Piriformis Syndrome: Symptoms, Causes, Treatment & Prevention

Quite some time ago now I posted one of my favourite stretches for runners to ease the often painful symptoms of piriformis syndrome.

In the new video above, I discuss some of the main causes of piriformis syndrome in runners, as well as the importance of addressing the root of the injury, not just the symptoms!

What is Piriformis Syndrome?

Piriformis syndrome is a relatively common injury amongst runners, where the piriformis muscle, gets chronically tight and creates pain either locally to its position in the buttock region, or pain referring down the path of the sciatic nerve into the back of the thigh. This sciatic pain can also sometimes be felt lower in the leg and down into the foot.

There are a number of conditions that can cause pain in the piriformis region, such as lumbar disc herniations. This sometimes causes cases of piriformis syndrome to be initially misdiagnosed.

However, there are a set of typical characteristics that, if present, can help confirm piriformis syndrome as being the cause of your pain, or altered sensation such as numbness or ‘pains and needles’:

  1. Pain local to the buttock/piriformis region
  2. Specific tenderness between the sacrum and the top of the femur – the location of the piriformis muscle.
  3. Buttock and sciatica-like pain made worse with prolonged sitting
  4. Symptoms can be aggravated when the hip and leg is positioned to put tension on the piriformis muscle
Glute Activation & Hip Mobility Routine >>
Free Download [PDF]

Anatomy of Piriformis Syndrome

The piriformis muscle is positioned close to the hip joint, covered by the gluteal muscle group. It’s often described as a deep buttock muscle. Piriformis runs from the sacrum (base of spine) to the outside of the top of the femur (thigh bone).

Anatomically it’s role is to help rotate your leg outward when your hip is extended, and to rotate your leg inward and into abduction when your hip is in deep flexion flexed.

what-is-piriformis-syndrome

The sciatic nerve is a very thick nerve which originates from your lumbar spine and passes through your glute muscles, down the backs of your legs, all the way down to your toes.

When it comes to the path of the sciatic nerve, there’s a degree of anatomical variation amongst the population. The sciatic nerve passes directly beneath the piriformis muscle in most people, however, research has shown that for between 15%-20% of the population the nerve actually passes through the belly of the piriformis muscle.

What Causes Piriformis Syndrome?

The main cause of piriformis syndrome is sustained pressure between the sciatic nerve and piriformis muscle of the hip. This can occur for a number of reasons, including:

  • Spasm of the piriformis muscle, potentially due to irritation of the piriformis muscle itself, or a local structure such as the sacroiliac joint. Often this is one of the body’s protective mechanisms.
  • Tightness (and potentially hypertrophy) of the piriformis muscle, due to increased physical demands on the muscle over time

In the case of most runners I have worked with over the years, it has been the case that piriformis has become tight as a result of the increased demand on the muscle, due to weak glutes and core muscles.

The gluteal muscles and muscles of the core region should provide stability to the hip, pelvis and lumbar spine region as we run. However, runners with weak glutes and core muscles will sometimes find that piriformis will become tight in an effort to provide the stability at the hip that would otherwise be coming from the gluteal muscles.

From a running technique perspective, one of the common biomechanical clues that a runner is weak through their glutes and/or core is the classic “hip drop” or Trendelenburg sign.

If your hips drop from side-to-side as you run, and you suffer from piriformis syndrome, you will certainly need to work on glute medius strength and incorporate work for your oblique abdominal muscles into your rehab programme.

Glute Activation & Hip Mobility Routine >>
Free Download [PDF]

How Long Does it Take to Recover from Piriformis Syndrome?

Typically a mild case of piriformis syndrome can be successfully treated in 2-3 weeks, but more severe and irritable cases can take 6 weeks or longer.

Recovery from piriformis syndrome is rarely a linear process, so you can expect occasional flare-ups along the way. It is important to learn how to manage these instances using the piriformis syndrome exercises show below.

Many runners will, unfortunately, have had experience of piriformis syndrome hanging around for months, or even years. Often in such cases, the focus of the treatment they’ve experienced has been on on the symptoms, rather than the root cause.

Clearly, if you’re in pain it’s important for treatment to successfully ease your symptoms, but I can’t emphasise strongly enough the importance of identifying weaknesses in your glutes and core region that probably caused the problem in the first place.

Fail to address these factors, and the chances of you experiencing another bout of piriformis syndrome when you return to running will be higher. We don’t want that!

If your physio simply has you stretching, foam rolling, and “enjoying” regular hands-on treatment, be sure to ask them to give you some strengthening exercises to help you work on the weak links.

Can you run with piriformis syndrome?

Can you run with Piriformis Syndrome?

The good news is that runners who suffer from piriformis syndrome don’t always feel their symptoms when running. If running doesn’t seem to irritate your symptoms, you can continue to run with piriformis syndrome. In fact, if your symptoms allow you to run, you may find that the movement of running helps your pain to ease.

