Piriformis syndrome

The piriformis is a small muscle located deep in the buttocks. If the muscle spasms or becomes tight, it can press on your sciatic nerve, causing pain, numbness and tingling in your buttocks and leg. This condition is known as piriformis syndrome.

In this guide, we look at the causes, symptoms and treatment options, that can help relieve your pain.

Pierre Schydlowsky Specialist MD in rheumatology


Content:
What is Piriformis Syndrome?
The Symptoms of Piriformis Syndrome
Causes of Piriformis Syndrome
Treatment For Piriformis Syndrome
Exercises For Piriformis Syndrome
Other Treatment Options for Piriformis Syndrome
Begin Your Journey Toward a Pain-Free Life!

Are you feeling a dull ache in your buttocks? Is it accompanied by numbness or tingling down one leg? In this article, we explore a condition called piriformis syndrome. We’ll dive into the symptoms, causes, and how the proper exercises can help speed up your recovery.

Looking for a solution to piriformis syndrome? Try the Injurymap exercise app now.

The piriformis is a small muscle located deep in the buttocks. It attaches at the lower part of the spine and extends in a triangle-like shape toward the femur, the bone that makes up your upper thigh. This small muscle plays a significant role in stabilizing your hip joint, as well as rotating your thigh outward. In other words, it’s activated in most instances where you are using your hips or legs.

While it may be just a tiny muscle, it can cause severe pain and tingling through the buttocks and down the legs when it spasms. If you suffer from these symptoms, you may be experiencing a condition called piriformis syndrome.

What is Piriformis Syndrome?

Piriformis syndrome is characterized as a neuromuscular disorder that produces sciatica. This means that when the piriformis muscle spasms or becomes tight, it presses on the sciatic nerve, the longest nerve in the human body that runs through the buttocks region and down the legs. In turn, this produces pain, numbness, and tingling in these areas.

Piriformis syndrome accounts for about 0.3 to 6% of sciatica or low back pain cases. Roughly, this comes out to about 2.4 million cases per year.

The Symptoms of Piriformis Syndrome

What should you watch out for when it comes to piriformis syndrome? How do you know if you have it or not?

A diagnosis from a physiotherapist or doctor is often required to determine if you have piriformis syndrome or not. You can try our symptoms checker to see if you should see a doctor.

Common symptoms
  • Pain, numbness, or tingling in the buttocks.
  • Pain, numbness, or tingling that spreads down the legs.
  • A dull-like ache deep in the buttocks.
  • Pain in the buttocks after prolonged sitting.
  • Pain in the buttocks when climbing stairs.
  • Pain when applying firm pressure to the buttocks area.
  • Decreased range of motion in the hip.
  • Issues getting out of bed.

If you are experiencing these symptoms, it is very likely you have piriformis syndrome. However, if you are only experiencing symptoms involving numbness, tingling, or pain running down the legs, this may mean you have sciatica, irritation of the sciatica nerve, due to another cause. It may be best to consult with a sports doctor or physiotherapist if this is the case.

Try our symptom checker now

Causes of Piriformis Syndrome

Generally, this condition is caused by the close proximity of the piriformis muscle to the sciatic nerve. Yet, under normal conditions, this close arrangement works perfectly fine. It isn’t usually until the piriformis comes under distress that this becomes problematic.

The piriformis can become irritated or aggravated by direct trauma. For example, sports injuries, such as a hit to the buttocks, sprains, strains, or scar formations, may result in a spastic piriformis.

It’s also been thought that sedentary behaviour may contribute to a tight piriformis, again, leading to spasms or a compressed sciatic nerve. For instance, if you spend the majority of your day working from a desk, you may be at a higher risk of developing this syndrome.

Other causes of piriformis syndrome may include:
  • Hip trauma.
  • An increase in size of the piriformis muscle due to training or intense weight lifting.
  • Separation of the piriformis muscle.
  • Abnormalities of the sciatic nerve.
  • Overuse of the piriformis muscle, such as excessive running or use of the hip.

