Piriformis Syndrome Can Be A Pain in the Butt

…But There Are Steps You Can Take To Treat It

Woman with Piriformis Syndrome

Can’t get comfortable while sitting? Can’t sleep on your side? Have radiating pain down the back of your leg? If what you’re going through is a literal pain in the butt, you may be experiencing symptoms of Piriformis Syndrome.

Piriformis Syndrome is a controversial diagnosis because there are several other impairments that can lead to similar symptoms.

With that said, let’s discuss what Piriformis Syndrome is, what are potential causes, and most importantly, what you can do to improve…

Piriformis Syndrome in a Nutshell

The Piriformis is a pear-shaped muscle in your buttock region. Its main role is to help rotate your hip outward. In most people, the Sciatic nerve runs just below the border of the Piriformis.

Here’s a nutshell definition of Piriformis Syndrome: an irritation of the sciatic nerve caused by compression of an injured or irritated Piriformis muscle 1.

Do any of these symptoms sound familiar?:

  • Buttock pain that radiates into the hip, the back of the thigh, and into the lower leg
  • Tenderness in the buttock region
  • Pain increases with sitting or squatting2,3,4,5

Ok, you get it…but what causes these symptoms?

Well…

There’s a Couple Potential Causes of Piriformis Syndrome

Stiffness and Compression:

Traumatic injury to the Piriformis can lead to muscle spasms, inflammation, or both, which then can lead to nerve compression 6,7,8,9,10.

What causes this trauma?

One common cause of compression, and something I always ask my patients about, is “wallet neuritis11.” Just like it sounds, this happens in people, mostly men, who wear their wallet in their back pocket. The “fix” for this is simple and obvious: take your wallet out of your back pocket.

Other potential causes are injuries following surgery, lower back or pelvic impairments , and overuse12,13,14.

This is the traditional view of Piriformis Syndrome: the muscle is thought to be tight or in spasm15,16,17.

However, another theory suggests the opposite may be true.

Over-lengthening and Compression

Some say that the Piriformis muscle isn’t being shortened, but rather it is being over-lengthened, which then leads to nerve compression 18.

How does this happen?

When you walk or run, if your hip rotates inward, this motion repeatedly pulls on the Piriformis – leading to compression of the nerve. Your hip might move this way if you have weakness in your glute muscles.

I’m not going to say one theory is more correct than the other.

Might I suggest, though, that either theory could be correct in different people? This is why your Physical Therapist is so valuable.

It is important for you to see a skilled Physical Therapist who can evaluate which impairments are specific to you. This way, you will know exactly what you need to work on.”

In addition, your PT will be able to help rule out other potential sources of your symptoms.

What You Can Do For Piriformis Syndrome

Here are a few options I would recommend to treat Piriformis Syndrome based on some common impairments:

1. Stretch the Piriformis

If your Piriformis muscle is stiff, it makes sense to stretch it19.

 

Taking this stretch a step further to help relax the muscle, a hold-relax technique can be performed: Hold a stretch for 30 seconds, then gently press your leg into your hands for 5–10 seconds, stop pressing and pull into a slightly deeper stretch for another 30 seconds. This can be repeated multiple times.

2. Mobilize the Sciatic Nerve

That’s right, your nerve can be mobilized. Since your nerve is likely being compressed and irritated, getting the nerve to gently slide back and forth can help to free it up to restore some motion and calm things down20.

 

3. Strengthen Your Glutes

Weakness of the glutes can lead to faulty movements at the hip, which can potentially lead to over-lengthening of the Piriformis muscle21. If your Physical Therapist determines this to be the case for you, strengthening the glutes would be a good idea22,23.

You know what, strengthening your glutes is always a good idea – so do it anyways!

Here are some great videos for glute strengthening.

Question: What have you found that works best for you to treat Piriformis Syndrome? You can leave a comment by clicking here.


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  3. Parziale JR, Hudgins TH, Fishman LM. The piriformis syndrome: a review paper. Am J Orthop. 1996;25:819–823  ↩
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  18. Tonley JC, et al. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. J Orthop Sports Phys Ther. 2010;40(2):103–111  ↩
  19. Kirschner JS, et al. Piriformis syndrome, diagnosis and treatment. Muscle and Nerve. 2009; 40:10–18.  ↩
  20. Rahul KK, et al. Neural mobilization: a therapeutic efficacy in a piriformis syndrome model: an experimental study. Int J Physiother Res. 2014;2(3):577–83.  ↩
  21. Tonley JC, et al. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. J Orthop Sports Phys Ther. 2010;40(2):103–111  ↩
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