What is Piriformis Syndrome?
Discover what causes piriformis syndrome and how to treat it.
by Brad Walker | First Published November 18, 2005 | Updated July 17, 2019
Patients often complain of pain deep within the hip and buttocks, and for this reason, piriformis syndrome has also been referred to as “Deep Buttocks Syndrome.”
Anatomy of the Piriformis Muscle
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.
As you can see from the diagram to the right, there are many muscles and tendons that make up the hip and buttocks region. The diagram shows the posterior (rear) view of the buttock. The piriformis is the horizontal muscle in the center of the picture running over the top of the sciatic nerve.
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, 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.
The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, 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, including pronation and supination;
- Tight, stiff muscles in the lower back, hips and buttocks; and
- Running or walking with your toes pointed out.
Symptom of Piriformis Syndrome
Pain (or a dull ache) is the most common and obvious symptom associated with piriformis syndrome. This is most often experienced deep within the hip and buttocks region, but can also be experienced anywhere from the lower back to the lower leg.
Weakness, stiffness and a general restriction of movement are also quite common in sufferers of piriformis syndrome. Even tingling and numbness in the legs can be experienced.
Piriformis Syndrome Treatment
Piriformis syndrome is a soft tissue injury of the piriformis muscle and therefore should be treated like any other soft tissue injury.
- Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regimen should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regimen be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.
- The next phase of treatment (after the first 48 to 72 hours) involves increasing the flow of oxygen and nutrients to the injured hip. The most common methods used to do this include ultrasound, TENS, heat and massage. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.
- Next, start to incorporate some very gentle range of motion exercises for the large muscle groups around your hips. The lower back, buttocks, hamstrings, quadriceps and groin are a good place to start.
- Once the pain has been reduced and you can feel some freedom of movement returning to your hip, it’s time to move onto the rehabilitation phase of your treatment, or physical therapy. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles around your hip and buttocks.
Piriformis Syndrome Prevention
There are a number of preventative techniques that will help to prevent piriformis syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are a number of preventative measures that I feel are far more important and effective.
- Warm Up: A thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury. Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.
- Avoid activities that cause pain: Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued.
- Rest and Recovery: Rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.
- Strength and Flexibility: Strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent piriformis syndrome. Flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur. To keep your piriformis, and the muscles around your piriformis flexible and supple you can Get videos and photos of piriformis and glute stretches here.
Research and References
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- Wikipedia contributors. (2019, June 29). Piriformis syndrome, In Wikipedia, The Free Encyclopedia.
- Jones, O. (September 27, 2018). Muscles of the Gluteal Region. Retrieved June 17, 2019, from https://teachmeanatomy.info/lower-limb/muscles/gluteal-region/.
- Hopayian, K. Song, F. Riera, R. Sambandan, S. (2010). The clinical features of the piriformis syndrome: a systematic review. European Spine Journal, 19(12): 2095–2109.
- Tonley, J. Yun, S. Kochevar, R. Dye, J. Farrokhi, S. Powers, C. (2010). Treatment of an Individual with Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report. Journal of Orthopaedic & Sports Physical Therapy, 40(2):103–111.
- Boyajian-O’Neill, L. McClain, R. Coleman, M. Thomas, P. (2008). Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach. The Journal of the American Osteopathic Association, Vol. 108, 657-664.
- Roy, B. (2014). Piriformis Syndrome. ACSM’s Health & Fitness Journal, 18(4):3–4.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.