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5 Tips for treating Piriformis pain

Your piriformis muscle is located deep inside your buttock. It runs from the underside of your sacrum and attaches to the side of your hip (greater trochanter on the femur). Your sciatic nerve can run over, under or through the piriformis muscle. This means that whenever the piriformis goes into spasm, it can also affect your sciatic nerve that runs down the back of your leg.


Image adapted from original by BodyParts3D/Anatomography at https://commons.wikimedia.org/wiki/File:Piriformis_large.gif

In this article:

  • The Piriformis muscle is very seldom the main cause

  • 5 Tips for treating piriformis pain

Here's the livestream video that I did about this in the Sports Injury Group



The Piriformis muscle is very seldom the main cause


Not many things are as painful as a piriformis muscle that is in spasm and I think that this is why it is so often (wrongly) seen as the main cause for people’s buttock pain. True piriformis syndrome is quite rare. When you have piriformis syndrome, the piriformis muscle compresses the sciatic nerve and causes sciatica type pain down your leg. It can feel like a crampy achy pain in your buttock and also gives your pain down the back of your leg. You don’t have piriformis syndrome just because your piriformis muscle is tight and/or sore.



It is much more common to find that the piriformis muscle is irritated by an injury nearby e.g. the lower back, sacroiliac joint, top of the hamstrings, bursitis or glute med tendinopathy. If you want to get rid of your buttock pain, you have to address the true cause of your pain, not just hammer the poor piriformis muscle. A physiotherapist can help you establish your cause by listening to how you describe your symptoms and getting you to do a few simple test movements.



5 Tips for treating piriformis pain


1. Diagnose

First of all, make sure that you understand why your piriformis is angry with life – a physio can help you with this. You have to address the cause (back, SIJ, hamstring etc.) in order for it to calm down and to prevent it from coming back in the future.


2. Stretches

GENTLE piriformis and glute stretches held for long periods can be useful to decrease the muscle tension and pain. The piriformis muscle is very easily irritated and you can make your pain worse by pulling too hard. I demonstrate one of my favourite ones in the video.


3. Massage

Massage and self-massage with a lacrosse ball can be useful. But again, be careful not to irritate the muscle. Remember, you sciatic nerve runs through it and you can easily make things worse by pressing too hard. You should apply firm pressure that is comfortably uncomfortable. You should not feel any pain or tingling down your leg during or after the massage. I find that doing it standing up against a wall can work well if it is very sensitive – see the video for a demo of this.


4. Strength training

General buttock strength training can also be useful. I find that exercises like the clam can often make it feel worse during the initial stages. The glute bridge seems to be a better option for my patients and I often get them to do a spine curl into the position to help mobilise their lower backs at the same time. The glute bridge is a great exercise that strengthens most of the muscles in the buttock including the piriformis, glute max and glute med.


5. Be careful with hamstring stretches

Be careful of doing hamstring stretches, because your sciatic nerve may take strain if the piriformis is still in spasm and holding on to it. When you take your leg into the hamstring stretch position, your sciatic nerve is meant to slide. But if the piriformis is holding on to it, the nerve will stretch rather than slide and that can make your pain worse. I only get my patients to stretch their hamstrings once I'm happy that the sciatic nerve can slide.


Let me know if you have any questions. You're also welcome to consult me online via video call for an assessment of your injury and a bespoke treatment plan.

Best wishes

Maryke


About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.



References:

  1. Franklyn-Miller, A., et al. (2009). "The gluteal triangle: a clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes." British Journal of Sports Medicine 43(6): 460-466.

  2. McCrory, P. (2001). "The “piriformis syndrome”—myth or reality?" British Journal of Sports Medicine 35(4): 209-210.

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