The piriformis muscle helps the thigh move side to side; piriformis pain related spasms can
put pressure on the sciatic nerve and cause symptoms. The result? Piriformis syndrome.
The piriformis muscle is one of the smaller muscles within the hip. Its origin point in at the base of the spine, and it connects along the back of the hip bone to a little protrusion at the top of the thigh bone. Functionally, it serves to help rotate the leg outwards (away from the center of the body) and extend the hip (going from a seated position into a standing position).
While this muscle is small, it plays an important role in how we move our legs, and its immediate adjacency to the sciatic nerve means that, if damaged, tightened, injured, or compressed, the piriformis muscle may cause numbness and pain to spread throughout the buttocks and down into the leg. When a person experiences piriformis pain related to having their sciatic nerve compressed inside the buttocks, it is likely that they are struggling with piriformis syndrome.
Causes and Symptoms of Piriformis Syndrome
The piriformis can be injured or irritated for several reasons. Most of these can be linked to two major causes:
- Muscle spasms and damage caused by strain.
- Direct compression and trauma.
Strenuous activities, ranging from a lifting injury to long-distance running and swimming, can aggravate and/or tighten the piriformis muscle, thereby squeezing on the sciatic nerve within. Depending on other factors, just walking up the stairs after long periods of inactivity can cause a flare-up, especially if the patient has experienced a prior injury in the area.
Other cases of piriformis syndrome are caused by a tightened or compressed piriformis, particularly when sitting on an uncomfortable or hard surface, or when sitting on something that compresses on the muscle itself, such as a wallet of phone in the back pocket. Sitting for long periods of time can compress and damage the sciatic nerve running through the muscle, sending feelings of pain and/or numbness down the entire leg.
In some cases, wearing very tight clothing for a long time can cause piriformis syndrome. Piriformis pain is centralized in the buttock and radiates down the leg and may be accompanied by numbness or weakness.
Other Causes of Sciatic Pain
Most of the piriformis pain experienced during a flare-up is caused by the nerve that runs through the muscle. However, the sciatic nerve origin point is higher up on the spine, and many cases of sciatic pain are caused by swelling or damage to the discs between the vertebrae of the spine rather than a swollen or damaged piriformis.
To diagnose piriformis syndrome and making sure that the origin of a flare-up is located in the buttocks and not the lower back, a specialist may utilize different imaging techniques to assess the health of the lower back and rule out any form of disc degeneration or spinal injury. In cases where both are occurring concurrently, piriformis pain treatment may include remedies for both the muscle and the damaged or inflamed discs in the lower back.
Treating Piriformis Pain
To treat piriformis pain, the cause of the flare-up must be identified. When it’s compression, it’s often enough to simply wait for piriformis pain to pass and avoid the activity, clothing, seat, or item that caused or contributed to the compression of the piriformis muscle.
If it’s a sports-related injury, taking a couple days to a couple weeks off before easing back into exercising and being aware of the cause of the injury helps. Strengthening the surrounding muscles, including the abductors, the adductors, and the glutes through a specialized training regimen set up by a physical therapist can reduce the likelihood of another flare-up during or after exercising.
Other piriformis pain treatments may include just letting the muscle rest, using painkillers, or utilizing exercises and stretches to relieve and relax the piriformis, warm up the surrounding muscles, and take pressure off the sciatic nerve.
Rest, Ice and Good Posture
When tackling piriformis syndrome, identifying the potential cause is half the battle. After that, it’s a matter of finding out what movements and postural issues a patient should avoid, ranging from sitting cross-legged to slouching at one’s desk, or going for a daily jog.
Avoiding compressing or overusing the piriformis may help reduce symptoms as well. While both ice and heat can help, people often prefer ice, and a pack applied over the piriformis can help reduce swelling and take some strain off the nerve.
Applying Piriformis Stretches Correctly
When a tight piriformis is the potential culprit, the piriformis can be stretched in a variety of ways. The simplest stretch involves lying back and taking the knee of the “problem” leg and pulling it to one’s chest, then pulling the ankle to the other side (folding the leg along the stomach).
Another helpful stretch is the “pigeon pose”, taking only the hip portion of it to ease the problem leg into external rotation at such a degree that it stretches the piriformis, and helps take pressure off the sciatic nerve. Lying down and pulling the knee of the problem leg across the body down onto the other side while keeping the back flat with the ground can also help stretch the muscles inside the buttocks.
When working on piriformis stretches as well as piriformis exercises or other exercises for sciatic pain, it is recommended to work personally with a trained physical therapist and pain specialist. If performed incorrectly or without knowledge of proper form, these stretches may inadvertently strain something else and cause greater pain. Ease into them, warm up properly, and practice with someone else.
Self-Massage and Professional Piriformis Release
If the discomfort in the leg and buttocks caused by a tight piriformis is minor, it may be released via self-massage. A tennis ball or a lacrosse ball can be used as a massaging device:
- Put the ankle of your problem leg on your other thigh to rotate the hip and stretch the buttock;
- Gently lower the piriformis onto the massage ball and work it into the muscle with slow rolling motions until the discomfort subsides.
Professional manual release is even better and can help greatly reduce feelings of piriformis pain down the entire leg, when the issue is caused by a tightened piriformis muscle.
When Piriformis Pain Symptoms Worsen
Piriformis syndrome can be painful, but usually goes away with very conservative treatment. However, should symptoms persist or get worse, it’s important to contact your doctor for a thorough examination. Chronic inflammation or serious damage to the area may call for use of nonsurgical interventions such as corticosteroid injections or Botox to relax the muscle and reduce swelling.
In very rare cases, a surgical cut may be made in the muscle to save the nerve. Most of the time, however, working with a professional at the first sign of trouble will help you deal with the issue long before the situation becomes that drastic.