Piriformis Syndrome is literally a pain in the backside...

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What is Piriformis Syndrome?

Piriformis Syndrome is literally a pain in the backside. It is a neuro-muscular condition characterised by hip and buttock pain.  Piriformis syndrome is caused when the piriformis muscle (located in the buttock region) spasms and causes pain. It can compress or irritate the nearby sciatic nerve. This causes pain, numbness and tingling along the back of the leg and into the foot. It can feel similar to sciatic pain. 

If you suspect you have piriformis syndrome or have any persistent pain, please seek professional advice.

Why is this muscle important? 

Your piriformis muscle is a flat band-like muscle that runs from the lower spine to the top part of your hip underneath your gluteus maximus. This muscle is important in lower body movement and is used in nearly every movement of the hips and legs. The muscle stabilises the hip joint enabling us to walk, run, and maintain balance. 

Signs and symptoms of piriformis syndrome

Symptoms are likely to feel worse after exercise or long periods of sitting. Symptoms may include

  • ache and tenderness in the buttock area
  • tingling sensation
  • numbness
  • pain down the back of the thigh, calf and the foot (sciatica)
  • discomfort when walking up stairs
  • increased pain after prolonged sitting
  • reduced range of motion in the hip joint
  • can cause lower back pain
  • stiffness in the hips

What causes Piriformis Syndrome?

There are several causes, including: 

  • overuse, injury, or strain causing the piriformis muscle to tighten, swell, or spasm
  • people who engage in sports where there is a repetitive forward movement of the legs, such as running, may be more susceptible to the condition. 
  • long periods of sitting.
  • lack of flexibility or weakness
  • posture

Treatment of Piriformis Syndrome

There are several treatments to help relieve symptoms of piriformis syndrome

Massage - to help reduce muscle tension and improve flexibility. This, plus exercises will help reduce the compression on the sciatic nerve.

Stretches and rehab exercises - to strengthen muscles and improve flexibility (see below)

Posture check - the way you sit at work or when driving could be a factor, so check your desk set-up at work and adjust your car seat. Avoid sitting for long periods of time.

Ask your therapist for a postural check to correct any imbalances which may be causing the piriformis syndrome.

Rest - rest is always good! Avoid those activities causing pain, whether that be sitting or actually moving around and doing something. Find a position that doesn’t cause a lot of pain.

Ice - if there is swelling or acute pain, use a wrapped ice pack and apply to the affected area for 5-10 minutes at a time three to five times per day. 

Yoga - may help stretch and improve flexibility.

Warm-up - always make sure you warm up before training to minimise the risk of  injuries. 

Avoid hilly running and sprinting until recovered.

In chronic conditions, cortico-steroid injections may be recommended by your healthcare professional. 

Exercises to help prevent and treat Piriformis Syndrome

Stretching and strengthening exercises will help reduce the risk of developing Piriformis Syndrome and will also aid recovery. 

These are examples of general exercises, your therapist may recommend additional exercises specific to you and your condition. 

Complete these a few times each day (you don't have to do them all at the same time!) - you should feel a slight pull/stretch, if you feel pain, stop immediately and seek advice. 

Foam rolling/spiky ball self-massage will also help.  If you are not sure show to do any of the stretches, please speak to your therapist and they will demonstrate the techniques for you.

1. Piriformis stretch

Lay on your back with your knees bent. Place one ankle onto the other thigh just above the knee. Gentle push the knee away from you and hold this. If you want a stronger stretch pick up thigh with the foot on the floor and you should feel a deeper stretch into your glutes. 

2. Piriformis stretch

Adopt the four point kneeling position, and bring your knee under your body, resting against your stomach, while your leg turns inwards. Now slowly lean forwards to create a stretch in the buttock muscle. Hold this position, and when you are ready, come back to the start position. Alternate each side. This will stretch your piriformis muscle.

3. Half squat single leg (strengthening)

Stand on one leg, and bend your knee to the 1/2 squat position. Make sure when you squat you keep the middle of your knee cap in line with the middle toes of your foot. Do not let your knee drift off to one side. Also keep your hips and pelvis level as you squat, so you go down in a straight line. Be careful not to slump forwards as you squat, maintain good posture.

4. Bridge (strengthening)

Lie flat on your back, with your knees bent, squeeze your bottom muscles and lift your body upwards. Keep your arms by your side and use them to help you balance. Make sure you maintain good posture (do not over-arch your lower back) and contract the deep abdominal muscles by squeezing your tummy towards your spine. This exercise helps to strengthen the abdominal, lower back, gluteal and hamstring muscles.

Using a foam roller or spiky ball can also help you reduce your pain. With the foam roller you can put pressure on your piriformis muscle and especially the tender point. 

5. Foam roller glute and piriformis stretch (lying down)

Lay a 4 inch (10cm) diameter foam roller on the floor. Lie on the roller so the roller is situated under your buttocks. Bend your knees. Simply lie there and move the roller backward and forward to create a stretch to the buttock (gluteal) muscle. Its normal for your back to arch slightly. Progress to a 6 inch (15cm) diameter roller.

6. Spikey ball gluteal/piriformis massage

Stand up straight, with good posture, and place a spikey ball between your butt and a wall. Bend your knees slightly to move the ball in circles around your butt, applying pressure towards the wall to make the stretch stronger. This exercise will help to reduce tension in your buttock muscles.

Time frames for recovery

Recovery times will vary depending on the individual and the severity of the injury. Speed up recovery with massage, rest and ice. Stretch your piriformis muscle and strengthen your glutes and core. If pain continues, take time off training and contact us.

What should I do? 

If you think you have signs of Piriformis Syndrome, speak to one of our therapists for assessment, treatment and advice.