How can you tell the difference between piriformis syndrome and other hip conditions?

The tell-tale signs of piriformis syndrome include pain in the buttocks accompanied by neural pain, such as numbness and tingling, down the legs. Other hip conditions, such as arthritis, may have more pain upon moving the hip in most directions. For arthritis, there may also be stiffness throughout the hip joint. If it is merely a pulled muscle, this will likely also appear as a more sore and stiff pain.

With piriformis syndrome, you will not have pain on the outer or front side of the hip. In the case of piriformis syndrome, pain is further isolated to the buttocks region and down the legs. These tips should help you differentiate between piriformis syndrome and other conditions. It may also help you to understand what is causing your pain in the first place by reviewing the causes above.

How Long Does it Take for Piriformis Syndrome to Heal?

Typically, piriformis syndrome does not require treatment. Usually, rest will suffice. Within a few weeks to six weeks and with the proper care, you should not longer be experiencing pain caused by a spastic piriformis.

Can You Recover Completely From Piriformis Syndrome?

You can absolutely make a full recovery from piriformis syndrome. Rest is sufficient in most cases, but if you find the pain returns, we suggest checking out your treatment options below. For some, exercises, medications, and heat or ice therapy may be necessary to make a full and complete recovery.

Treatment For Piriformis Syndrome

You’ve determined you likely have piriformis syndrome - now what? You’ve tried resting, but it doesn’t seem to help too much. Or perhaps the pain has returned a second or third time. What else can you do?

Exercise is an excellent way to help your body heal and recover. It can help soothe a spastic muscle, such as the piriformis. It can also help strengthen often weak areas, which can aid in future pain prevention. Exercise further helps increase blood flow and increases your body’s natural healing mechanisms.

The body is very capable of healing itself, and movement can often help the healing process along. Usually, it comes down to performing the right movements as per your condition, injury, or pain.

Whenever you are performing any exercise, it is also important to listen to your body. If you ever feel an increase in pain, you should immediately ease off of the exercise. This may mean releasing a stretch to the point before pain or only performing a strengthening movement to the point before pain. Always go slow with any new exercise and ensure you are performing it correctly.

Now, what exercises can help relieve your piriformis pain? Let’s take a look!

Exercises For Piriformis Syndrome

The three exercises below offer a few ways you can help yourself when it comes to alleviating the symptoms associated with piriformis syndrome. For the two stretches, hold each for 20-30 seconds. This will maximize the benefits of the stretch. Aim to perform the stretches 2-3 times on each leg on a daily basis. The strengthening exercise can be performed for 8-12 repetitions. Listen to your body and determine an amount that is right for you. Aim to complete a specific number of repetitions for 2-3 sets on every other day.

Exercises

  1. The Lying Glute Stretch

    While this exercise says ‘glute,’ it also gets right into that small piriformis muscle.

    Lying glute stretch
    30 sec. x 3 sets

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    • Lie on your back and grab your knee with the hand on the same side.
    • Use the other hand to slowly pull your lower leg and knee towards the opposite shoulder.
    • Make sure your knee is bent at a 90-degree angle.
    • Repeat the exercise with both legs.
    • Keep the stretch for 30 seconds with both the left and right leg.
    • Perform 3 sets.
  2. The Lying Hamstring Stretch

    Tight hamstrings, the muscles located on the back of your thighs, can create a variety of problems when it comes to the posterior side of your body. When the hamstrings become tight, other muscles, such as the piriformis, may start to compensate for it. In other words, it can produce a pain reaction, resulting in an aggravated piriformis, back or hip pain, and sciatic pain

    Lying hamstring stretch
    30 sec. x 3 sets

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    • Lie on your back and place a towel over the toes of one of your feet.
    • Stretch the leg until it is fully extended.
    • Grabbing the towel on either end, use your arms to pull the towel towards you, so that your foot is pulled towards the opposite shoulder.
    • Hold the stretch for 30 seconds and perform 3 repetitions with each leg.
  3. Strengthening for Your Glutes & Hips

