Commonly mistaken for sciatica pain, piriformis syndrome occurs when the piriformis muscle in the hip becomes short and tight, causing spasms that impinge on the sciatic nerve. This condition is differentiated from sciatica in that sciatica is generally a symptom of a spinal injury or degeneration in which a vertebra or disc puts pressure on the nerve; piriformis syndrome, though its diagnosis is rarely straightforward, presents with sciatica pain in the absence of any spinal issues. The result is pain, numbness, tingling, and muscle weakness that can extend from deep in the buttocks all the way down to the foot.
What is the Piriformis Muscle?
The piriformis is a small muscle found deep in the hip, beneath the gluteus maximus, that aids in externally rotating the hip joint (turning toes out). This muscle can become tight and overactive from inactivity as well as from imbalanced training. Sedentary individuals may develop a tight piriformis from sitting for long periods, which can cause tight hip flexors and weak glutes; therefore the piriformis, along with the hamstrings and hip adductors, will become overactive during movement to compensate for the work not being done by the glutes.
Those who are active, however, may also experience an overactive piriformis, particularly cyclists, rowers, and runners. This is generally due to the forward motion required by their sport; they may not train the muscles used in lateral movement as frequently, resulting in tight hip flexors/adductors and weak abductors, an imbalance which can also lead to tightening of the piriformis.
Identifying Piriformis Syndrome
While seeing a doctor to rule out any spinal causes is advisable, it can’t hurt to check for underlying muscle imbalances that might be the culprit. First, perform a bodyweight squat facing a mirror. As you squat down, do your toes turn out, knees buckle in, and/or feet roll in? This is likely the result of said muscle imbalances: weak glutes and abductors, tight hip flexors and adductors.
Next, seek out an exercise professional who specializes in self-myofascial release, or SMR---many trainers and physical therapists are experienced in this area. SMR involves sitting or lying on a cylindrical foam roll and applying pressure with your body weight on areas that are tight or tender and is a key technique used in locating a spasmodic piriformis. If it’s the culprit, you’re sure to find it using SMR---pressure applied to the side of the buttocks will yield noticeable pain and tenderness.
Finally, perform the stretches described below to confirm if the piriformis muscle feels tight. If so, if you’re experiencing the muscle imbalances described above, and if you’ve ruled out any spinal problems, you may turn to exercise to help set you straight.
Corrective Exercises for Piriformis Syndrome
Piriformis syndrome and its resulting pain can be corrected via stretching of the piriformis muscle as well as strengthening exercises for the glutes and abductors.
To stretch the piriformis muscle, perform a seated variation of the Figure 4 stretch: Sit upright on the front edge of a chair and cross your right ankle over your left knee, with left foot planted flat on the floor and right knee pointing out to the side. Slowly lean forward from the hip with your back straight until you feel the stretch deep in your right hip; hold for 20 seconds. Alternately, lie on your back on the floor with right ankle crossed over left knee, grab your left thigh with both hands, and pull it toward your chest. Repeat stretch on opposite side.
To strengthen the glutes, try heel pushes on all fours. Get down on hands and knees with your back straight, abs drawn in, hands directly under shoulders, and knees directly under hips. Raise one leg behind you with your knee bent 90 degrees, thigh parallel to floor, and bottom of foot aimed toward ceiling. Squeeze your glutes and press the bottom of your foot up toward the ceiling; perform 15--25 small pulses and switch sides.
To strengthen the abductors, or the muscles that raise your leg to the side, try lateral stepping with a circular resistance band (looks like a large rubber band, can be found at most sporting goods stores). Slip the band around your ankles, stand upright, and then take wide steps sideways down a room and back, making sure not to let your toes turn out.
Perform these exercises three times weekly, ideally under the supervision of a certified fitness professional, and don’t be surprised if your pain diminishes or disappears all together.
Shelby Miller - A 2007 grad of DePaul University's MA in Writing program, Shelby is a newly minted freelance writer. Her undergraduate degree in ...
