Piriformis syndrome, a really pain….in the butt
Recently, I came across an Instagram post of a runner stretching out her glutes. The caption under the photo said how the pain in her butt was KILLING HER after her long run and she was stretching it every chance she got.
Can you relate?
The piriformis can be a real pain in the butt. It can cause symptoms such as pain, numbness, burning and tingling which may or may not extend down the length of the leg. This small pizza slice shaped muscle, lies deep under the gluteus maximus and is responsible for external rotation of the hip and pelvic stabilization.
But is it really sciatica or something else?
Many of the runners we see, who come in with this pain, have been told by their doctor (or self diagnose) they have sciatica, when more likely it's something called piriformis syndrome.
Because compression of the sciatic nerve can cause pain to radiate up to the low back or down the leg, most people, even doctors, associate with sciatica.
The way to tell the difference between sciatica or piriformis syndrome is where the compression occurs.
Sciatica is a compression of the nerve at the lumbar vertebrae. This can be caused by spinal rotation, vertebral disc compression or asymetrical pelvic rotation and typicially, but not always, sends pain, tingling and numbness down the entire length of the leg. In many cases of sciatica, there will also be pain in the buttocks.
The piriformis lies on top of the sciatic nerve, and in rare cases, inervates (passes through) the muscle belly. When the muscle gets too tight it spasms causing it to compress the sciatic nerve, like a kink in a garden hose. Pain is often centered in the middle of the glutes and can be tender to the touch and/or painful upon sitting. In some cases, the spasm will pulse in the glute.
What causes the piriformis to tighten up? Excessive amounts of sitting can cause a the glutes and hamstrings to become underactive. This can lead to the piriformis going into spasm after running.
Additionally, since the piriformis is an external hip rotator, too much internal rotation of the femur can cause it to become tight and compress the sciatic nerve. This is sometimes the result of tight adductors, like adductor magnus, sartorius, gracillis, and deep hip rotators, as well as, gluteus medius and tensor fascia lata.
Treating Piriformis syndrome - Luckily, piriformis syndrome is relatively easy to treat, in most cases. Here are 4 simple and effective ways you can get rid of piriformis syndrome.
Ice - sitting on a bag of frozen peas can help to reduce inflammation and swelling which in turn can take some pressure off the nerve.
Stretching - One of my favorite yoga stretches for the piriformis is pigeon pose. This effective pose will target not only the piriformis, but the glutes and deep hip rotators, however, if your piriformis is tight because of too much internal rotation, it’s far better to stretch the adductors to take some stress off the piriformis.
Foam rolling - Using a foam roller or small ball to target the muscle’s attachment points at the sacrum or the greater trochanter of the femur can help relieve pressure on the nerve as well. The mistake that many people make with foam rolling this area is to sit on the ball directly where the pain is. This makes an already irritated muscle even more irritated and can cause more issues including nerve damage. We carry the Trigger point pro line of foam rollers and offer instructions on how to use them.
Massage - If stretching and foam rolling isn’t enough, it might be time to see a professional. A licensed massage therapist can use technique like active release and strain/counter strain as well as myofascial release to easy piriformis pain. When working with a massage therapist, you want to avoid direct elbow pressure on the piriformis where it compresses the nerve, to avoid irritating the muscle even further.
This is why it’s important to see a therapist who has experience working with runners and sports injuries.
Once the soft tissue dysfunction is removed, strengthening the glutes is recommended for lasting results. We suggest seeing a physical therapist for specific exercises to strengthen weak muscles will keep this problem from ruining your next run.