Piriformis syndrome is a painful condition of the buttocks, though the pain can also extend down through the legs. It’s an uncommon neuromuscular disorder caused by compression of the sciatic nerve or weakness of the piriformis tendon. The piriformis muscle is located in the buttocks. Much of your lower body movement depends on this muscle because it stabilizes the hips and is highly involved in thigh motion — helping to maintain balance as we walk. Because of this piriformis syndrome can be highly debilitating if left untreated.
People with piriformis syndrome often feel pain, numbness or tingling in the buttocks. Sometimes, the pain can be severe along the length of the leg following the injured line of gluteal fascia. You may notice pain while sitting, going up and down stairs, or running.
The condition comprises about 5% of cases of low back, buttock, and leg pain.
It is mainly caused by overuse and childhood jumping/landing injuries to the piriformis tendon, which can cause myofascial radiating pain.
Diagnosing Piriformis Syndrome
There is no official way of diagnosing piriformis syndrome aside from symptoms of pain and a history of trauma to the buttocks. We’ll put you through a physical exam that uses many of the muscles central to this condition. To rule out other causes of sciatic nerve compression, we’ll also do radiologic tests such as MRIs. These conditions can feel very similar to piriformis syndrome.
Treatment of Piriformis Syndrome
Try to avoid positions or certain activities that trigger the pain. Rest and heat can do wonders. Work with a physical therapist to develop exercises and stretches that help balance the gluteal muscles for the weakness in the tendon.
PRP therapy or trigger point injection therapy can help restore tissue integrity, alleviate the spasms, and provide relief. Growth factors in the PRP can help heal the afflicted tendon. Stem cell therapy can provide additional “healing power.”
Massage therapy can provide significant relief to the symptoms of piriformis syndrome. Massage can relax the piriformis and other gluteal muscles, reduce pressure on the sciatic nerve, and prevent spasms. It also releases pain fighting endorphins, which act as natural pain killers against the pain of piriformis syndrome.
Self Massage & Stretching for Piriformis Syndrome
You can also do self massage by using a foam roll, similar to a pool noodle. Sit on the foam roll, crossing your ankle over your knee. Lean towards the affected side and stretch until things feel tight but not too tight. Hold for 30 seconds. Do the opposite side. Continue to stretch both sides as you ease relaxation to the muscles.
You can also do self massage using a massage ball. Start in a seated position with your knees bent. Locate the ball under a buttock. Cross the opposite leg over top of the other leg. Stretch for over 30 seconds. Be careful to not overdo it. If you feel extreme pain, stop.
Another approach is to stretch the piriformis muscle by placing your bent leg over top a table. Lean forward to stretch the buttock. Hold for 30 seconds. Do two sets, alternating between legs.
Another approach is to stretch your hips by lying on your back and crossing one foot over the opposite knee. With the opposite hand, pull your knee towards your shoulder. Hold for 20 to 30 seconds. Repeat each side 2 to 3 times, alternating each time.
The piriformis cross-leg stretch can also be very helpful. Lie on your back with your feet flat on the floor. Raise your knees towards the ceiling. Next, bring your right leg towards your body with your right ankle resting on your left knee. Finally, pull your left knee towards you and gently stretch out the buttock muscles. Switch legs and do the opposite side.
The hamstring chair stretch is also a great way to stretch out the piriformis muscle. This stretch is perfect to do at home or in an office. Place two chairs facing each other a little far apart. Sit on one chair, placing the heel of your right leg on the other chair. Lean forward, bending your hips, until you feel a gentle stretch along your thigh. Hold for 30 seconds. Switch legs. Repeat 2 to 3 times.
Easy Does It
Again, with stretching we want to stress the importance of not over doing it. If it hurts too much, stop. The idea is to ease your muscles into the stretch so you are flexing the muscles without causing overdo strain.
And it is always easier to stretch after massaging out the kinks with the rubber ball techniques described in “Winners’ Guide to Pain Relief.”