It may be there when you first wake up, after a run, or it can even haunt you as you are sitting at your desk. And whether it is called sciatica or piriformis syndrome, it can literally be a pain in the butt. Piriformis syndrome is a condition in which a small muscle (piriformis) in your posterior hip irritates the long sciatic nerve that runs down your posterior leg. The sciatic nerve commonly runs under your piriformis, but if you're one of the lucky few (approx 17% of the population) it can also run directly through it which has thought to increased your odds of developing this condition. It can cause a variety of symptoms ranging from a simple annoyance or pain in the butt or posterior hip, to pain, numbness, or tingling down the back of your leg.

What causes it?

There can be a variety of reasons that the piriformis muscle can decide to tighten up on you. Commonly in non-athletic populations it occurs as a direct injury to the lower back or tailbone, causing the piriformis to tighten up in response to the injury as it tries to brace and protect your back from further damage. In athletes or those that workout regularly it can be from weakness in their gluteus muscles of the posterior hip, or from faulty mechanics while lifting, running, or working out. Externally rotated hips for extended periods of time can also lead to piriformis syndrome and allow for a shortening of this muscle to occur. If you tend to walk or run with your toes turned outward, this can indicate a possible source of the problem. Misalignment of the bones of the pelvis may also be involved.

To properly diagnosis piriformis syndrome is not the difficult part, but finding out the cause behind it can be. And to treat it without knowing the cause is likely to assure that this pain in your butt is not going anywhere anytime soon. This is why it is important to see your physical therapist so we can evaluate you and find the culprit as soon as possible.

What to do about it?

Fixing piriformis syndrome on your own can be challenging if you do not know the exact cause. I can tell you how to "plug the leak" for now, but if you don't know why the piriformis muscle is squeezing the life out of the sciatic nerve, then it will come back. The most basic way to decrease the tension of a tight muscle is to stretch it. You can do this by laying on your back with your feet flat on the ground, place one ankle on the opposite knee, and pull the thigh with the foot still on the floor to your chest (see picture). A deep pressure to the muscle can also help to release the tension in it. We sometimes will do this manually, almost like a deep tissue massage directly to the piriformis, or we advise our patients to sit on a tennis ball to perform a self massage. However, to do this effectively you will need some guidance on exactly where the piriformis is, or you could actually inflame it. Our clinics also use trigger point dry needling to help decrease the tension on the piriformis and other muscles that may be contributing to your symptoms. But when you come to Synergy Manual Physical Therapy we will likely find the cause and address the specific issues that are causing this in the first place. Sometimes it can be as simple as doing some simple stretching and exercises to improve glute activation which will decrease the need for the piriformis to fire during your runs or workouts.

As you read, there can be a ton of reasons for this pain in your butt and even more ways of how to correct it. This is why a little guidance from a musculoskeletal expert such as a physical therapist can help you get to the cause quickly and set you on the right track to making a full recovery without all the guess work you may be doing on your own. If you have any questions or want to know more, stop by one of our 2 physical therapy clinics in the Colorado Springs area today!

- Synergy Physical Therapy Team

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112