Piriformis Syndrome: A Pain in the Butt

Piriformis Syndrome is literally a pain in the butt. It causes pain in the buttock area and may include pain or tingling in the back of the thigh and calf. The piriformis muscle is one of your hip rotator muscles and is located deep in the buttock area. It is adjacent to the sciatic nerve where the nerve exits from the pelvis on its way down the leg. In some people, the sciatic nerve actually runs right through the piriformis muscle. Piriformis syndrome may result from blunt trauma to the buttock region (such as falling on your bottom), or from overuse of the piriformis muscle in activities such as running. Factors that may contribute to overuse of the piriformis include tightness of the hip adductor muscles and weakness of the hip abductor muscles, especially gluteus medius. Excessive foot pronation may also overwork the piriformis as it works to limit internal rotation of the leg every time your foot hits the ground.

You can initially treat piriformis syndrome by refraining from activities that aggravate symptoms. Start an exercise routine that includes stretching of your hip adductor muscles and piriformis muscle; and exercises that strengthen your hip abductor muscles, especially the gluteus medius. A physical therapist or personal trainer can assist you if you need help with exercises that target all of these areas. When you no longer feel any symptoms with your daily activities, you can gradually return to your usual workout and sports activities.

Pain in the buttock region and back of the leg can come from other sources. The sacroiliac joint can generate pain in the buttock area, and lumbar spine pathology, such as arthritis or disc problems can cause pain in the buttock and leg. If you have persistent symptoms in these areas, your doctor and/or physical therapist may need to examine you to determine the source of your symptoms. Additional treatment in physical therapy for persistent piriformis syndrome may involve deep tissue work and stretching of the piriformis, or special techniques for releasing tension or spasm of the piriformis. Physical therapists also look for muscle imbalances and prescribe specific exercises accordingly.

David Kandel, PT, OCS, CSCS

PVHMC Physical Therapist

909-865-9810