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EPISODE 42: Understanding Piriformis Syndrome - Prevention & Treatment

Updated: Apr 1

Piriformis pain

Do you have pain in your butt? Like this nagging, sharp pain when you sit down, stand up, walk, or run? Pain in the gluteal muscles can be awful and debilitating. It can stop you from performing your daily activities and also limit your sports participation and performance. We want you to have some clarity on what that nagging pain in your butt is and the BEST methods to treat & fix it. If you are ready to put that pain in your backside behind you, look no further! In this blog we are breaking down everything you need to know about Piriformis Syndrome.

To fully understand Piriformis Syndrome, we need to review the anatomy:


Piriformis muscle

  1. Piriformis muscle- you have both a right and left piriformis muscle, one for each hip. This muscle is flat and narrow, spanning from your pelvis to the top of the femur. The piriformis m. lies deep below the layers of the glutes, closer to the hip socket. It is unique with many actions. It can move the leg sideways (abduction) and aid in the rotation of the hip; depending on the orientation of the leg, it can be either an external or an internal rotator.

  2. Sciatic nerve is a collection of nerves that leave the spine and travel down the back of the leg. The sciatic nerve is very important for this injury because its path takes it directly underneath the piriformis muscle.

Now that we understand more about the structures, let's dig deeper into all the details of Piriformis Syndrome.

First, we need to start by discussing the most common causes & symptoms of this condition.

Next, it is very important to clarify how to get a diagnosis of Piriformis Syndrome and rule out Sciatica.

Lastly, we will review the best options for treatment and prevention. We love this part because this is our specialty as physical therapists!

Piriformis Syndrome occurs when the sciatic nerve is compressed by the Piriformis muscle resulting in inflammation. This may occur due to injury, swelling, muscle spasm, or scar tissue at the site of the piriformis.

There are several scenarios that may cause inflammation to this region:

  1. A lack of strength in the Piriformis muscle when performing high repetition or distance for walking, running, cycling and climbing stairs. Any athlete that participates in a sport that challenges hip rotation can be at risk.

  2. Lifting heavy loads without proper form

  3. Not participating in warmup before exercise

  4. Overuse for performing repetitive motions like long distance running or cycling

  5. Sitting for long periods of time for work or school

  6. Occasionally, an abnormal anatomy of the sciatic nerve or the piriformis can contribute to predisposition.

If you suspect you are dealing with Piriformis Syndrome, symptoms to look for include:

  • Aching or burning Pain

  • Numbness/tingling deep in the gluteal area, back of the hip or upper thigh. This is said to feel a lot like sciatica, but piriformis syndrome is more localized.

  • Sitting for prolonged periods

  • Hip stiffness in the glute region

  • Loss of motion to stretch.

Diagnosis of piriformis syndrome involves a physical examination by your healthcare provider which will check joint range of motion, muscle flexibility, and palpation of the area. Examination of surrounding body parts will help rule out other diagnosis, for example: Sciatica. Tests such as ultrasound, CT scan, MRI, or EMG may be ordered to assist in confirmation.

A correct diagnosis is very important because this will ensure you can get the proper care to heal as quickly as possible. Piriformis Syndrome and Sciatica have some similarities but we need to understand the differences between the two conditions.

Pain in the sciatic nerve aka Sciatica can result from either a Herniated Disc or Spinal Stenosis. Both start in the lower back but can also radiate throughout the back of the hip and thigh.

There are some key differences that set Sciatica apart from Piriformis Syndrome:

With Sciatica:

-pain location starts higher in the lower back.

-pain/numbness can radiate down to the foot based on the area of the spine involved

-symptoms can affect both legs at the same time if the spine is affected centrally

Piriformis Syndrome is always on just one side.

When you are confident that you have isolated, you are dealing with a true Piriformis Syndrome, it's time to get the healing process started. We see this condition regularly in our center and we have great success treating it. It does takes commitment to the treatment plan because you may have to make some changes in your lifestyle to and modify the way you are moving. In the end, the results are worth it as you become pain free and a stronger athlete as a result.

Let's go though some things we do in physical therapy to treat Piriformis Syndrome.

Treatment Options

  1. Rest and Activity Modification: incorporate rest periods and avoid painful activities.

  2. Medication that may target pain, inflammation, or muscle tone may be needed.

  3. Physical Therapy aimed at improving length and strength of the Piriformis m. is the main course of treatment.

    1. Manual therapy: improve muscle quality and length, mobilize joints for greater range of motion

    2. Strength training: strengthen the hip and any surrounding areas contributing to poor movement mechanics

    3. Mobility and flexibility exercises: Home Exercise Program geared at maintaining a functional ROM of the joint and length of the muscle

    4. Balance drills: challenge the stability of the limb for proper postural alignment and reactivity

    5. Movement Re-education: facilitate of correct muscle timing and break down movements to learn to use the body as a unit and reduce the chances for overuse

    6. Return to Sport Guidance: guide each athlete to progress at a safe volume and intensity to resume their sport without aggravation of their symptoms to ensure full healing of the condition

  4. Surgery is not typical but may involve removal of scar tissue or other sources of pressure on the sciatic nerve

Even more than helping people heal, we love to prevent injuries :)

You can prevent the occurrence of Piriformis Syndrome by using this checklist:

-Properly warmup before exercise, this included mobility and activation drills for the hip

-Avoid sitting for long periods of time

-Practicing good posture and work on maintaining correct alignment during sitting, standing and your sport will reduce the stress to the Piriformis muscle

-Cross train. Keep a variety in your training routine to prevent overuse of specific muscles.

If you are struggling with pain in the posterior hip region, don't wait- get it checked out! We are always happy to help with both treatment or strength and conditioning so you can make the necessary changes to your routine or training. So many activities and sports challenge the Piriformis muscle. Let's beat this thing and don't let it keep you sidelined. Reach out because we would love to help you! We work with clients on-site and virtually through Telehealth.

Click here if you are interested in booking a session or getting more information! 

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All the best,

The PTSP Docs

Dr. Bay, Dr. Brown, Dr. Yana

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