    Strengthening the piriformis, glutes, and areas around the hips can help prevent future pain or from piriformis syndrome from returning. By performing this exercise, you work the piriformis, other external rotator muscles, and internal rotator muscles of the hipn

    Strengthening for the glutes/hips I
    10 reps x 3 sets

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    • Lie on the side with your legs bent and your feet on top of each other.
    • Place the upper arm on the hip so that you avoid rotating backwards in the hip during the exercise.
    • Tighten the muscular corset.
    • Lift the upper knee off the lower knee.
    • Keep your feet together and the pelvis in the same position.
    • Perform 3 sets of 10 repetitions with each leg.

Other Treatment Options for Piriformis Syndrome

If the pain is severe, it may benefit you to seek out the advice of your physician or a rehab exercise expert, such as a sports doctor. The following may apply if you are experiencing higher levels of pain. Some of these treatments may also help you cope with the pain, especially early on.

Ice and Heat Therapy

The preference of ice or heat may depend on you and what you prefer. Ice can help numb the pain. When applying an ice pack to the painful area, ensure you place a cloth between your skin and the ice pack. Apply the ice for a maximum of 20 minutes with 45 minutes in between each application.

Heat, on the other hand, can help relax tight muscles. Similar to applying an ice pack, ensure you have a cloth or towel in between your skin and the heat pack. Again, only apply the heat pack for up to 20 minutes with at least 45 minutes in between each application. These two types of therapies can help you cope with the pain until it begins to subside. You may also benefit from alternating between heat and ice.

Medications

Most times, the piriformis or surrounding tissues, as well as the sciatic nerve, are inflamed. If necessary, over-the-counter NSAIDs, such as ibuprofen, may help alleviate your inflammation, pain, and associated symptoms.

Occasionally, and often when other treatments fail to work, an injection may be recommended. Corticosteroid injections are common and help reduce muscle spasm and pain. A botox injection to the area may also relieve your symptoms by relaxing the muscle, which then decompresses the sciatic nerve.

Electrotherapy

TENS, transcutaneous electric nerve stimulation, may be used to help block pain signals. It does this by replacing these signals with a tingling sensation. Small electrode pads are placed on the skin attached to wires. These wires are attached to a small device which sends electricity through the wires to the pads. The placement of the pads for piriformis syndrome are illustrated in the picture below. This type of therapy may also help reduce muscle spasms. Usually, you can purchase these devices online or they are available as part of your physiotherapy or sports therapy treatment.

Surgery

In very rare cases, surgery may be performed. This is only done if a severe injury is present that won’t heal properly on its own. It may also be done if there are any abnormalities present causing the condition, such as a split piriformis muscle.

Begin Your Journey Toward a Pain-Free Life!

Understanding your pain is the first step toward solving it. Through this article, we hope we gained a greater understanding of the piriformis, piriformis syndrome, and the potential ways to treat this condition.

If you want more in terms of at-home exercises you can perform to say goodbye to your piriformis pain for good, check out the Injurymap app. This app offers customized training and rehab programs to help you gain back control in your life. It’s like having your own personal sports therapist in your pocket. Get started today and find out how you can start your journey toward a better and pain-free life.

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About the author

Pierre Schydlowsky is a specialist MD and Ph.D. of rheumatology with a diploma in sports medicine. He has published multiple research papers on shoulder and ski injuries and is teaching various advanced courses in sports medicine at Danish Universities.

References:

  • http://www.jmedsoc.org/article.asp?issn=0972-4958;year=2013;volume=27;issue=2;spage=94;epage=99;aulast=Singh

  • https://www.spine-health.com/conditions/sciatica/symptoms-and-diagnosis-piriformis-syndrome

  • https://www.ncbi.nlm.nih.gov/books/NBK448172/

  • https://www.injurymap.com/exercises/EMGTsjhYSgNU