The Piriformis: A Tiny Muscle That Can Cause Annoying Problems

May 24, 2020

by Cathe Friedrich

When we strength train, we focus on the big muscles that show, like our glutes, quads, hamstrings, chest, and muscles in our back that make us look firm in a tank top. We tend to neglect the smaller muscles that we can’t see. One of those muscles is called the piriformis muscle and it can cause problems for people who are physically active. In fact, it can be a cause of recurrent pain in some people.

What is the Piriformis Muscle?

Although you think of your glutes as being the gluteus maximus, gluteus medius, and gluteus minimus, there’s another deep muscle underneath your glutes that connects the base of your spine to your thigh bone. Shaped like a band, this small muscle is close to the hip joint where it helps keep the hip joint stable. Along with the glutes, it helps us take each step when we walk. Every time you rotate your thigh away from your body, you use this muscle.

The problem with the piriformis muscle is it runs close to the sciatic nerve, one of the longest nerves in the body. The sciatic nerve travels from the base of the lumbar spine, through the buttocks, and into the lower legs. You may have heard of sciatica, a condition that causes numbness, tingling, and pain in the buttocks and lower extremity. Sciatica is caused by something pressing on or irritating the sciatica nerve. One of the most common causes of sciatic nerve compression is a herniated disc.

If you’ve injured your lower back or buttocks in the past or have scoliosis, your risk of developing piriformis syndrome is greater. Another anatomical problem that predisposes to it is having legs that differ significantly in length. Some people have an unequal leg length and don’t know it. Sitting too much and too much intense exercise also raises the risk. Long-distance runners and sprinters may have problems with piriformis syndrome. Another recognized factor, strangely enough, is carrying a wallet or other firm object in your back pocket since this creates uneven pressure on the lower back and spine.

The Problem of Piriformis Syndrome

As much as you need your piriformis for hip stability, it can also cause discomfort. The path the sciatic nerve takes as it travels to the lower extremity is a factor in whether your piriformis muscle causes pain or other problems. In almost a quarter of the population, the sciatic nerve penetrates the piriformis muscle, and that’s a little too close for comfort. People who have a sciatic nerve that follow this path are at higher risk of developing piriformis syndrome, a condition where the sciatic nerve and muscle become inflamed and painful.

If you’re prone to piriformis syndrome, all it takes is a little trauma to the buttocks from overuse or from an injury to cause a piriformis flare-up. Some people even develop it when they sit on a hard surface too long. For example, taking a long road trip where you sit for several hours can bring on a flareup, so can running or climbing stairs. A common sign of piriformis syndrome is pain that radiates down one leg to but not below the knee. Some people also experience numbness and tingling along the path of the sciatic nerve.

In fact, many people discover they have piriformis syndrome when they develop buttock pain after sitting too long. Sitting may compress on the sciatic nerve and cause discomfort or the piriformis muscle itself can go into spasm. However, piriformis syndrome can also cause other distressing symptoms such as problems walking,

How Do You Know if You Have It?

If you have buttock pain after sitting too long and it radiates down your leg to the knee, be suspicious of piriformis syndrome. But don’t self-diagnosis. You may need an MRI to rule out a herniated disc or spinal stenosis as a cause of your symptoms.

Once you’ve ruled out other conditions, you can often treat the symptoms at home with ice packs or alternating heat and ice. Some health care providers prescribe non-steroidal anti-inflammatory medications (NSAID) but avoid taking them for a lengthy period as they can have serious side effects, like bleeding from the intestinal tract, kidney injury, and elevate the risk of a heart attack. Some healthcare providers are even using Botox to relieve the symptoms of piriformis syndrome. Another approach is to inject the region with a steroid. The steroid helps ease the inflammation around the sciatic nerve. However, there are risks and drawbacks to this approach. Discuss those with your physician.

Some people also get relief from using a foam roller to lengthen and relax the piriformis and surrounding muscles. By loosening up these muscles, it reduces pressure on the sciatic nerve. Start by rolling over the entire muscle. If you find an area that’s painful or sensitive, stop and hold for 15-20 seconds until the pain dwindles. It may be helpful to foam roll the area as soon as you wake up in the morning and several times throughout the day.

How to Prevent Piriformis Syndrome

Beyond the obvious advice of not sitting too long or sitting with something in your back pocket, strengthen your glutes and the underlying piriformis. If these muscles are weak, it causes your hip to turn inward and that can irritate the piriformis and place pressure on the sciatic nerve. If you run, cross-train so you’re not working the same muscles over and over in the same way. Vary the exercises you do too to avoid overstressing any one group of muscles.

The Bottom Line

Piriformis syndrome is a common cause of buttock pain and it isn’t always diagnosed in a timely manner. Now, you know some signs and symptoms, what causes it, and how you can lower your risk of developing this annoying and painful syndrome.

References:

The Journal of the American Osteopathic Association, November 2008, Vol. 108, 657-664.
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Org. “Piriformis: Is It Really Tight? Really?”
2015 Jul; 34(3): 206–210. Published online 2015 Jan 23. doi: 10.14366/usg.14039.
com. “Piriformis Injection”