Pain in the Butt! How to Overcome Piriformis Syndrome…often confused as Sciatica!

Pain in the Butt! How to Overcome Piriformis Syndrome…often confused as Sciatica!

Yesterday, I discussed a “pain in the butt” condition and no it was not tax pain (for those that have seen the H&R Block commercials).   The blog was actually about the discomfort of a condition known as coccydynia.   Today, I am going to write about a “pain in the butt” condition known as piriformis syndrome.  I see this particular condition very often!

Case Study:

A 34 Year old man has a stabbing pain in the buttock with a sharp electrical feeling going down the back of his leg (sciatica).  He felt this immediately after exiting his pick up truck after a long day at work.

Have you ever felt or heard of this condition before?  Most people have heard of someone who has experienced these particular symptoms.  First off, sciatica (as a symptom of pain going down the back of the leg) is very common and so is pain near the lower back/buttock region.

It is Time to Review Our Anatomy 

SI joint

SI joint

I know, I know – you do not like this part of my blogs.  It is crucial, however, that we understand where we are talking about and the specific structures in the area, if we are to understand what this condition is all about.

As you can see to the right, the piriformis muscle attaches from the hip (greater trochanter) to the vertebral column (the sacrum to be specific – the triangular bone at the base of the spine).  The connection of the sacrum to the pelvis bones forms the sacroiliac joint.  We have two of these joints – both left and right.T he piriformis muscle is one of the external rotators of the hip and leg.  What is an external rotator you ask? An external rotator is a muscle that helps turn the foot and leg outward.  As you may notice in the image to the right, there is a yellow string under the piriformis muscle belly.  This string is actually the sciatic nerve.  In 80% of individuals, the sciatic nerve runs below the muscle.  In 5-10% it runs above the muscle and in 10-15% it pierces through the muscle belly (especially if someone is born with two piriformis muscle bellies).  The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica (pain going down the back of the leg).

What Causes Piriformis Syndrome?

As indicated above, the piriformis muscle can irritate and squeeze the sciatic nerve, which causes a variety of symptoms going down the back of the leg.  But how and why does piriformis become tight?  Well, sometimes it is due too sacroiliac joint dysfunction.  The sacrum and the pelvis bones create a sacroiliac joint on both the left and right side.  This joints provided slight movement, but act move as a shock absorber or force dampener. If the sacroiliac joint becomes tight on one side it may lead to disruptions on how the muscles in the area function – thus resulting in tightened and irritated muscles and nerves.   Furthermore, piriformis syndrome may also come about, as a result of  an injury such as a fall onto the buttock.  If bleeding in and around the piriformis muscle occur it will form a hematoma.  Thus, the piriformis muscle begins to swell and put pressure on the sciatic nerve. Soon the hematoma dissolves, but the muscle goes into spasm and affects the surrounding joint and muscle structures.  Usually, I find piriformis syndrome one either the left or the right side, but not both at the same time.

I think I have Piriformis Syndrome, now what?

In order to diagnosis piriformis syndrome, a number of physical orthopaedic exam tests need to be performed.  Resisted external rotation of the hip as well as passively turning the leg inward, will create symptoms.  Direct [slideshow] (feeling the muscle) will also elicit symptoms and may refer pain down the back of the leg.  Predisposition to piriformis syndrome may be an anatomically short leg, pronation at the feet, or pelvic rotation.

How do I reverse these Piriformis Syndrome symptoms?

Stretching techniques or soft tissue therapy techniques (massage with a stretch) really help.  Furthermore, I find that acupuncture, chiropractic, electrotherapy, heat therapy and laser therapy also help!  In my practice, I use a variety of stretches (difficult to perform on your own).   These stretches really help to loosen the piriformis area.  I find that a combination of a variety of treatments often does the trick!  Usually within four to six treatments, a patient is walking better, has less pain travelling down the back of the leg and does not feel spasm in the buttock.  I always find that massage therapy in conjunction with chiropractic care really helps when it comes to piriformis syndrome.  Massage therapist are excellent has relaxing tight muscles and chiropractor can work on relaxing the joint (via a chiropractic adjustment).

I hope you enjoyed this pain in the butt blog today.

MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.


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Dr. Luciano Di Loreto