Condition Overview: Piriformis Syndrome
Don’t underestimate the piriformis. It may be small but it can cause a firestorm of pain in runners, especially when running higher mileage.
The piriformis is a muscle located in the buttock. It originates at the outer edge of the lower sacrum and inserts on the upper aspect of the femur or thigh bone. When standing straight up, the muscle externally rotates the hip. When the hip is flexed to 90 degrees, the muscles functions as an internal rotator and abductor.
Presentation
Pain in the buttock or down the back of the leg that is made worse by prolonged periods of sitting, walking and/or running is the most common presentation of piriformis syndrome. It isn’t uncommon to experience a combination of numbness, tingling, weakness or pain with this condition. Low back, knee and foot pain are also possible symptoms.
Other common conditions that can mimic this condition include lumbar and sacroiliac joint dysfunction, lumbar disc herniations and spinal stenosis. Since these symptoms are not specific to piriformis, it’s necessary to seek a health care professional to make a proper diagnosis, not Google or WebMD.
Cause of Piriformis Syndrome
While the cause isn’t completely agreed upon, the widely accepted theory is that piriformis syndrome is a result of a tight piriformis causing compression and/or irritation of the sciatic nerve which passes directly underneath the piriformis.
In 15% of the population, the piriformis is actually comprised of two muscle bellies with the sciatic nerve piercing directly between them. People with this anatomical make-up are thought to be more prone to this syndrome.
Treatment of Piriformis Syndrome
Options for this condition vary based upon provider. Most chiropractors will focus on enhancing joint function throughout the lumbopelvic joints as well as the hip. They will most likely incorporate some sort of manual therapies like cross friction massage and trigger point therapy.
I prefer using Active Release Technique®(A.R.T.). I find it to be more efficient and effective. Most patients will report a noticeable difference within a couple of treatments. There’s a reason why A.R.T. is the official treatment technique for all of the Ironman events.
Graston Technique®, neural flossing, massage therapy, kinesiology taping, therapeutic ultrasound and electric muscle stimulation are other available options. Rarely is an injection or surgery necessary. I recommend avoiding rolling on a lacrosse ball or foam roller in this area due to possibility of further compression of the sciatic nerve.
Prevention
It’s important to focus on stretching and strengthening exercises to enhance recovery and prevent recurrence. I like the seated piriformis stretch. It’s also important to focus on abductor and adductor strengthening as well as strengthening the glutes. Sick of hearing that yet?
Avoid sitting for extended periods of time. This is difficult to do in our culture. Most people work desk jobs and need to sit all day. Take minibreaks throughout the day. Stand up and walk around every hour. This will help keep the piriformis loose. Standing desks can help but just like sitting, you can stand with poor posture.
This is a condition that responds well to conservative care which should always be the first option. If you are having similar symptoms, be sure to seek a health care professional for a proper examination to rule out more serious conditions. The goal is to keep you running, not cooped up inside because of a tight butt.
Does any of this sound familiar? If you think you might be suffering from this condition, let us know and we’ll get you connected with someone who can take a look at it.
