Health

Piriformis Syndrome: What is it and how to self-treat it

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The Piriformis muscle can be a huge pain in the butt. Severe cases of Piriformis syndrome can even cause sciatic nerve issues down the leg. Fortunately, through proper piriformis release, stretching, and strengthening Piriformis Syndrome can be avoided [1].

Piriformis Muscle Anatomy

Piriformis is a deep glute muscle and the largest of the short hip rotator muscles. It connects from the sacrum (tailbone) to the top of the femur and lies underneath the Gluteus Maximus muscle.

These attachments allow the Piriformis muscle to rotate the leg outward – think rotating the knee 90 degrees to the side of the body.

Piriformis is particularly active in sports with lateral side-to-side movements like tennis and basketball. If untrained or unconditioned, Piriformis is susceptible to developing trigger points and tightness from lateral movement sports [1]. 

Piriformis Syndrome Pain Mechanism

The Piriformis muscle can cause a plethora of problems when tight. Piriformis can refer muscle-induced pain to nearby areas in the back of our hip, but it also can compress the large Sciatic nerve that runs from the base of the spine down the leg.

The latter – compressing the Sciatic nerve – is known as Piriformis Syndrome.

Piriformis Syndrome occurs when the Piriformis muscle is so tight that it compresses on the Sciatic nerve that runs directly underneath it. In this case, the Piriformis muscle is undoubtedly tight and likely has trigger points that need attention.

Piriformis Syndrome Symptoms and Pain Pattern

Piriformis tightness is required for Piriformis Syndrome, but tightness does not always cause the nerve compression associated with Piriformis Syndrome.

If your Piriformis is tight and contains trigger points you will likely feel the following symptoms:

  • Pain at the tailbone or outer buttock, as shown in bright red below
  • Discomfort sitting too long
  • Difficulty crossing one leg over the other
  • Difficulty pointing the toes inward
Piriformis syndrome Symptoms and pain patterns

Now that we unpacked Piriformis tightness symptoms as the key symptoms, we can better understand Piriformis Syndrome symptoms.

The tightness and Syndrome go hand in hand, so if you are experiencing Piriformis Syndrome it is best to understand the tightness going on first.

Sciatic nerve compression is the key symptom of Piriformis Syndrome. This can feel like pain, numbness, and/or tinging felt running down the leg and potentially all the way to the foot.

In addition to nerve-induced symptoms down the leg, all symptoms of Piriformis tightness listed above are likely at play.

Note: sciatic pain down the back of your leg can be caused by other issues so make sure to see your GP for assessment as this post is not medical advice.

Piriformis Syndrome Treatment

Piriformis Syndrome relief should be treated in two steps: 1) Massage/Release and 2) Stretch.

1. Massage/Release: 

Piriformis Syndrome is the manifestation of a tight, knotted Piriformis muscle. The best way to break up any tightness and trigger points is by physically smashing and loosening up the muscle tissue.

Piriformis release can be done by a trained massage or physical therapist, or at home on yourself. Self-release is best done with a targeted deep tissue massage tool, but some have found success with a lacrosse or tennis ball.

Deep Tissue Massage Tool for Piriformis syndrome

2. Stretch: 

After breaking up any tightness, trigger points, and knots in the Piriformis it will be much more compliant to stretch. This is an important step because once the tightness is broken up, Piriformis will likely still be short.

To relieve the nerve pressure that is causing Piriformis Syndrome the muscle will have to be lengthened.

Upon effectively massaging and stretching the Piriformis muscle for a few days consecutively, pain relief should be felt. 

To improve Piriformis resilience after releasing the muscle, it would be beneficial to include glute and hip strength sessions into your week.

In addition, continued massage and stretching after exercise is a great long-term strategy to avoid Piriformis Syndrome in the future.

Sources:

[1] Davies, Clair, and Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. 3rd ed., New Harbinger Publications, Inc., 2013.

[2] Donnelly, Joseph M. Travell, Simons & Simons Myofascial Pain and Dysfunction: the Trigger Point Manual. 3rd ed., Wolters Kluwer Health, 2019.