Getting To the Bottom of Piriformis

Getting To the Bottom of Piriformis

What Do You Mean by Piriformis Muscle?

The piriformis muscle is a tiny muscle that is located right in the deep part of the buttock and that too just behind the gluteus maximus. Well, the piriformis muscle begins from the lower spine, and then it connects to the upper surface of each of the thighbones or the so-called femur.

The major function of this muscle is to help in the rotation of the hip and then turn the leg and the foot outward. Furthermore, the muscle would run diagonally along with the sciatic nerve that runs vertically in the direct way just beneath it.

What Do You Know About Piriformis Syndrome?

Like most muscle syndromes, piriformis syndrome is an uncommon neuromuscular disorder that occurs as and when the piriformis muscle compresses the sciatic nerve. Here the piriformis muscle would be flat, just like the band one muscle that is situated at the buttocks, right to the top of the hip joint.

This muscle is necessary for the lower body movement as it can stabilize the hip joint and even lift and rotate the thigh just away from the body. Also, this can allow one to walk, shift the weight from one foot to another and even maintain balance. Furthermore, the muscle is commonly used in sports that involve rotating and lifting the thighs.

So, in short, it is commonly used in all kinds of motions related to legs and hips. The sciatic nerve of the piriformis is one of the thick and long nerves present in the body. It can easily pass alongside and even go through the piriformis muscle. Then it goes down to the back of the legs and would, later on, branch off into small kinds of nerves that end up in the feet. The compression of the nerve happens due to the spasm of the piriformis muscle.

What Are the Symptoms of Piriformis Syndrome?

Some of the major symptoms of piriformis are constant pain, tingling, and numbness. For certain people, it can even lead to intermittent pain, pain that moves from the back to the foot, and even sometimes severe pain that occurs when one attempts to do certain movements (like climbing stairs, running, walking, etc).

Various healthcare professionals do diagnoses that are based on the history of the patient and the physical exam and followed by other most common and same types of issues that are diagnosed and even ruled out through MRI, CT, and injection tests.

Now the treatment of piriformis syndrome is based on the chronicity of the disease and even contains exercise, physical therapy, stretching, medical treatments like NSAIDs, injection therapy, and infrequent surgeries. Furthermore, health professionals and doctors that are experienced in treating piriformis syndrome are osteopathic physicians, orthopaedists, occupational therapists, physical therapists, sports medicine doctors, etc. Not only that, but there are also many home-based remedies like exercise, cold pack, stretching that you can do for reducing the symptoms of the piriformis and even allowing the muscles to heal.

Another thing to keep in mind is that the treatment of the acute-based piriformis syndrome would have a good prognosis, the prognosis would decline as the disease becomes chronic. You can avoid piriformis syndrome using the correct usage of the musculature and even avoiding all kinds of trauma to the lower back and buttock area. Also, you can even avoid the recurrences through the following of the individually created rehabilitation program.

Who Can Suffer From Piriformis Syndrome?

Of course, piriformis syndrome is quite uncommon. In the USA alone, healthcare professionals usually diagnose around 200,000 individuals each year. The syndrome usually begins from a single-leg pain, that further goes and becomes numbness and tingling to the back and even the buttock area. This can even go further down to the back of the leg or thighs and that follows the sciatic nerve and even lead to the sciatic nerve pain.

The never compression through the contracture and spasm of the piriformis muscle would lead to piriformis syndrome. Here the piriformis muscles are just flat muscles that are in the buttocks. They would help one to stabilize the hip joint and even lead to the lift and rotation of the thigh away from the body. Hence, this muscle would pair with the obturator externus muscle and lead to the pulling of the lower pelvis to the back.

Wallet sciatica, pseudo-sciatica, hip socket neuropathy is some of the other names that are used for piriformis syndrome. Also, it is most associated with the repetitive actions that are commonly occurring during sports like playing tennis, long-distance running, football injuries, etc.

Causes and Risk Factor of Piriformis Syndrome

Keep in mind that the cause of the piriformis syndrome is all related to the location of the sciatic nerve that is present in the piriformis muscle. The sciatic nerve would pass out of the pelvic through four major routes. Swelling or the spasm of the piriformis muscle would lead to signs and symptoms due to the pressure that is placed on the many areas of the sciatic nerve that are adjacent to the muscle.

The risk factors related to piriformis syndrome contain the following and they often happen due to sports injuries like trauma (a blunt trauma to the buttocks), inflammation (can be due to sprain, overuse, etc), scar formation, hematoma, etc.

Furthermore, those individuals that can end up having or suffering from piriformis muscles can suffer from the risk of tumours, cysts, and pseudo-aneurysms.

