It may be there when you first wake up, after a workout, or it can even haunt you as you are sitting at your desk. And it can literally be a pain in the butt! Piriformis syndrome is a condition in which a small muscle, your piriformis, located in your posterior hip irritates the sciatic nerve that runs under it. It can cause a variety of symptoms ranging from simple annoyance, to pain, numbness or tingling down the back of your leg. Your sciatic nerve most commonly runs underneath it, but if you’re one of the unlucky few, it can also run directly through it. When your piriformis muscle tightens it can be like stepping on a watering hose, stopping or decreasing the flow of signals down your leg. While it very rarely stops the flow, it often does become easily irritated by becoming compressed and can let you know how bad it is by how far the symptoms travel down your leg.
What causes Piriformis syndrome?
There can be a variety of reasons that the piriformis muscle can decide to tighten up on you. Commonly it is either a direct injury to the lower back or tailbone, causing the piriformis to tighten up in response to the injury as it tries to brace and protect your back from further damage. Or it can also arise from faulty mechanics when lifting, running, or working out. Externally rotating the hip for extended periods of time can also lead to piriformis syndrome, something that is common among ballet dancers. If you tend to walk with your feet turned outward, this can indicate a possible source of the problem. Misalignment of the bones of the pelvis may also be involved. To properly diagnose piriformis syndrome is not the difficult part, but finding out the cause behind it can be. And to treat it without knowing the cause is likely to assure that this pain in your butt is not going anywhere anytime soon. This is why it is important to see your physiotherapist so we can evaluate you and find the culprit as soon as possible.
What to do about it?
Fixing piriformis syndrome on your own can be challenging if you do not know the exact cause. We can tell you how to “plug the leak” for now, but if you don’t know why the piriformis muscle is squeezing the life out of the sciatic nerve then it will come back. The most basic way to decrease the tension of a tight muscle is to stretch it. You can do this by laying on your back with your feet flat on the ground, place one ankle on the opposite knee, and pull the leg that is on the ground towards your chest (see picture). A deep pressure to the muscle can also help to release the tension in it. We sometimes do this manually, almost like a deep tissue massage directly to the piriformis, or we advise our patients to sit on a tennis ball. However, to do this effectively you will need some guidance on exactly where the piriformis is. Our clinics also use acupuncture to help decrease the tension on the piriformis and other muscles that may be contributing to your symptoms. But when you come to Elite Sports Injury we will likely find the cause and address the specific issues that are causing this in the first place. Sometimes it is your running mechanics or shoes. We can create custom orthotics if needed. If it is your posture while sitting at work we can prescribe corrective exercises and educate you on what you are doing wrong.
As you read, there can be a ton of reasons for this pain in your butt and even more ways of how to correct it. This is why a little guidance from a musculoskeletal expert such as a physiotherapist can help you get to the cause quickly and set you on the right track to making a full recovery without all the guess work you may be doing on your own. If you have any questions or want to know more, stop by one of our physiotherapy clinics in the Winnipeg area today!