Piriformis Syndrome: Symptoms, Causes & Rehabilitation Treatment

Piriformis SyndromeDo you have a pain in your left or right butt cheek? Does it feel like you have a trapped nerve in the bum? Maybe you have a sciatica pain going down your leg. Did you know you might be suffering with a bad case of piriformis syndrome? It really is a pain in the bum, excuse the pun.

There are various reasons for pain around the bum and hip region. The sciatic nerve can get trapped at the spine from a herniated disc or arthritis in the spine. The nerve could also get pinched in your buttocks by the piriformis muscle. Athletes like runners and cyclists are prone to this type of sports injury. Find out all about what is Piriformis Syndrome and what to do about it below.

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 muscle the syndrome is named after.

The piriformis muscle is just one of the many muscles found in the pelvis that help to stabilise and control the hip joint to the sacro-iliac (SI) joint connection.

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. The picture helps you see some of the important muscles in the back of the pelvis.

Causes of Piriformis Syndrome

The problem with this bum muscle is its very close relationship with the sciatic nerve.

We are all anatomically different in this area. In some people 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 some of the common and unusal 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 this patient in front of them has a mechanical source of pain: “Is it coming from the 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.

Trendelenburg TestAnother good test to do 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.

You can see the picture of a positive Trendelenburg sign versus normal. A positive Trendelenburg test is not a good thing.. It is not a specific test for the piriformis muscle, but can be a big reason why the muscle is being overloaded and not working properly.

Piriformis 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.

Stretching Exercises

Everyone who has this buttock pain 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 three ways to stretch the piriformis muscle tension out.

Knees to Opposite Shoulder Stretch

Start by laying on your back on the carpet or a yoga/pilates mat then bend your affected side’s leg at the knee and start stretching by bringing the knee to your chest. Now try take that same knee across your chest to the opposite shoulder. For instance, take the left knee to the right shoulder. You should feel a good muscle pull in the bum in the sore area.

Foam rolling

This is a very powerful way to give yourself a piriformis massage. A cheap, basic way is to get a piece of foam like a pool noodle the one’s you see kids playing with in a pool or those more professional foam rollers you may see in the yoga 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.

Figure Four Stretch

This is one of my all time personal favourite stretches. Not only for piriformis syndrome, but even for low back pain. Learn more about my favourite stretch and find out loads about the Figure Four stretch here. The beauty of this stretch technique is you can stretch the muscle by laying on your back, sitting or even standing up.