Piriformis Syndrome: Symptoms, Causes & Rehabilitation Treatment

Piriformis Syndrome

Maybe you have a pain in your left or right bum cheek, maybe you have a sciatica pain going down your leg, did you know it could be a problem called piriformis syndrome.

Your sciatic nerve can get trapped at the spine from a herniated disc or maybe arthritic changes in the spine. The nerve could also get pinched in your buttocks by the piriformis muscle. Runners and cyclists are prone to this injury which is a real pain in the bum, excuse the pun. Today I want to go over this condition causing a trapped nerve in the bum which could be the source of your sciatica pain.

Symptoms of Piriformis Syndrome

Here are some of the common things I have heard people say to describe painful piriformis syndrome symptoms:

  • The pain feels like it is in the space between the top of my hamstring muscle and the bottom of my bum,
  • When I sit I get a deep ache feeling in my bum cheek that goes into the side or back of my thigh,
  • It feels sore to sit for too long,
  • There wasn’t any reason this pain started, but it has been getting progressively worse,
  • It feels sore when I move from sitting to standing,
  • It can ache in my bum when resting at night,
  • I like walking, but the pain in my leg get too sore eventually and I need to rest.

Do some of these descriptions above sound familiar to you? These are just a few ways to describe pain and discomfort coming from a pinched sciatic nerve in the piriformis muscle.

Anatomy of the Piriformis Muscle

Piriformis Muscle AnatomyYou think you may have a slipped disc causing your buttock or leg pain, you may also think you have a muscle strain, but don’t know why. First thing to know is “what is the piriformis muscle?” After all this is why the condition is called piriformis syndrome.

The piriformis muscle is just one of the many muscles found in the pelvis that help join the hip joint to the sacro-iliac joint in our pelvic structure.

The muscle is attached from the inside of the pelvis, on the bone called the sacrum, and runs through the same space as the sciatic nerve called the greater sciatic foramen.

The muscle then inserts into the hip bone of the leg on the anatomical land mark called the greater trochanter. it is probably easier to look at the picture to see where is this hip and SI joint stabilising muscle.

Causes of Piriformis Syndrome

The problem with this bum muscle is its relationship with the sciatic nerve that runs down the leg.

We are all anatomically different because the sciatic nerve can run above, through or below the piriformis muscle. This means you get structural differences between people.

When this buttock muscle tightens up it can squeeze the sciatic nerve causing sciatica symptoms down the back of the thigh into the leg.

Here are the reasons why a piriformis muscle might tighten up:

  • Poor muscle control causing compensation with exercise,
  • Sitting for too long on an office chair or bicycle saddle that puts pressure on the muscle,
  • Muscle strain injury from running or jogging that doesn’t recover properly,
  • I had one patient with Parkinson’s causing shuffle gait (walk) straining the muscle,
  • Direct blow to the muscle from a slip or a fall,
  • Wallet sciatica from sitting on your wallet too much.

How to Test For Piriformis Syndrome

When your doctor or chiropractor is examining you for the first time they will be testing different structures to look for the source of the pain. They will be asking themselves if they are looking for a mechanical source of pain is it bone, muscle, nerve or a combination.

They may rule out a trapped nerve coming from your spine by checking your knee or Achilles reflexes and muscle strength. They may do some nerve tension tests like a straight leg raise or a slump test to check the pressure on the sciatic nerve. They will examine your hip movement looking for restriction in movement. You will be sensitive to pressure over the piriformis muscle which may radiate sciatica pain into the leg as well. Another good test is the Trendelenburg sign.

The Trendelenburg sign is an orthopaedic test for when your muscles in your hip area are weak and cause you to drop a hip when standing on one leg. See the picture of a positive Trendelenburg sign below. This is not specific for the piriformis muscle, but can be a big reason the muscle is being overloaded.

Trendelenburg TestPiriformis Syndrome Treatment Options

There are some treatments you can do on yourself for piriformis syndrome pain. These include some piriformis syndrome exercises and piriformis stretches.

Muscle Strengthening Exercises

When the piriformis muscle is sore it tends to be tight and weak. So piriformis syndrome exercises are apart of the treatment program.

Some exercises for the piriformis muscle are:

  • Bum Squeezes – Start off with this exercise. Laying on your back in bed try contract each bum muscle individually. So left then right keeping the other relaxed completely. You can do this standing or even sitting in a chair.
  • Bridge – this is when you would lift your pelvis up in the air laying on your back. You would then try lift one foot off the ground so all the pressure would go through one bum cheek. Try hold you pelvis still without letting it fall to the floor for 3 seconds. Repeat on the other side. Try do this till fatigue, which is when you notice you can’t hold you pelvis up in the air.
  • Standing Hip Extension – Whilst standing contract one bum muscle and pull your straight leg backwards from the hip not the lower back. Key thing here is movement must come from the hip not from arching your lower back to extend your hip.

Piriformis Stretch Techniques

Everyone who has piriformis syndrome loves stretching it out. Remember with muscle stretching to not push to pain, try hold for 30 sec at a time and breath when you’re in the stretch.

Here are some ways to stretch the piriformis muscle tension out.

  1. Figure Four Stretch: This is one of my all time personal favourite stretches not only for piriformis syndrome but even for low back pain. You can see more about the Figure Four stretch here. The figure of four piriformis muscle stretch can be done laying on your back, sitting or even standing.
  2. Knees to Opposite Shoulder Stretch: Laying on your back bend your affected leg side at the knee bringing the knee to your chest. Then try take that knee across to the opposite shoulder. For instance take the left knee to the right shoulder direction. You should feel a good muscle pull in the bum in the sore area.
  3. Foam rolling: This is a very powerful way to give yourself a piriformis syndrome massage. You need a piece of foam like they one’s you see kids playing with in a pool or those blue ones you may see in the studio or stretch area at a gym. Then you would place the foam on the floor, lay on your back with the foam roll perpendicular to your body and your sore buttocks area on the foam. You would then put as much body weight as you feel comfortable on the foam and begin rolling on the foam roll back and forth. I have included a video for you to see how to use a foam roller for a piriformis syndrome. Again this will be an intense muscle massage if you put your full body weight on it so be careful.