Being injured is a pain in the butt, right? In the case of Piriformis Syndrome, we’re talking both metaphorically and literally. But what is Piriformis Syndrome?
Piriformis Syndrome has been described in medical literature for over seventy years, yet it remains controversial. There are on-going debates as to whether it is over-diagnosed, or under-diagnosed.
But here’s what we do know about this common running injury.
The symptoms Piriformis Syndrome include pain in the buttock region, tightness or loss of movement, tingling or pins and needles, and weakness or numbness. These symptoms can sometimes radiate into the lower back and down the backs of your legs, as far as the toes.
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What is Piriformis Syndrome?
There is no universally agreed upon criteria for Piriformis Syndrome, but most people consider it when pain is caused by compression of the sciatic nerve by the piriformis muscle.
The piriformis is a small, relatively short muscle buried deep within the glutes, one of only two muscles that join the spine to the legs. It runs from the sacrum (base of spine) to the outside of your hip. Its job 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 flexed.
The sciatic nerve is a very thick nerve which originates from your lower back and goes through your glute muscles, down the backs of your legs, all the way to your toes. The sciatic nerve passes directly under the piriformis muscle in most people, however, research has shown that for between 15%-20% of the population the nerve actually passes through the piriformis.
For more on the causes of Piriformis Syndrome, you should checkout this article/video:
Piriformis Syndrome: What Runners Need to Know <- Learn more about the real causes of Piriformis Syndrome in runners
What can we do about Piriformis Syndrome?
Although there is limited conclusive research, most treatment methods target what is thought to be the causative factor: a problematic piriformis muscle, through stretching and strengthening.
Other popular methods to address the symptoms include massage, foam rolling and a few lifestyle changes: less sitting, more standing.
If you are able to still run, try avoiding aggravating workouts such as speed sessions and dedicated hill repeats.
Our recommendation: Befriend your local therapist if symptoms persist. Remember, other conditions (like herniated discs or other low back/pelvis issues) can cause similar symptoms. So when in doubt, ask your doc!
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References / Further Reading
- Posttraumatic piriformis syndrome: Diagnosis and results of operative treatment
- The clinical features of the piriformis syndrome: a systematic review
- Rehab recommendations for piriformis syndrome
- Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report
Re ‘job’ of piriformis, the article states that the job of the piriformis “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 flexed.” I’m confused as I thought it helped prevent your leg from rotating inward (i.e. prevented the knee from collapsing inward) when flexed. Also, abduction is away from the midline so this seems contradictory. Can you please explain? Thx.
Hi Kerry, This is something people get confused about frequently. Piriformis is an external rotator of the hip up to a certain point (~90 deg) of hip flexion, where due to the anatomical lever arm around the hip joint, the deeper angle of flexion then makes piriformis an internal rotator. This is why exercises such as a Figure 4 Stretch target piriformis thtough deep hip flexion + external rotation = piriformis stretch.
What can I do to sort this problem apart from stretches? I’ve suffered with this all lady year without realising till recently
Hi, I have this at the moment and am also suffering with a tough Achilles which I never had before the piriformis syndrome.. do u these are related? Thanks Joanne
Chiropractic care can really help in addition to stretching.