Piriformis Syndrome: A Pain in the Butt
Piriformis Syndrome is literally a pain in the butt. It causes pain in
the buttock area and may include pain or tingling in the back of the thigh
and calf. The piriformis muscle is one of your hip rotator muscles and
is located deep in the buttock area. It is adjacent to the sciatic nerve
where the nerve exits from the pelvis on its way down the leg. In some
people, the sciatic nerve actually runs right through the piriformis muscle.
Piriformis syndrome may result from blunt trauma to the buttock region
(such as falling on your bottom), or from overuse of the piriformis muscle
in activities such as running. Factors that may contribute to overuse
of the piriformis include tightness of the hip adductor muscles and weakness
of the hip abductor muscles, especially gluteus medius. Excessive foot
pronation may also overwork the piriformis as it works to limit internal
rotation of the leg every time your foot hits the ground.
You can initially treat piriformis syndrome by refraining from activities
that aggravate symptoms. Start an exercise routine that includes stretching
of your hip adductor muscles and piriformis muscle; and exercises that
strengthen your hip abductor muscles, especially the gluteus medius. A
physical therapist or personal trainer can assist you if you need help
with exercises that target all of these areas. When you no longer feel
any symptoms with your daily activities, you can gradually return to your
usual workout and sports activities.
Pain in the buttock region and back of the leg can come from other sources.
The sacroiliac joint can generate pain in the buttock area, and lumbar
spine pathology, such as arthritis or disc problems can cause pain in
the buttock and leg. If you have persistent symptoms in these areas, your
doctor and/or physical therapist may need to examine you to determine
the source of your symptoms. Additional treatment in physical therapy
for persistent piriformis syndrome may involve deep tissue work and stretching
of the piriformis, or special techniques for releasing tension or spasm
of the piriformis. Physical therapists also look for muscle imbalances
and prescribe specific exercises accordingly.
David Kandel, PT, OCS, CSCS
PVHMC Physical Therapist