Why Your Piriformis is Literally a Pain in the Butt

Painful hips made in 3d software
People often say, it’s the little things in life that

make the biggest impact.  I say, it’s the smallest

parts of your body that cause the biggest problem.


The piriformis is a small muscle deep in your hip,

and it has give me trouble for years.  It runs

diagonally across your buttock from your pelvis

to your thigh bone.  It acts up when I decide I’m

going to start running, have a baby, or just sit too

much. And it might be giving you trouble too and

you don’t even know it.


Why is it such a problem for so many?


Although small and seemingly insignificant it is

located next to a thick nerve.  The infamous sciatic

nerve runs from the base of your spine down the

back of your leg.  We have individuals walk into our

clinic every week reporting (often self diagnosed)

sciatica as the cause of their back and leg pain.


You can feel your piriformis right in the middle of

your buttock muscle.  Pressing deep into the tissue,

people often report local pain, or even pain that

radiates down their leg.  It is a common muscle to

experience trigger points and muscle spasms. . .

literally a pain in the butt!


Piriformis muscle injury, called piriformis syndrome

can occur due to a trauma like a car accident or fall.

However, more commonly, we do not see a true

piriformis syndrome but an irritation due to repetitive

everyday activities or athletic activities.


Symptoms of piriformis syndrome include:

  • Pain, tightness, or tingling in your low back
  • Discomfort extends down the back of the leg
  • buttock pain and tightness
  • Weakness in the legs
  • Pain that is worse with prolonged sitting


Piriformis involvement is often overlooked because

it mimics other diagnoses including low back injury,

arthritis, degeneration, disc herniation, or even hip



The most common cause is weak buttock muscles

due to excessive sitting.  Additionally, poor sitting

posture can cause the piriformis to be overworked

and spasm.


The differentiation between piriformis involvement

and other back conditions are typically increased

pain after sitting 15-20 minutes and with crossing

your legs in sitting.


Unfortunately, rest or repositioning doesn’t usually

fix this problem. Treatment by a healthcare

professional is the best way to quickly and

permanently solve the problem.  The treatment

should include stretching of the piriformis muscle

and strengthening of surrounding muscles.


Manual therapy is often necessary for problems

with body alignment.  Misalignment of bones in the

lower body such as flat feet or knock knees can

contribute to the irritation.  Additionally,

misalignment of the pelvis can cause a pull or

tightness to the muscle.  Realigning the low back

and pelvic bones are critical to pain relief and

preventing recurrence.


I don’t have all bad news though.  Piriformis irritation

may largely be preventable.  Those at increased risk

should consider these preventable measures.


This is especially true for athletes who perform

forward moving activities like running or cycling.  It’s

important that these athletes  engage in lateral

stretching and strengthening to prevent muscle

imbalances that lead to pain and injury.


Prevention of piriformis injury or irritation:

  • Get aligned – not running on slants, pick the

flattest part of the road.

  • Strengthening – particularly your buttock and

hip muscles.

  • Good sitting posture – head, shoulders and hips

aligned, feet flat and weight evenly distributed.

  • Stand up – don’t sit for long periods of time

without getting up and walking around a bit.

  • Use proper lifting techniques – bending at the

knees and not the back or hips.

  • Stretch – your hip rotators and foam rolling

across the buttocks.

  • For the Men – don’t sit with your wallet in your

back pocket.


So, if you are someone who runs, bikes, or sits (I guess

that covers all of you), you are at risk for developing

pain and tightness in your piriformis muscle.  Start

with some daily stretching you can do at your desk

throughout the day.  See our Facebook page this week

for some example stretching videos.


If you have more severe pain that may be from your

piriformis, or you want to sort out what exactly is

causing your back pain, give us a call this week.


Our physical therapists are available to discuss with

you the causes of your pain and treatment options

available to you. . . NO OBLIGATION!

Request a call HERE today!