Piriformis syndrome – it’s a real pain in the butt

When it comes to causing trouble the tiny piriformis muscle certainly punches above its weight. While estimates vary, around 6% of pain that feels like classic sciatica is probably due to piriformis syndrome. If you’re experiencing a shooting or numbing pain that runs from your lower back or buttock down your leg and possibly into your foot, an irritated piriformis may be the cause.

Physiotherapy is key in diagnosing and treating piriformis syndrome. Your physiotherapist can work with you to relieve the pain and correct postural and other biomechanical issues that can irritate your piriformis or lead to a muscle imbalance. They can also teach you a series of stretching and strengthening exercises to reduce the risk of the piriformis syndrome reoccurring.

Meet the piriformis muscle

As this video clearly shows, the piriformis is a small muscle located deep in your buttock. It is a rotator muscle that lets you turn your legs and feet away from your body. Your piriformis and your sciatic nerve both pass through a small opening in the pelvic bone called the sciatic notch. In some of us the sciatic nerve actually passes through the piriformis itself. This close proximity can be problematic.

What causes piriformis syndrome?

Irritation caused by overuse and imbalance is the most frequent cause of piriformis syndrome. If you’re wondering how you can sustain an overuse injury in a tiny, deeply embedded buttock muscle here are some common contributing factors:

• Spinal misalignment through hip and back injuries or surgery
• Biomechanical issues including differing leg lengths, and foot problems such as overpronation or Morton’s neuroma
• Weakness or imbalance in your hip joints or in the muscles that stabilise your hips
• Prolonged periods of sitting particularly if you add the impact of fat wallet syndrome . This is caused by carrying your wallet in your back pocket adjacent to your piriformis and sciatic nerve.
• Unusual development or placement of the piriformis or the sciatic nerve
• Prolonged intense athletic training or sudden high intensity exercise
• Sciatic nerve irritation cause by sharing a small space with a tight or swollen piriformis

While men may be more prone to fat wallet syndrome, for reasons that are not currently understood, piriformis syndrome affects far more women at a ratio of around 6 to 1.

What are the symptoms of piriformis syndrome?

Typically, piriformis syndrome feels like sciatica. When you consult your physiotherapist or your doctor, they will perform a full clinical assessment to determine and the cause of your pain. This may include MRI or other scans to identify or eliminate issues originating from your spinal discs or lower back or sacroiliac joint or hips.

An accurate diagnosis is the first step in treating the causes of your discomfort and relieving the symptoms.

Common symptoms of piriformis syndrome include:

• Buttock pain – you sit lopsided to avoid putting pressure on the affected muscle
• Spasms or shooting pains – that start in the buttock but run down your leg and sometimes to your foot
• A turned out foot caused a shortened piriformis muscle
• Sitting or walking or running very often aggravates the pain.

Piriformis syndrome treatments

Physical therapy, stretching and exercise are key treatments for piriformis syndrome. Our comprehensive care pathway includes a thorough assessment of the biomechanical health of your back, hips and pelvis and your Brisbane Spine Clinic physio will work with you to establish the source of your pain. Then they will tailor a treatment and recovery to suit your needs.

Piriformis treatments may include:

• Dry needling and massage to help relieve pain and muscle spasms and increase blood flow to reduce inflammation and aid healing
• Joint mobilisation to restore mobility and function in your sacroiliac joints
• Stretching to improve strength and flexibility in your piriformis and hip abductors and support deep core and spinal stability
• Exercises to help restore alignment in your feet and lower legs which may also be supported by wearing orthotics prescribed by a podiatrist.

Your physio will teach you a series of stretches you can do at home. This video illustrates three common piriformis stretches.
Protecting your piriformis and reducing injury risks

Although there is no known way to prevent piriformis syndrome, early diagnosis and treatment can often relieve pain after several days and address the causes over several weeks.

Doing some or all of the following things may reduce your risk of developing piriformis syndrome or having it reoccur:

• Following your physiotherapist’s stretching regime
• Avoiding sitting for long periods
• Not carrying your wallet in your back pocket
• Wearing orthotics to correct gait issues
• Booking a spine special consult to identify and treat other source of back pain and sciatica

“Piriformis syndrome can be easily mistaken for sciatica from nerve compression. We have seen many occasions where this has been incorrectly diagnosed and patients received inappropriate treatment that didn’t target the true cause. Our experience allows us to help identify the true cause of sciatica.” – Kelvin Choi – Physiotherapist and Accredited Exercise Physiologist of The Brisbane Spine Clinic

Most cases of piriformis syndrome respond well to physiotherapy and at home stretching. If you’re experiencing this particularly annoying ‘pain in the butt’, book an appointment.