Pain in the Butt? 5 Ways to Banish Nagging Piriformis Pain

Liz Merritt
September 12, 2017

If glute pain has you squirming in your seat like a kindergartener on the first day of school, then it’s time to explore the possibility of piriformis syndrome.

Walking, running, cycling, even too many squats in the gym can result in throbbing pain and tightness deep in the glutes. That could be your piriformis muscle – which controls external hip rotation – talking to you. Piriformis pain can radiate into the legs and lower back, and often mimics a sciatic nerve, hamstring or disc injury.

Get to the Bottom of Piriformis Pain

Getting to the bottom of the issue first takes an awareness understanding of what may be causing the pain. Piriformis syndrome is a classic overuse injury.

Piriformis Pain

Piriformis syndrome is a classic overuse injury.

“In the athletic population, piriformis syndrome is extremely common.,” says Dr. Kevin Sherman, a sports chiropractic physician in Scottsdale, Arizona. “I treat athletes for this condition every day. One of the major causes is overuse.” In the nonathletic population, these symptoms are more often the result of a disc pressing on a nerve root in the lower back, causing true sciatica.

Piriformis pain is felt deep in the glute area with a dull ache. The pain sometimes radiates into the hamstrings and occasionally into the lower back. It hurts when sitting, walking up stairs, running or walking uphill, and driving. “Most of my patients first notice it when sitting because there is more tension placed on the nerve and muscle in a seated position,” Dr. Sherman explains.

Overuse Injuries

Piriformis Pain

Piriformis syndrome can plague anyone at any age.

Overuse injuries are among the most common ailments for athletes and non-athletes alike. An overuse injury is any type of muscle or joint injury, such as tendinitis or even a stress fracture that’s brought on by repetitive use or trauma to an area of the body and can plague anyone at any age.

Taking on too much physical activity too quickly often will invite an overuse injury. “Patients will notice that it usually gets worse over time, and there is more tension and pain in the glute when they are in a seated position,” Dr. Sherman says.

Know the Source

Dr. Sherman says true piriformis syndrome involves both the sciatic nerve and the piriformis muscle. “It is brought on by overuse, which triggers the piriformis muscle to become inflamed or spasm.”

Inflamed piriformis muscles can then push against the sciatic nerve, causing referred pain in the lower back, buttock and hamstrings. “The sciatic nerve can become tethered, in a sense, by myofascial adhesions in the piriformis,” he says.

5 Ways to Banish Piriformis Pain

Dr. Sherman recommends the following 5 steps to preventing and treating piriformis pain:

Strengthen Gluteus Medius Muscles

Three effective exercises for working these small muscle are glute kickbacks in which the active leg is extended not only back, but also slightly outward with each rep.

Next, do two to three sets of 15 paces forward and then backward monster walks – aka gorilla walks. Use a resistance band around the ankles and walk slowly forward and backward.

The third exercise is clamshell side lifts. Lay on your side with one hand extended out and the other hand on the floor stabilizing your body. Bend legs at the knees about 45 degrees. Keeping the feet together, slowly lift the top leg up and then back. Repeat for 2-3 set of 12-15 reps. Use a resistance band placed above the knees for added intensity.

Foam Rolling

The best time to use a foam roller is just before a workout as a pre-stretch warm-up or as an alternate to stretching altogether. For best results, use the roller at least 4 times per week, for short periods, making 3 to 5 passes over the glutes, quads, IT band and calves.

Glute Stretch

Dr. Sherman recommends a seated glute stretch in which you pull your opposite knee up and toward the opposite shoulder. Hold stretch for 2-3 seconds, release, and repeat 10 times on each side.

Cold therapy

Piriformis Pain

Cold therapy is a great way to reduce the inflammation related to a piriformis pain.

Keep a cold therapy pack in the refrigerator to guard against frostbite and apply 10 minutes on, 10 minutes off several times  a day. A pack cooled to just 55 degrees will provide full therapeutic benefits. Avoid heat. Even though it may feel good, applying heat to the area will cause more harm than good.

Active Release Therapy

As soon as self-care measures are no longer working, seek out the help of a doctor. A physician trained in Active Release Therapy  – or ART – will generally begin with treatments designed to break up thick myofascial adhesions. The number of treatments will vary depending on the patient.

“ART can be a highly effective treatment for piriformis syndrome. Not only does it deal with the fibrosis and the shortening of the muscle, but it can also release the sciatic nerve where it becomes stuck to the muscle and surrounding tissues,” Dr. Sherman explains. “Often, when it is a true piriformis syndrome and not disc related sciatica, patients will respond within a couple of treatments.

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