The piriformis is a muscle in your buttocks, right behind the hip joint, running from your lower back to the outer hip bone. Piriformis syndrome is caused when the muscle and its tendon are too tight and pinch, rub, or tether against the sciatic nerve, causing pain and irritation to the nerve. It also leads to a decrease in blood flow to the area. There are no specific tests that can be done to accurately diagnose the syndrome, which leads to many misdiagnoses. Piriformis syndrome and its symptoms are typically confused with and diagnosed as sciatica.
Causes of Piriformis Syndrome
Because the piriformis muscle is long and connects to your hip bone, it is greatly affected by running, which can result in repetitive motion injury (RMI). RMI occurs when a muscle is asked to perform beyond its level of capability, not given enough time to recover, and then asked to perform again. The overuse of this muscle, most often found in runners, can lead to muscle spasms, irritation of the piriformis muscle, or irritation of the hip joint. It can also lead to further tightening, swelling, or bleeding of the muscle in response to injury or spasm. All of these issues can worsen and cause piriformis syndrome.
As previously mentioned, symptoms of piriformis syndrome mimic those of sciatica: pain behind the hip and in the buttocks, pain traveling down your legs, numbness in your legs, and tenderness of the piriformis muscle which usually causes pain when sitting.
Here are some tips for preventing piriformis syndrome:
- Avoid running on uneven surfaces. Try to find flat surfaces rather than running on hills. However, remember that is it important to vary your terrain in order to avoid further back pain.
- Warm up and stretch properly before working out. Don’t go from zero to sixty too quickly. Increase your intensity level over time.
- Try to maintain good posture while working out, especially while running. If you are having trouble maintaining good posture, try using ActivAided to help train your back into the correct posture.
- If you do begin to feel pain, stop and take a break immediately. If that pain does not subside, call your doctor.
There are no known guaranteed cures for piriformis syndrome. There are, however, many accepted and useful forms of treatment. If you think you may have piriformis syndrome, you should contact your doctor to see if they have any advice specific to you and your medical history. Rest is also a key factor in treating the syndrome. Try avoiding activities that exacerbate RMI or pain for at least a few weeks or until the pain begins to subside. Some doctors recommend deep tissue massages to help relieve pain; however, these types of massages are vigorous and may cause more muscle swelling. Physical therapy is also a helpful form of treatment. Your physical therapist will focus on stretching and strengthening your hip muscles. Watch this video for some tips and techniques.
Your doctor may recommend anti-inflammatory medications or cortisone injections, both of which are used to decrease the inflammation and swelling around the piriformis muscle. In rare cases, a surgery called a piriformis release can be done to loosen the piriformis so it will no longer rub against the sciatic nerve. However, this is usually only recommended after six months of unsuccessful treatments.
Piriformis syndrome is a pain in the butt, literally. It is most commonly caused by overuse of the piriformis muscle. However this does not mean you should stop activity all together. Seek the help of a physical therapist or a doctor to help you get back on the right active track.