stems from the outside of the hip and runs towards the lower part of the spine. It sits directly underneath the glute max and is one of the deeper buttock muscles. Its function is to assist in turning the leg, hip and foot outwards. Another key role of the piriformis is to stabilise and provide balance to the pelvis – this is particularly utilised during one legged standing, walking and running.

 

Sciatic Nerve 

 

This is a thick and very long nerve. It can pass alongside the piriformis and in some of the population it will pass through the piriformis – this can be a big factor in whop develops piriformis syndrome and how easy it is to manage. The sciatic nerve runs in to the back of the thigh then splits in to smaller nerves that supply the lower legs and feet.

Symptoms

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Here are a list of symptoms which you may experience when suffering from piriformis syndrome:

  • Buttock pain
  • Tingling in the buttock – extending in to the thigh when worse
  • Numb type feeling in the buttock
  • Pain to touch or sit
  • Pain with movement
  • Reduced ability to run/function

This problem is essentially a neuro muscular problem meaning it involves both the muscle and the nerve – so symptoms can range between the 2 types of tissues.

Diagnosis

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There isn’t one particular test that you can do and the exact diagnosis can never be certain but, if your history of developing buttock pain in the piriformis area matches this then there’s a good chance you have a form of piriformis syndrome:

  • Increased sitting time – this can cause excessive compression on to the piriformis and sciatic nerve
  • Poor sitting habits – twisted sitting postures and cross legged sitting habits can place increased stress to the nerve.
  • Excessive running or sudden increase in running – combined with one sided muscle imbalance.
  • Palpation of the piriformis to determine pain levels / tension.

A good assessment by a physiotherapist is necessary to confirm this issue. This is because of other diagnosis and different ways of managing them being possible. Piriformis syndrome can mimic back referred buttock pain caused by issues such as spinal discs.

An assessment must take a comprehensive history, movement screen and objective testing to determine the correct diagnosis.

It is unlikely you will ever need to have anything more than this for piriformis syndrome – you will not need to go for any type of x-ray, scan or invasive procedures.

A positive diagnosis of piriformis syndrome will be done with a combination of good assessment combined with the history you have provided. See a musculoskeletal specialist as general doctors may not be able to specialise with a problem like this.

Treatment

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Unfortunately there isn’t one magic treatment which will reduce your symptoms but it is often a combination of measures which will in time help to reduce the symptoms of piriformis syndrome.

Activity modification – this is probably the most important one for everyone to do. Find out what triggers your symptom and temporarily reduce this activity but do not totally avoid it. When your symptoms are at your worst you may have to adjust what you do to stop it aggravating your problem.

For example – if running for 30 minutes causes the problem – reduce your running time to 15 minutes and see how that helps. Alternatively, swap running for walking which will keep you active and keep the muscles working.

Another problem for piriformis syndrome can be up and downhill running and walking – if possible stick to flat surfaces whilst you have your problem, this is because it can place more stress on the piriformis and trigger your symptoms.

If sitting causes your problem – look at how you are sitting and potentially adjust your position, add a cushion or even sit for shorter periods of time with more movement breaks.

If you have a weakness – which can be identified by your physio – then this will need to be strengthened. Tightness of the muscle can often be caused by weakness in the muscle. In the next section we will look at exercises that can help to manage and improve piriformis syndrome.

Never use cold therapies on your piriformis syndrome – this can really aggravate it. This is due to nerve involvement and placing cold on to a nerve can really aggravate things. Instead, use heat – this helps to deliver blood flow and also relax the muscle and reduce tightness.

Massage / Pressure Release treatments are extremely effective as the applied pressure helps the contracted muscle to temporarily release. This can be uncomfortable to do but can also provide a nice release of the buttock which then can alleviate symptoms. You can have this done in many ways, such as getting a physiotherapist to kneed in to the buttock, typically using their elbow. There is also the use of a massage gun which can be very effective. Foam rollers and soft tissue release balls are a great way to really get a deep penetration of the muscle and help tom reduce tightness.

Needle based therapies are very effective at releasing tighten muscles. When needles are inserted in to the muscle it elicits a twitch response which helps the muscle to relax and de-tension. A physiotherapist or acupuncturist can perform this treatment.

It is important to be aware that passive treatments are great for immediate pain relief and to manage the symptoms, but they must be combined with rehabilitation and habit change for them to be truly effective.

If you only pursue treatment and do not make any other changes – this will result in the problem continuing for longer than usual.

Exercises

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Exercising to reduce piriformis syndrome needs to be separated in to 2 separate types of exercise which have different purposes. Stretching and mobility helps to reduce the tightness of the muscle in the buttock and also improve nerve pain if there is any. Mobilising the muscles and nerves help to deliver blood and reduce tension in to the surrounding tissues, which aids their healing/rehab process.

The next section is strength work – often the buttock muscles will have been weakened by the stress of the piriformis syndrome and they will need strengthening to bring them back to their best. Muscles can typically become tight when they are weak and shorten in length. After mobilising and stretching the muscles for immediate relief, it is essential to then strengthen the muscles.

Adding strength helps to reduce pain levels but also helps the muscle to relax and lengthen back to its most optimal length, which achieves maximum function.

If you haven’t got piriformis syndrome and want to reduce your chances of developing it then please consider these exercises as good prehab. It’s better to prevent a problem than to develop and then deal with it.

 

Stretching and Mobility

 

Knee to chest – Diagonal BiasThis stretch is very simple to do and specifically targets the piriformis. Bring your knee in to your chest whilst lying on your back and then push it to the opposite side so that it points in the direction of the opposite shoulder.

This directly applies tension to the piriformis – hold for 20-30 seconds and you can even perform little pulsing movements at the end of range.

 

Cross legged stretchsitting with your back to a surface, bend the affected leg upwards toward your chest, pass across to the side of your other leg and lean over the top to create a stretch. This again loosens the buttock off. To maximise the stretch – try placing your leg further across the body and then leaning on the top of it to increase its effect.

 

Knee Extension on BackLying on to your back, place your hands behind the affected leg’s knee. Raise your leg in to the air and gently extend the knee til your leg goes straight. This is great for your sciatic nerve. Please perform this gently and slowly so you don’t over aggravate or tension it. To add an extra tension to the nerve, when your leg is fully straight you can bend and flex the ankle up and down. This can be performed regularly throughout the day, only perform for periods of 20-030 seconds at a time.

 

Strength Work

 

Glute Bridgethis exercise is done with both legs or with a single leg. Lie on your back and push through your feet and raise your hips as high as possible. Perform with a slow controlled technique, pause at the top and slowly lower down. When working for strengthening a muscle, work for as many reps as possible and work in 3-4 sets.

 

Hip Abductionlie on your side and gently raise your leg up to the side. This is great for piriformis syndrome as it targets the smaller muscles of the hip. This can be made harder by applying a glute band to add resistance. To begin with however you may just want to start with bodyweight.

 

Crab WalksThese are exercises performed with a glute band around the ankles. The feet need to be turned to a 10 to 2 position and settle in to a partial squat position. From here – simple move in very small side steps in one direction, and when tired move in the other direction.

 

That concludes our guide to piriformis syndrome which we hope has been helpful. If you have found benefit from this, please share it with someone you know.

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