Be sure to always perform a thorough warm-up incorporating gentle hip mobility drills and glute activation exercises.

However… be careful if you try to run with piriformis syndrome, and listen to your body. If you feel your pain worsening during a run be sure to stop.

Piriformis Syndrome Exercises

There are a number of great piriformis syndrome exercises you can perform at home, both to help ease the symptoms and to fix the weak links that cause the injury in the first place. These piriformis syndrome rehab exercises fall into four categoires:

  1. Soft Tissue Treatment
  2. Hip Mobility Exercises
  3. Glute Activation & Hip Stability Exercises
  4. Neural Mobility Exercises

Soft Tissue Treatment for Piriformis Syndrome

Here’s an example of a simple foam roller technique you can use to release the piriformis muscle and get relief from your piriformis syndrome symptoms.

Hip Mobility Exercises for Piriformis Syndrome

Below are two examples of simple hip mobility exercises you can use to stretch the piriformis muscle and get relief from your piriformis symptoms.

Glute Activation & Hip Stability Exercises for Piriformis Syndrome

It is important to work on glute activation and hip stability as part of your piriformis syndrome rehab plan. Below are two exercises to get you started.

Neural Mobility Exercises for Piriformis Syndrome

The neural slump exercise is a great drill you can use to improve neural mobility. Be gentle with this one, especially if your piriformis syndrome symptoms are quite easily aggravated.

With all of the piriformis rehab exercises listed above; if you are unsure, please consult your physio.

Glute Activation & Hip Mobility Routine >>
Free Download [PDF]

How to Heal Piriformis Syndrome Quickly

It’s important to be proactive in your recovery from piriformis syndrome, and catch the warning signs early, before it becomes a chronic injury. If you are able to begin treatment as soon as you notice the buttock pain of piriformis syndrome, you should be able to recover quickly.

Lifestyle factors cannot be overlooked, as making small changes to your lifestlye can certainly make for a quicker recovery from piriformis syndrome. If, as is common for piriformis syndrome sufferers, you know that prolonged periods of sitting will tigger your symptoms, it is important to find ways to avoid this habit. Easier said than done, I appreciate.

Avoid sitting in seats which put you in deep hip flexion (hips below knees), as sitting in this position for prolonger periods may cause aggravation of your symptoms. Bucket seats in cars can be a problem, for example.

Employing some pattern recognition to figure out what activities and positions seem to cause aggravate your piriformis syndomre, and some lateral thinking to find alternative options, you can learn to manage your symptoms very effectively and speed-up your progress on the road to full recovery from piriformis syndrome.

Good luck!

Read Next >>
How to Engage Your Glutes Before Running
Last updated on July 3rd, 2019.
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10 Comments

  1. Thanks James! I’ve had this for some time now on and off. Yep did the stretches which relieved it, and yep it came back again. Many thanks for your great explanation, and advice. Hopefully I’ll see the end of this irritating pain in the butt.

  2. Thanks James totally agree with Suzanne, inspired to be more diligent on the exercises and hopefully improve running form to sort properly. Do you do any specific courses for the ageing runner…..50+

  3. Thanks so much for the info. I work in as a physio in Canada with a faiy high sports referral. I’ve used your tips and exercises in addition to my own repertoire. I am currently training for my first marathon with high hopes!!!

  4. This is very well explained, as usual. Thank you! When I started running, PS was such a worry as I didn’t know what it was and thought I’d damaged my hip. It was a relief to find it’s a nerve thing, like a tooth-ache. I keep a tennis ball by my bed and lie on it for a few minutes whenever the problem starts to annoy me, as well as stretching and strengthening exercises. I recommend also Brett Blankner’s Youtube PS video, especially ‘neural flossing’.

  5. I have really tight hip flexors. Do you have a video on stretching them?
    Thanks! Just subscribed, Love all the videos I have watched so far!

  6. I had a very severe bout this summer. What made it more difficult to tackle was that the worst pain wasn’t in the buttock but in that sciatica type of cramping pain radiating down my leg all the way down to the inner side of lower leg. Naturally I ran from orthopaedist to physio and back again but to no avail, they only concentrated on the lower leg suggesting stress fractures (although I tried to explain the type of pain and the location made no sense). Finally an osteopath started to unravel the mess by working on realigning of my pelvis and correcting the position of the affected leg, while acupuncture relieved the tension of the piriformis and the pain eased off. Stretching the glutes is now part of my maintenance routine I simply cannot miss!

  7. Hi James

    Been really suffering with this in 2016.in fact did a 3.6 mile race this weekend and was a gut wrenching 2 minute slower than the same race in 2014 and 2015. Been rollering doing your stretches and others and it still is painful especially when driving. Was seeing a sport therapist which didnt help and seeing an acupuncturist this week( although not convinced on that one) any suggestions welcome

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