Piriformis Syndrome

Buttock and hip pain may include sciatica symptoms.

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If you’ve ever felt pain in the hip, pain in the center of the buttock, or pain down the back of the leg, you may likely be suffering (at least partially) piriformis syndrome that may cause sciatica symptoms. What is the piriformis muscle? It is located in the buttock region and runs from your sacrum (pelvis) to the outer hip bone (trochanter). The piriformis muscle works overtime especially in people who are runners. The muscles in and around the gluteal region help with 3 bodily movements:

  1. Rotation of the hip and leg
  2. Balance, while one foot is lifted off the ground
  3. Stabilizing the pevlic region

woman runner stretching knee to chestWoman runner on the beach standing while stretching her knee to her chest. Photo Source: 123RF.com.

3 Piriformis Muscle Injury Symptoms

The piriformis muscle is a target for repetitive motion injury (RMI). RMI occurs when a muscle is driven to perform beyond it’s level of capability, not given enough recovery time and must perform again. The typical response from the piriformis muscle or any other muscle is to tighten—the muscle's defensive response. In runners, piriformis muscle tightness can manifest itself in several ways.

piriformis muscle, sciatica nerveThe anatomy of the lower back/sacrum illustrates the piriformis muscle and sciatic nerve. Photo Source: Shutterstock.

Piriformis Syndrome Symptom #1

The first symptom suggesting piriformis syndrome is pain in and around the outer hip bone. The tight piriformis muscle can produce increased tension between the muscle's tendon attachments at the front (anterior) of the sacrum and trochanter (hip bone). This can cause joint bursitis resulting in discomfort and pain. Bursitis is inflammation of the hip joint's fluid filled sac that may develop in reaction to increased joint stress and tension.

Piriformis Syndrome Symptom #2

The second symptom of piriformis syndrome is pain or soreness felt in the center of one or both buttocks and may be brought about by compressing the buttock. This piriformis syndrome symptom may be caused by reduced muscular blood flow.

Piriformis Syndrome Symptom #3

The third symptom is sciatic neuralgia; low back pain that travels downward from one buttock into the back of the affected leg, sometimes below the knee. Piriformis syndrome may cause the muscle to compress the sciatic nerve creating pain and sensations such as tingling and/or numbness.

To learn more about the sciatic nerve and sciatica, visit SpineUniverse's Sciatica Slideshow.

Piriformis Muscle Physiology and Recovery

Any muscle repetitively used needs an opportunity to recover. Muscle recovery can either be on Nature’s clock or can be facilitated and sped up with proper knowledge and treatment. Since the muscle is tightening due to overuse, continued use will only make it worse. The injured muscle needs to relax with increased blood flow for more rapid healing. Piriformis muscle tightness reduces normal blood circulation to the muscle and reduces the speed of muscle recovery. Circulation of fresh, oxygen-rich blood into the muscle is the most powerful way to encourage muscles to restore normal function. Multiple massages daily to treat the piriformis muscle is recommended.

Placing a tennis ball under the buttock and hip area is a good next recovery step. While sitting down on the floor, roll away from the side of involvement and place a tennis ball just inside the outer hip bone under the buttock area. As you begin to allow your weight onto the tennis ball, note areas of increased pain and soreness. Trigger points will tend to accumulate in a repetitively used muscle, and until these toxins are manually broken up and eliminated, the muscle will have an artificial ceiling with regard to flexibility potential and recovery potential. So, if it’s sore and hurts while you are sitting on it, you are doing a good job.

Let the tennis ball work under each spot for 15-20 seconds before moving it to another area. Once you’ve been on the ball for 4-5 minutes, move the ankle of the involved leg over the knee of the non-involved leg (crossing your legs). Now place the tennis ball just inside the outer hip bone again and work the tendon of the piriformis muscle. The pain is typically excruciating and takes some time to effectively reduce but the benefits are huge. Be patient, consistent and good things will happen.

Additional Treatments and Concluding Advice

Due to the fact that sciatic neuralgia, hip bursitis and/or tendonitis are inflammatory in nature, ice, or cryotherapy applied over the affected area 15-20 minutes at a time may be beneficial. This should be done multiple times per day.

Stretching the hip muscles should not be done until acute pain is gone. At that point in time, begin with gentle stretching, such as the cross-legged stretch while pulling up on the knee. The muscle should have increased flexibility before actively returning to running.

Finally, I’m always discouraging the use of anti-inflammatory medications. Not only do they greatly aggravate the intestines, but they also suggest an artificial wellness that can lead to bigger problems. Proteolytic enzymes, such as bromelain, are both natural and extremely beneficial with no side effects.

Conclusion--the piriformis muscle is pretty important for all of us. If you've been diagnosed with piriformis syndrome, check out our video series on pirifomis syndrome exercises.

Commentary by Edward C. Benzel, MD

Dr. Maggs presents a thorough but brief description of piriformis syndrome. It should be emphasized that piriformis syndrome is rarely a surgically treatable problem. It does, however, manifest itself commonly in runners and other active people. "Educated athletes" should be aware of this syndrome and treat it accordingliy. Dr. Maggs has provided the formula for doing just that.

Updated on: 04/30/19
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Sciatica Self-care: 5 At-home Remedies for Low Back and Leg Pain
Edward C. Benzel, MD
Neurosurgeon and Chairman
Cleveland Clinic
Department of Neurosurgery
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