Piriformis Syndrome

Updated August 19, 2016
piriformis syndrome and lower back pain

The piriformis muscle is large and often gives us discomfort due to tightness

The Piriformis muscle is a small muscle located in the region deep within both sides of the hips.  It travels and attaches down the back of the pelvis to the top of your femur.  Its purpose it to externally rotate the femur, extend the hip slightly and to abduct the hip.  This is when the hip is flexed.  The piriformis helps to keep the hips stable while standing or walking.  It is a flat muscle with a pyramidal shape.

Sciatic nerve irritation

When this muscle gets overused or irritated, it affects the sciatic nerve.  A swollen or inflamed piriformis puts pressure on the nerve causing discomfort.  Inactive glute muscles are also a factor.  This happens from overactive hip flexor muscles leading to tighter and shorter glute muscles that compress the nerve.

The sciatic nerve is located directly underneath the piriformis muscle and is covered by it.  This nerve is very thick and long.  It originates as 5-6 separate nerves and combines to form one large nerve which runs from the base of the lumbar spine, underneath the piriformis and out down to the back of the thighs and feet.  For some people, this nerve is more susceptible to irritability than usual because it travels through the muscle itself rather than underneath it.

Piriformis Syndrome Symptoms

Symptoms of Piriformis Syndrome include:

  • soreness
  • tightness
  • aching pain
  • tingling sensation
  • weakness or numbness
  • irritable sensations from the buttocks, down the legs
  • worsening symptoms with extended sitting
  • pain when running or walking
  • tenderness when pressure (palpation) is applied to the buttock
  • aggravated from keeping a wallet in the back pants pocket
  • pain after intense physical exercise while in a seated position

Piriformis syndrome is NOT sciatica

sciatic nerve and back pain

The sciatic nerve is very large and prone to irritation

It is similar to sciatica in the respect that it can produce the same symptoms.  The difference is the cause of the nerve compression and the location.  Both causes can produce the same symptoms such as pain or numbness radiating down to the back of the thigh.  Both affect the motor function of the foot also.  This difference in the origin of the cause of compression determine the method used to detect this painful condition and also the treatment required to improve pain symptoms.

Piriformis syndrome can be difficult to diagnose and treat.  It frequently is overlooked or misdiagnosed in clinical settings.

Other conditions such as ‘deep buttock’ syndrome which involves gluteus medius, buttock, leg and hamstring pain contribute to some of the confusion with adequate diagnosis.  Genuine sciatica is often misdiagnosed as piriformis syndrome.  As much as 6% of patients who are diagnosed as having lower back pain actually have this condition instead.

Obturator internus muscle irritation

Another muscle that travels in a similar path as the piriformis is known as the obturator internus.  This muscle can also become tight, weak and irritated.  When inflamed and tight, it will also put pressure on the sciatic nerve mimicking symptoms to that of piriformis syndrome.  Treatment for problems from the obturator internus can benefit the piriformis and vice-versa.

Without timely diagnosis, the condition of the piriformis muscle, sciatic nerve and the muscle that the sciatic nerve feeds can worsen.   Treatment can become more difficult or less effective as a result of this delay.

The most common age for symptoms to appears is in the early 40’s and 50’s.  Women are affected more than men.  This syndrome does not correlate to any particular occupation or level of fitness as it can affect anyone.  As much as one-third of people with lower back pain also have complications that involve pain from the piriformis muscle on the sciatic nerve.

Treatment Options

Exercise has not only been a proven method of treatment of piriformis syndrome but a necessary one.  Strengthening and stretching are vital tools to improving and treating pain symptoms.  When the piriformis muscle is stronger from exercise, it is much less likely to become injured and inflamed.  It is also less likely to put pressure on the nerve by lengthening it from specific stretching techniques.

It is exercise from specific strengthening and stretching techniques that is important for treating this syndrome.  Exercise that is intense while seated only serves to aggravate this condition.  This applies especially to seated exercises such as rowing and cycling.  Repetitive activities cause overuse injuries to the sciatic nerve and piriformis muscle.

In addition to exercise, ice, rest, muscle relaxants and anti-inflammatory medication also provide significant but temporary relief.

Soft tissue mobilization, mobilizing the hip joint, specific stretches and movements, strengthening of the glutes can improve this syndrome dramatically.  All of these techniques are available in detail through many targeted exercises that condition these muscle groups.   These varied and selected exercises each specifically strengthen and stretch the piriformis, obturator internus, and glutes effectively to alleviate piriformis syndrome, sciatica, lower back and hip pain.

Do This Stretch

The stretch for glute muscle pain will help to alleviate both piriformis and sciatic discomfort if done slowly and consistently.  It is easy to do and can be done anywhere while seated.  If done well, you will begin to feel a strong stretch sensation directly from the deeper and higher part of your butt muscles just in behind the back of your hip.  This will take several minutes to occur because during the first few minutes of your stretch, you will only feel resistance.

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