Getting Rid of that Pain in the Butt: Piriformis Syndrome

Experienced frequently by runners and athletes, piriformis syndrome is a condition that has to do with pain in the buttock region due to spasms in the piriformis muscle. It is a neuromuscular disorder that oftentimes extends down and irritates the nearby sciatic nerve, causing pain, and numbness and tingling along the back of the leg and foot. Though the condition can vary in the severity of discomfort experienced by the patient, piriformis syndrome is more often viewed as an irritating and cumbersome condition than as a serious debilitating injury. While many who experience it find the recovery process lengthy and frustrating, understanding the condition itself and its causes and prevention strategies can help those who experience it to understand the process of recovery better and why it is important to stay consistent with treatment.

In order to deal with piriformis syndrome, it is imperative that we gain a clear understanding of where the symptoms originate and of the piriformis muscle itself. The piriformis is a small, flat, band-like muscle and is located deep in the buttock, underneath the larger gluteus maximus. The piriformis serves the function of rotating at the hip and turning the leg and foot outward. It runs diagonally with the sciatic nerve running vertically adjacent to it. However, the location of the piriformis relative to the sciatic nerve is varied person to person, with the nerve running beneath, above or through the muscle (around 10% of the population) in different people. Thus, some people may experience piriformis syndrome and never experience any pain!

The specific causes of piriformis syndrome are as of yet unknown, exactly, but researchers and doctors can say with some certainty that causes most likely originate from irritation of the hip or muscle itself or tightening or swelling of the muscle in response to injury or spasms. Spasms in a muscle may occur when it is overused, and in the case of piriformis syndrome can result in pressure on the sciatic nerve, causing radiating pain down the back of the legs and foot. Besides sciatica-like symptoms, other symptoms include aching in the buttock, pain when walking up stairs, reduced range of motion at the hip joint or increased pain after sitting for lengthy periods of time. Since piriformis syndrome is usually caused by sports or activities that require repeated stress on the piriformis, such as running, lunging, or squatting, this condition presents in many runners and athletes.

Diagnosing piriformis syndrome is difficult and often misdiagnosed as there is no simple test to determine the condition. Instead, piriformis syndrome is based on an in-depth review of the patient’s medical history, symptoms, and a physical examination. The options are further narrowed down by eliminating other serious conditions such as a disc herniation. After eliminating these conditions, examining the patient’s range of motion of the hip and legs can reveal if there is any sensitive pain in the lower back or legs which may further point to piriformis syndrome.

The good news is, almost every approach to treating piriformis syndrome can be done without invasive surgery. Most treatment paths focus on progressively stretching the piriformis muscle and fixing imbalances in the hip that may have worsened due to increased dependence on one leg or the other. Due to the nature and location of the piriformis, patients can find it difficult to relieve tightness in the correct muscle when stretching. This is where getting professional help from a qualified therapist may become helpful and they will most likely demonstrate appropriate piriformis stretches as well as hamstring, groin, lower back, and hip abductor stretches. In addition to stretching, a qualified professional might introduce deep massage techniques to increase blood flow to the affected area, decreasing risk of muscle spasms. Since most flares of pain in piriformis syndrome arise due to inflammation, patients may also be recommended to take anti-inflammatory medications such as ibuprofen while they continue their treatment. More extreme treatments include electrotherapy or injection of anesthetic, but most cases can be resolved with a consistent routine of stretching.

Once symptoms subside, you may need to implement changes in your lifestyle or activities to avoid developing the condition again. These are the same changes that can prevent development of piriformis syndrome in the first place. First, it is suggested that you exercise regularly and include an adequate warm-up prior to intensive activity. If you are lifting weights or any other heavy object around the house, lift it by bending your knees and squatting to pick it up rather than bending over. On the way up remember to keep your back straight and hold the object close to your body while avoiding any twisting of your body while lifting. Maintaining proper posture when you are sitting (or standing) is also important in keeping a healthy body. Lastly, avoid sitting down or lying on your buttocks for long periods of time without stretching. In today’s sedentary world where we sit at offices, dinner tables, or at school for most of our days, it is especially important to keep this last tip in mind.

Although physical therapists make schedules and specifically tailored programs readily available, treatment of piriformis syndrome is largely in the hands of the patient. It is up to the patient to keep up with their daily recommended routines, and to determine the level of stretching that is comfortable to them. Although it is generally not suggested that the patient take rest from all physical activity, as inactivity may actually make symptoms worse, it is up to the patient to find the fine line between keeping the muscle active and exacerbating the condition. As those who have experienced it might tell you, treating piriformis syndrome can be a long and frustrating road but with the right amount of care and consistency getting rid of that pain in the butt should be a walk in the park.


Richard Yoon


This is an informational article and is not a substitute to the opinion and guidance of a medical professional. If you feel that you may have piriformis syndrome, we suggest you visit a board-certified physician specialist to help you discuss your options.

Richard Yoon