What is piriformis syndrome?

Piriformis syndrome is a fancy way of saying that a tight buttock muscle (piriformis) is causing pressure on the nerve (sciatic) that passes underneath it. When this happens it can cause buttock pain and referral of pain down the leg (usually down the back of the leg). It may also cause pins and needles or numbness. Tightness of piriformis also restricts hip rotation.

Ending any diagnosis with the word “syndrome” often makes it sound like a terminal illness however, piriformis syndrome is generally not too serious and responds quickly to treatment so there’s no need to update your Will. Having said that, it can be a very painful condition if left untreated.

What causes it?

Piriformis syndrome is usually the result of one of three things:

• Poor technique and hip control during leg exercises such as lunges, squats (especially single leg), running etc
• Irritation of the low back joints
• Irritation of the pelvic joints

How do I fix it?

For pain and symptomatic relief, the best treatment is to have the piriformis muscle loosened up. This can be done through massage, dry needling, or muscle energy techniques. Once the muscle is loosened, the sciatic nerve can pass more freely through the buttock musculature instead of getting tethered.

Contrary to what many people think is logical, stretching the hamstring does not help and often worsens symptoms. This is because the nerve is trapped under the piriformis muscle and stretching the hamstring creates a tug-of-war effect on the nerve as it ends up being pulled on by the buttock and hamstring in opposite directions.

Once the muscle has been loosened, the movement pattern causing the problem needs to be identified and corrected. Depending on the underlying cause, exercises often include correction of the pelvic posture and strengthening of the stabilising buttock muscles. Accuracy of performance of exercises is paramount to a quick recovery and avoiding recurrence. Your physio is the best person to guide you on technique and the most effective exercises you should perform.