It’s a Pain in Your Bottom
The Piriformis is one of the small muscles deep in the buttocks that rotates the leg outwards. It runs from the base of the spine and attaches to the thigh bone (femur) roughly where the outside crease in your bum is. The sciatic nerve runs very close to this muscle and sometimes even through it! If the muscle becomes tight it can put pressure on the sciatic nerve and cause pain which can radiate down the leg.
A common cause of Piriformis syndrome is having tight adductor muscles (inside your thigh). This means the abductors on the outside cannot work properly and so put more strain on the Piriformis.
Symptoms of piriformis syndrome:
Tenderness in the area of the muscle.
Pain in the buttocks.
Reduced range of motion of the hip joint.
What can you do to help combat piriformis syndrome?
Stretch the Piriformis muscle.
Strengthen the Piriformis muscle.
See a Physical Therapist professional who can advise on treatment, rehabilitation and prevention
What can a Physical Therapist do?
Apply specific sports massage techniques.
Stretch the Piriformis muscle using Muscle Energy Techniques.
Advise on strengthening and rehabilitation to avoid injury recurrence.
Rehabilitation (Piriformis syndrome)
The guidelines below are for information purposes only. We recommend seeking professional advice before starting any rehabilitation.
Aims of rehabilitation of Piriformis syndrome:
Improve flexibility and condition of the surrounding muscles through deep massage and stretching and strengthening.
Return to full fitness.
Ice (apply for 20 minutes)
Heat in the form of a hot bath or hot water bottle.
Rest from activities that produce pain. This is likely to include running.
Gentle stretching if pain allows.
Flexibility and conditioning
After the first two to three days a stretching and strengthening programme can begin.
It is important to stretch in conjunction with strengthening and massage.
Deep sports massage techniques can be used to release the tension in the Piriformis muscle. Massage can be applied on alternate days. At the very least two to three sessions at the start of rehabilitation is a good idea.
Muscle energy techniques are an excellent way of improving the stretch of the muscle.
On a daily basis perform Piriformis strengthening exercises immediately followed by stretching.
Hold stretches for 30 seconds and repeat 5 times.
In addition to the specific Piriformis stretches it is important to stretch the hamstrings, hip abductors and lower back.
Return to full fitness.
In most cases a return to jogging is possible within 5 days.
But this should be a gradual process combining running and walking.
It is essential that stretching and strengthening are continued throughout the rehabilitation process and beyond.
The following steps can be taken to avoid
Piriformis syndrome returning:
Stretch religiously before and after training.
If you have a break from training, keep doing the stretches as you may find things tighten up, especially if you sit for long periods.
Get a regular sports massage. A good therapist will spot potential problems before they happen.
Get a bio mechanical assessment. If you over pronate or have one leg longer than the other then this may make you more susceptible to injury.
Maintain regular hip and Piriformis strengthening exercises.
Make sure you have the right footwear for your activity and that they are not too old.
Finally when recovering from injury, do not do too much too soon.