Piriformis syndrome is a condition in which the piriformis muscle becomes tight or spasms, and irritates the sciatic nerve. This causes pain in the buttocks region and may even result in referred pain in the lower back and thigh. The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum (lower region of the spine) to the top of the femur (thigh bone) and aids in external rotation (turning out) of the hip joint.
What Causes Piriformis Syndrome?
Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.
Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:
- Exercising on hard surfaces, like concrete;
- Exercising on uneven ground;
- Beginning an exercise program after a long lay-off period;
- Increasing exercise intensity or duration too quickly;
- Exercising in worn out or ill fitting shoes; and
- Sitting for long periods of time.
Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty mechanics of the sacroiliac joints, lumbar spine, hip, knee and foot, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:
- Poor running or walking mechanics;
- Tight, stiff muscles in the lower back, hips and buttocks;
- Running or walking with your toes pointed out.
- Lie on the back with the legs flat. Pull the affected leg up toward the chest, holding the knee with the hand on the same side of the body and grasping the ankle with the other hand. Trying to lead with the ankle, pull the knee towards the opposite ankle until stretch is felt. Do not force ankle or knee beyond stretch. Hold stretch for 30 seconds, then slowly return to starting position.
- Lie on the floor with the legs flat. Raise the affected leg and place that foot on the floor outside the opposite knee. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or a towel, if needed, until stretch is felt. Do not force knee beyond stretch or to the floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.
- Lie on the floor with the affected leg crossed over the other leg at the knees and both legs bent. Gently pull the lower knee up towards the shoulder on the same side of the body ( until stretch is felt. Hold stretch for 30 seconds, then slowly return to starting position.
- Buttocks stretch for the piriformis muscle: Begin on all fours. Place the affected foot across and underneath the trunk of the body so that the affected knee is outside the trunk. Extend the non-affected leg straight back behind the trunk and keep the pelvis straight. Keeping the affected leg in place, scoot the hips backwards towards the floor and lean forward on the forearms until deep stretch is felt. Do not force body to floor. Hold stretch for 30 seconds, then slowly return to starting position.