Piriformis Syndrome

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If you’ve ever felt pain in the hip, pain in the center of the butt, or pain down the back of the leg, you are likely suffering, at least partially, with piriformis syndrome. The piriformis is a muscle which runs from your sacrum (mid-line base of spine) to the outer hip bone (trochanter). This muscle truly works overtime on anyone who runs at all.
Woman with back pain holding her aching hip.The first symptom suggesting piriformis syndrome would be pain in and around the outer hip bone. Photo Source: 123RF.com.The muscles in and around the gluteal region help with three areas

  • rotation of the hip and leg;
  • balance while one foot is off the ground; and
  • stability for the pelvic region.

Needless to say, all of these characteristics are highly needed by runners (and everyone else, when you come to think of it).

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.

Injuries to the Piriformis
This muscle is a prime candidate for repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond it’s level of capability, not given enough time to recover, and asked to perform again. The typical response from a muscle in this situation is to tighten, which is a defensive response of the muscle. This tightness, however, manifests itself in several ways to a runner.

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

The first symptom suggesting piriformis syndrome would be pain in and around the outer hip bone. The tightness of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing a bursitis. Again, a bursitis is an inflammation of the fluid filled sac in a joint caused by an elevation of stress and tension within that joint.

The second symptom suggesting piriformis syndrome would be pain directly in the center of the buttocks. Although this is not as common as the other two symtpoms, this pain can be elicited with direct compression over the belly of the buttocks area. A tight muscle is a sore muscle upon compression due to a reduced blood flow to that muscle.

The third symptom suggesting piriformis syndrome would be a sciatic neuralgia, or pain from the buttocks down the back of the leg and sometimes into different portions of the lower leg.

The sciatic nerve runs right through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, tingling and numbness.

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

Simple Physiology
Any muscle repetitively used needs to have an opportunity to recover. This 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. This injured muscle needs to relax and have increased blood flow encouraged to it for more rapid healing. This tightness that exists also reduces the normal blood flow going to the muscle reducing the speed with which the muscle can recover. To encourage fresh, oxygen-rich blood to the muscle is the most powerful means of getting the muscle to begin to relax and function normally. Multiple massages per day to this area is greatly encouraged.

The next step in this "recovery" process is to use a tennis ball under the butt and hip area. 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 butt 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 your sitting on it, you’re doing a good job. Let the 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, now put 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. While this pain is typically excruciating and takes some time to effectively reduce, the benefits here are huge. Be patient, be consistent and good things will happen.

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

Stretching of the hip muscles should not be done until the 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 an active return to running.

Finally, I’m always discouraging the use of pharmaceutical anti-inflammatories. 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. For more information, visit your health food store or check out Rehab Plus on our website.

Until next time, remember, they can’t throw dirt on you if you’re moving, so keep on running.

Commentary by Edward C. Benzel, MD

Dr. Maggs has presented a thorough but brief description of the piriformis syndrome. It should be emphasized that the 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 forumula for doing just that.

Updated on: 12/04/18
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Edward C. Benzel, MD
Neurosurgeon and Chairman
Cleveland Clinic
Department of Neurosurgery
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