The piriformis is quite a small muscle located deep within the buttocks but it can cause quite a lot of pain if it is injured or inflamed.
Piriformis syndrome is common in runners and cyclists, especially if they have a desk-based job or do not have an adequate stretching regime. It can also be caused by sacroiliac joint issues or hip problems. Pain deep in the buttocks (usually one sided) that worsens when sitting for long periods of time, especially on hard surfaces, could be piriformis syndrome. Sometimes it can trigger sciatic symptoms with pain radiating down the leg.
So what is the piriformis muscle? The piriformis is found under the gluteus maximus, it connects the sacrum (or tailbone) to the femur (thigh bone) and it’s function is to rotate the hip outwards. Underneath the piriformis muscle is the sciatic nerve. The sciatic nerve is the longest in the human body. It originates in the lower back, passes under the piriformis muscle and down to the lower leg
Overloading the piriformis muscle causes it to spasm, tighten and/or swell, this puts pressure onto the underlying sciatic nerve. The pressure on the nerve causes the radiating pain in the back of the leg and sometimes right down to the foot.
Treatments.
Massage Therapy– deep tissue treatments such as trigger point release can help reduce the tension in the piriformis and reduce pain levels. For those wondering about the practicalities of massage in that area, I work through a towel! Massage on the hamstrings and general glute area can also help relieve piriformis pain.
Injuries and pain do not happen in isolation and the body will find ways to adapt, these compensation patterns can cause issues elsewhere. With piriformis syndrome pain in the lumbar spine, mid-back (on the opposite side), sometimes even up in to the base of the skull (causing headaches) can occur. During a massage treatment these compensation issues will also be addressed
Initially massage treatment weekly is recommended, once symptoms start to improve the frequency can reduce.
Ice and Heat– sometimes an ice pack on the affected area can help as can alternating an ice pack with a heat pack. Make sure you don’t apply either pack to bare skin and keep the total treatment time to a maximum of 20 minutes in one session.
Stretches– It is important to increase the mobility of the glutes and piriformis with daily stretching. Warm up for 5 minutes before starting. Hold each stretch for around 30 seconds, and repeat 3 times on each side. Focus should be on the affected side but it is also important to stretch the other side as well to address any compensatory issues.
Glute Stretch. Laying on your back with knees bent, cross one leg over the other, pull both legs up by clasping your hands behind the knee.
Seated Glute Stretch. This is a very useful exercise as it can be done pretty much anywhere, if you’re desk-based you can do this one at your desk, ideally try to do it several times throughout the day. Sitting on the edge of the chair, cross one ankle onto the other knee. Making sure the torso is lifted, lean forward until you feel the tension in the glutes, use the elbow to gently press the bent knee outward.
Pigeon Pose. Start from all fours (on hands and knees), bring your right knee forward and place it more or less behind your right wrist. Place your ankle somewhere in front of your left hip. Slide your left leg back, straighten the knee and point the toes. Make sure your leg is behind your body and not drawing outwards and your heel is pointing up to the ceiling. Keep your hips square. Gently lower your upper body towards the floor. This is quite a challenging stretch at first but it is very good for hip mobility.
Seated torso twist. Sitting up on the floor with both legs straight in front, cross the right leg over the left with the right foot on the floor. Slowly rotate the body placing the left elbow onto the outside of the right knee and place the right hand on the floor for balance.
Strength work– Strengthening the glutes and hip can help to reduce symptoms and prevent reoccurrence. Pilates or yoga are very good all round workouts that will help improve strength and flexibility. Specifically exercises like the bridge, clam shells and squats will all help to improve strength.
Ongoing Prevention.
It is important to continue stretching to prevent the pain returning. For runners it may be worth getting a gait analysis to see if there is any underlying biomechanical cause and for cyclists a bike fit. Strengthening the glutes and hips is also important to prevent reoccurence.
If you have a desk-based job then try to stand and move about more during the working day. This will also help to prevent back and neck pain and is just generally good for you.
Feel free to leave comments or questions below.