Piriformis Syndrome – Literally a Pain in Your Butt

Has this winter been a pain in your butt? On top of the winter blues and life, are you getting aches and pains in the back, buttock, and leg that just won’t seem to go away? If you answered yes to either of these, you may have piriformis syndrome. Piriformis syndrome occurs when the piriformis muscle is tight or when the pelvis is not in proper position resulting in mild to severe pain in the back, buttock and occasionally down the leg.

So what exactly is the piriformis muscle?
The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint while the sciatic nerve runs underneath this muscle. This muscle stabilizes the hip joint and lifts and rotates the thigh away from the body. During day to day activities this muscle helps us walk, shift our weight from one foot to another and maintain balance. When the muscle gets tight, you get the “pain in the butt”. In the picture below, you can also see how a tight piriformis can pinch on the sciatic nerve causing pain down the leg.

Can physical therapy help get rid of the pain in my butt?
The quick answer is YES!
Often times when patient’s come in with these symptoms, we discover their pelvis is not in the correct position. This may happen from miss-step, crossing legs, standing with more weight on one leg, walking on uneven surfaces, sports and exercise injury, muscle imbalances, poor flexibility, or leg length discrepancy. It is common to see the piriformis tightness is a secondary problem. This is why it is imperative your physical therapist addresses the primary cause by checking hip alignment, leg length, posture habits, body mechanics and the flexibility and strength of the muscles surrounding the hips, glutes, and abdominals. Correcting hip alignment, decreasing tightness, and strengthening the surrounding muscles will help to abolish the pain and prevent future issues. If the primary cause isn’t addressed the pain will come back over time.

Does this sound like you? Does your pain always come back? You may not have address the primary problem yet!

What can you do to help the pain? 

Using a tennis ball or getting a massage to release the piriformis muscle helps! However, to keep the muscle relaxed, it is important to do the following stretches and strengthening exercises to avoid it getting tight again.

Here a few ways to help stretch the piriformis and relieve symptoms (please stop if any stretch or exercise causes increased symptoms or pain).

PIRIFORMIS STRETCH
While lying on your back with both knee bent, cross your affected leg on the other knee. Next, hold your unaffected thigh and pull it up towards your chest until a stretch is felt in the buttock. Hold 30 seconds and repeat 3 to 5 times a couple times per day.

Below are some modifications of the same exercise.

Lay on your back and use a ball to help bring the knee toward your chest. This helps to take pressure off the knee if you have difficult bending your knee.

Sitting in chair, you can do this stretch virtually anywhere and you don’t have to get on the floor. Bring your foot (of the affected side) on your opposite leg. Gently lean forward at the waist until you feel a good stretch in your bum!

SCIATIC NERVE GLIDES

Here are some Sciatic nerve glides that will help to relieve the pain down the leg from the sciatic nerve being pinched. With these exercises, we are attempting to get the nerve to move more freely behind the piriformis muscle. Again, if any of these increase your symptoms, stop doing them.

SCIATIC NERVE GLIDE – Lying on your back
Start by lying on your back and holding the back of your knee. Next, attempt to straighten your knee as much as you are able to feeling a good stretch behind your leg (you may not be able to get it as straight as the picture). Lastly, hold this position and then bend your ankle forward and back as shown. Perform 10 ankle pumps 3 times.

SCIATIC NERVE GLIDE – Sitting
Start by sitting up straight in a chair or on the edge of a bed. Then, extend your knee and hold this position. Next, bend your ankle forward and back. You can also sit toward the edge of the chair and with your leg straight keep you heel on the ground and move your ankle back and forth in this position. Perform 10 ankle pumps 3 times.

STRENGTHENING 

As we mentioned earlier, you can’t just stretch to get results and keep them! So here are a few exercises we recommend to go along with your stretching. These five exercises help to strengthen the glutes and the core. Strengthening these muscles will help to stabilize the pelvis and take pressure off the piriformis so it doesn’t have to work as hard.

HIP ABDUCTION – SIDELYING

While lying on your side, slowly raise up your top leg to the side. Keep your knee straight and maintain your toes pointed forward the entire time. Keep your leg in-line with your body.

The bottom leg can be bent to stabilize your body.

PRONE HIP EXTENSION – BENT

While lying face down with your knee bent, slowly raise up your knee off the ground.

Alternating Leg Extension (Quadruped)

Begin on hands and knees with knees directly under your hips and hands directly under your shoulders. Keep your abdominals tight and engaged throughout this exercise. Raise one leg straight back as pictured without letting your hips drop to one side and without losing your abdominal contraction. Hold for 3 seconds, then return to the start position and repeat with the opposite leg. This is one repetition.

BRIDGING

While lying on your back with knees bent, tighten your lower abdominals, squeeze your buttocks and then raise your buttocks off the floor/bed as creating a “Bridge” with your body. Hold and then lower yourself and repeat.

PELVIC TILT – SUPINE

Lie on your back with your knees bent. Next, arch your low back and then flatten it repeatedly. Your pelvis should tilt forward and back during the movement. Move through a comfortable range of motion.

We know the winter blues can be a pain in the butt, not to mention other life stressors such as work, family,  sicknesses, and chores, so why not get rid of the real pain in your butt – your piriformis syndrome – to help deal with life!

All of these are just a recommendation and may temporarily relieve symptoms and not cure the problem without more treatment. If you need further treatment please reach out to us so we can help!

pictures courtesy of www.hep2go.com

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