What can I do for piriformis syndrome?

Piriformis syndrome is synonymous with an individual complaining of deep buttock pain. The piriformis muscle is a small stabilizer muscle located beneath the bigger gluteal muscles and on top of the sciatic nerve. The piriformis is responsible for decelerating hip flexion, adduction, and internal rotation. The piriformis muscle runs into problems when it is asked by the body to do the work of the bigger hip muscles. Although it can do the job, it is not the most effective or efficient at doing the job. As a result, the piriformis muscle can become congested, spasm, and inflamed. This enlarges the tissue and begins to press into the sciatic nerve, which then can cause sharp pain in the buttock region and potentially cause referred pain down the leg.

The first step for piriformis syndrome is to confirm the diagnosis with a qualified medical doctor. Once confirmed potential strategies to alleviate the piriformis is to address the congestion in the tissue, and then move to increase the mobility and stability of the muscle. An individual can utilize self myofascial techniques and/or hire a health professional to address the soft tissue complex. On your own a foam roller can be your best friend, by rolling through the posterior and lateral hip region the individual can decrease tension and increase circulation in the tissue. By working to alleviate the tissue we can now work for mobility and stability.

Commonly, an exercise utilized to enhance mobility in the piriformis is to lie on your back and take the affected leg and place the ankle of the side to be stretched upon your opposite knee. Then place the hand of the same side to be stretched on your knee and gently push your knee away from you. 

My challenge with this move is it places the piriformis muscle in an externally rotated position. The piriformis needs to be moved into internal rotation. A move that would emphasize the true function of the piriformis would put the individual in an upright position. If the right piriformis was the issue we would start in a right leg balance position, with the left foot elevated sideways on a box or step. We would initiate the move by swinging the hands rotationally to the right towards the down leg. This would emphasize the hip internal rotation maximally.

To enhance the strength and stability of the piriformis, we would then stand on our right leg and bend from the hips while reaching our left hand down towards the right at knee height.
Generally, the treatment for piriformis syndrome begins with stretching exercises and massage. Anti-inflammatory drugs may be prescribed, and cessation of running, bicycling, or similar activities may be advised. A corticosteroid injection near the area where the piriformis muscle and the sciatic nerve meet may provide temporary relief. In some cases, surgery is recommended.

This answer is based on source information from National Institute of Neurological Disorders and Stroke.

Piriformis syndrome is characterized by pain over the piriformis muscle (located in the buttock), with occasional pain referral to the back of the thigh. Other characteristics that may be present include restriction in internal rotation (turning the femur in), and pain/weakness in external rotation (turning the femur out). Piriformis syndrome can lead to compression of the sciatic nerve if the piriformis muscle becomes tight or spasms, which can cause symptoms in the back of the thigh and leg. If you have piriformis syndrome, you should perform a combination of flexibility and strengthening techniques to help your body heal and prevent further injury. Begin by foam rolling your piriformis, adductors, and IT-band. Foam rolling is a form of self-massage that can help relax tight muscles before you stretch them. Hold the tender spots for 30 seconds to allow your muscle time to relax and release the knots that are causing tension in the muscle. After you have completed the foam rolling, statically stretch your adductors and hip flexor complex. Hold each stretch for 30 seconds to allow your muscles time to elongate. Next, perform strengthening exercises for the hips and core. This can be done by performing stability ball bridges and planks to help strengthen the muscles that stabilize the core and pelvis. Also, you can perform lateral tube walking which will strengthen the muscles in your hips that help control your foot and ankle. Lastly, perform a single-leg balance exercise to strengthen the muscles of the entire leg. When performing any single-leg exercise, ensure that you keep the arch of your foot lifted while performing the exercise. Perform 1-3 sets of 10-15 repetitions of each of these exercises.

Brian Yee
Physical Medicine & Rehabilitation
The pirformis muscle is located deep in your posterior hip, underneath the larger gluteal muscles. The pirformis is involved with rotary stability of the hip. Many times the pirformis becomes overused and spasms. The sciatic nerve can also run over, through, or under the pirformis muscle with patients at times complaining of sciatic nerve symptoms down the leg. Patient's classically complain of deep buttocks pain.

Please consult with a qualified health practitioner to diagnose the cause of pirformis syndrome.

For self-help tips -- use of foam rolls to improve the muscle and fascia in the buttocks can help. Improve gluteal stability such as bridges and quarter squats, once the acute buttocks pain subsides, can help as well. I am also a firm believer of also assessing gait mechanics and determining why the pirformis muscle is being over used.

This can be due to a stiff ankle, and unstable pelvis, residual nerve tension from a previous herniated disc that presses on the sciatic nerve. All could be factors that eventually causes the pirformis muscle to compensate -- and thus cause pain.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.