Diagnosis of Piriformis Syndrome

Frankly, there is no definitive test for piriformis syndrome. Further, in most cases, there can be a history of trauma to that area, followed by repetitive, vigorous activity like long-distance running, or prolonged sitting. When you check the diagnosis of piriformis syndrome, you can see that it is made by the patient’s report of symptoms and by physical exam, where a variety of movements is used to elicit pain to the piriformis muscle. In some cases, the contracted or tender piriformis muscle can be found during any kind of physical exam.

As symptoms can be similar in other conditions, radiologic tests like the normal MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.

Treatment of Piriformis Syndrome

Sometimes the pain can be caused by sitting or doing certain activities. In those cases, try to avoid positions that would trigger the pain. Here, rest, ice, and heat may help to get rid of and relieve symptoms. Checking out with a doctor or physical therapist would lead to the suggestion of a program of exercises and stretches to help reduce sciatic nerve compression.

At times, one can use the osteopathic manipulative treatment to help relieve pain and increase range of motion. Some healthcare providers would even recommend the usage of anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid or anaesthetic. There are other therapies like iontophoresis, which would be using the mild electric current, and injection with botulinum toxin (Botox) have been tried by some doctors. Using the paralytic properties of the botulinum toxin, Botox injections are thought by some to relieve muscle tightness and sciatic nerve compression to minimize pain. An ultimate resort would be surgery.

When Should You Call or Consult a Doctor?

Make sure to call the doctor only when you are going through some of the below issues – 

  • When the pain is lasting longer for a few weeks. 
  • Your pain begins as soon as you have been injured in the traumatic event. 
  • You end up with sudden, sever pain right in the lower back of your leg and even you end up with muscle weakness and numbness of your leg. 
  • You have issues controlling your bladder and bowels.

What Type of Exercises You Can Do for Piriformis Syndrome?

1) Simple Seated Stretch

First, begin by sitting on the chair and crossing your sore legs just over the knee of your other leg. When you are keeping your spine straight, try bending your chest forward. If you are not feeling any kind of pain, all you need to do is bend forward a little more. Try to hold this position for around 20-30 seconds and then repeat the stretch using your other leg.

2) Doing Standing Piriformis Stretch

Some people would have issues when they are balancing with this kind of a stretch. In that case, just stand with your back against the wall and make sure your feet are around 24 inches from the wall for getting extra support.

As you are standing, just place the leg that would be causing the pain over the knee of the other leg of yours. Somewhat this would create the shape of the number four. Then you would have to lower your hips right at the 45-degree angle until you are reaching the ground. After that bend your leg that you are standing on as and when you require.

Slowly, when you are bending forward right at the waist, try to reach your arms down to the ground while making sure that your spine is straight. Try to hold this position for around 40-50 seconds. Then when done, switch the legs.

3) Supine Piriformis Stretch

In this exercise, you must lie down and try to bend your knees upwards. After that, you would need to cross the affected leg right over the other leg and try to bend it upward towards your chest. Then you need to grab the knee with a single hand and with the other hand your ankle.

Pull the bent leg right across your body till the glutes are pretty much pulled in the tight manner. Try to hold this way for 30-40 seconds to around a minute and then release.

4) Outer Hip Piriformis Stretching

For this exercise, you would need to lie on your back, then try to bend your sore leg upwards and try to place your foot just close to the back of your other knee. Later, you do need to tuck your foot right behind that knee and twist the leg to the opposite side. Make sure to ensure that your knee is touching the ground.

After that place your hand on the opposite knee and try to raise the opposite arm in the air. Try to hold on to this position for around twenty seconds. Then you need to switch to the other leg. Of course, you would need to recover from this stretch. Now lie on your back and try to bend both of your knees together and slowly pull them using your hands towards your chest.

5) Long Adductor and Groin Stretch

For this exercise, you need to sit on the floor, then you must stretch your legs and make sure that they are straight out right in front of you. Try to spread as far apart as much possible. After that place your hands on the floor right next to each other and try to angle your torso towards the ground.

Then you can lean forward and even rest your elbows on the ground. In case you are encountering any pain, right away stop. Try to remain in this position for around 10-20 seconds.

Can Piriformis Syndrome Be Avoided or Prevented?

As soon as the symptoms improve, you would have to change your activities for avoiding piriformis syndrome again. The first and foremost thing you would need to do is exercise regularly and make sure to stretch first.

Try to maintain good posture as and when you are driving, sitting, and even standing. Also, you need to avoid lifting by bending over. Try to lift any object by bending your knees and even squatting for picking the object.

Living with piriformis syndrome can be tough as it can come and go. That too is based on your activity level. Of course, if you do have issues and suffer from extreme piriformis syndrome, then it is better to consult your doctor. Make sure to inform your doctor well in advance and not take it to the extreme level.


Saravavan Nadarajan (Vanan)

Vanan, fitness expert and leader at EzFit Singapore, specializes in holistic training—home-based, boot camps, and corporate fitness—with over a decade of industry experience.

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