Pain in the Butt: Dealing with Piriformis Syndrome

About a year ago, I started feeling pain in my right hip during my runs. It appeared, seemingly, out of nowhere after an interval workout. The pain was intense, and felt worse during long stretches of sitting. During a visit with my PT, I was informed that this was most likely piriformis syndrome, and given a list of exercises to perform to strengthen my hips. I had never heard of piriformis syndrome before and had no idea what a pain in the ass this small muscle was going to cause.

What exactly is your piriformis, and why is it so important? The piriformis muscle is a tiny muscle located beneath the glutes that is responsible for external rotation of the leg, as well as stability of the hip during running and standing. The sciatic nerve also runs directly behind the belly of the piriformis muscle, and as the muscle becomes irritated and inflamed, it can rub on the sciatic nerve which causes pain. There is also a small portion of the population where the sciatic nerve actually runs through the belly of the muscle, which can predispose those individuals to piriformis syndrome.

The causes of this injury are generally due to the overuse of the muscle, which is common during long distance running, or from sitting on hard surfaces, which is common in many of us who spend a large portion of our days sitting in front of a screen. The way this pain presents itself can vary from a sharp shooting pain down the back of the leg (commonly referred to as sciatica), pain in the hamstring, or a pain in the hip or butt when sitting. Common symptoms of piriformis injury are a pain after sitting, standing or lying for extended periods of time, pain that improves with movement, and pain that can radiate from the low back through the glutes and down to the knee. This injury can often be misdiagnosed due to the location of the pain and its proximity to the low back and the sciatic nerve, as well as the variability and severity of symptoms from one person to the next.

So you were diagnosed with piriformis syndrome, now what do you do? How to treat and prevent this injury from recurring in the future is dependent on a correct diagnosis as well as working with someone who is experienced in treating piriformis injury. A good rule for preventing piriformis syndrome is to make sure your hips are strong, which includes plenty of exercises that incorporate adduction and abduction, as well as glute strength. The Myrtyl routine is a great, quick set of exercises that targets the hips. If you’re looking for a more in-depth resource, Kim Nedeau, is a wealth of knowledge on this topic. She has detailed videos on her YouTube channel and website, as well as instructions for exercises specific to strengthening the piriformis muscle in addition to the other important hip muscles. There are also many stretches that can help target the piriformis muscle, such as the figure-4 stretch and pigeon. I think it’s important to strengthen that muscle, but also to stretch and encourage that muscle to relax and lengthen after you’ve spent time aggravating it. Foam rolling can also be a useful tool, and my favorite torture device is my Orb ball from Pro-Tec Athletics, which is about the size of a softball and perfect at really digging in deep to the muscle.

Injuries are often boring and incredibly unglamorous. Day after day I’m doing the same tedious exercises that will make that piriformis muscle stronger. As someone who tends to get bored easily, they certainly aren’t my favorite things to do, but I know that the result is a body that is strong and can withstand higher mileage and a lifetime of running. An injury is our bodies’ way of telling us that something isn’t working properly, a warning sign to address the pain. Listen to your body and take note of those pains and niggles that are more than just soreness from a hard run or increased mileage. If I can leave you with one piece of advice, it would be to strengthen your hips, regardless of whether you think you need to or not. Those muscles in your hips and glutes are what power your stride, and even if you already have strong hips, think of these exercises as preventative maintenance. Here’s to many happy, and hip pain-free, miles ahead!

Sources:

The Journal of American Osteopathic Association