What is Piriformis Syndrome and how to fix it

What is Piriformis Syndrome and how to fix it

Piriformis Syndrome can be a common cause of buttock and low back pain in runners and other athletes. The pain from Piriformis Syndrome can sometimes mimic sciatic or a herniated disc, but the treatment can be completely different.

What is Piriformis Syndrome?

Piriformis Syndrome is irritation of the sciatic nerve by the piriformis muscle in the buttocks. In most people, the sciatic nerve runs over the piriformis muscle. But in some people, the sciatic nerve actually runs thru the middle of the piriformis muscle. In these people, if the piriformis muscle develops spasm or a trigger point, the muscle can contract and irritate the sciatic nerve.

piriformis muscle

When the piriformis muscle irritates the sciatic nerve, it causes pain in the low back and buttock that is called Piriformis Syndrome.

What are the symptoms of Piriformis Syndrome?

Piriformis Syndrome usually causes pain on one side on the buttocks and leg. The pain is usually intermittent and comes and goes, although in some people, the pain can be constant.

The pain with Piriformis Syndrome usually starts in the buttock and radiating down the back of the thigh to the knee.

How Piriformis Syndrome is different from Sciatica?

Piriformis Syndrome can sometimes be misdiagnosed as sciatic or a herniated disc in the lower spine. However, there are usually some key differences between Piriformis Syndrome and sciatica.

Pain from Piriformis Syndrome will usually radiate from the buttocks down the back of the thigh and stop at the back of the knee. In sciatica, depending on which disc is involved, the pain will usually radiate all the way down the leg into the foot.

Sciatica can also cause numbness in the leg and weakness of the leg muscles. Leg muscle weakness is less common in piriformis syndrome.

Pain from a herniated disc is usually worse when the doctor performs a Straight Leg Test by flexing the hip and keeping the leg straight. This movement stretches the sciatic nerve.

Piriformis pain is usually worse with the FAIR test, 1 which is flexion, adduction and internal rotation of the hip. Putting the leg in this position stretches the piriformis and can increase the irritation of the sciatic nerve at the level of the piriformis.

Can something else be causing my buttock pain?

The pain from an inflammed piriformis muscle is localized just to the buttock, it can also be confused with a proximal hamstring strain, high hamstring tendinopathy or gluteal muscle tendonitis.

Stretching Exercises for the piriformis

Stretching the piriformis muscle can help with Piriformis Syndrome symptoms. To stretch the piriformis, you have to internally rotate the hip by either crossing the leg across the body and by flexing the hip.

You can do piriformis stretches either sitting down or laying on your back.

best stretches for Piriformis syndrome for runners
Piriformis stretch

You can also do a prone piriformis stretch where you lay face down with the hip externally rotated and the knee flexed to the side and then press the leg down into the floor.

Prone Piriformis Stretch

Read more on our article about our favorite piriformis stretches.

Strengthening Exercises for the Piriformis

Strengthening exercises for the piriformis have also been found effective for treating Piriformis Syndrome. 2 Once your piriformis pain is better, you can start strengthening exercises for the piriformis.

Clam Shell Exercises

Clam shell exercises can be effective for strengthening the piriformis since the clam shell motion focuses on internal and external rotation of the hip with the hip flexed.

Glute Bridging Exercises

Strengthening the gluteal muscles can also help prevent piriformis pain from recurring. The Glute Bridge will teach you how to correctly fire and contract the glutes as well as the smaller buttock muscles like the piriformis.

single leg glute bridge exercise
Single Leg Glute Bridging exercise for the buttocks

Find out more about the best piriformis strengthening exercises.

Foam Rolling for Piriformis Syndrome

Foam rolling can help release and relax trigger points in the piriformis muscle, although it can be hard to find the find position and spot to foam roll.

How to use a foam roller for the piriformis

If foam rolling makes the symptoms worse, STOP and get evaluated by a sports medicine specialist.

Trigger Point Release for Piriformis Syndrome

If you are having difficulty getting the piriformis muscle to release with the foam roller, you can try using a massage ball instead. The smaller surface area of the massage ball allows a more specific and accurate location for trigger point release.

How to use a massage ball for the piriformis

Again, if foam rolling or the massage ball makes your symptoms worse, STOP and get evaluated by a sports medicine specialist.

Where to buy foam rollers and massage balls

Use our Amazon affiliate links below (at no added cost to you) to buy a foam roller or trigger point massage ball.

Find out more about preventing running injuries!

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Research
  1. https://www.ncbi.nlm.nih.gov/pubmed/11887107[]
  2. https://www.jospt.org/doi/full/10.2519/jospt.2010.3108[]

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