Piriformis syndrome

Piriformis syndrome: what causes it?

Piriformis syndrome is a compression or irritation of the sciatic nerve by the piriformis muscle, a small, pear-shaped muscle deep in the buttock. The piriformis runs from the front of the sacrum to the greater trochanter on the outside of the thigh bone. The muscle rotates your thigh outwards and keeps your hip stable when walking and running. The sciatic nerve runs directly below, or sometimes through, this muscle towards the leg.

If the piriformis becomes cramped, thickened or irritated, it can put pressure on the nerve. Causes are prolonged sitting, especially on a hard surface or with a wallet in your back pocket, a fall onto your buttock, running with weak hip muscles and a lot of cycling or stair climbing. A stiff hip or an abnormal walking pattern also increases the load on this muscle.

Which nerve is trapped?

With piriformis syndrome, the sciatic nerve is involved, but how that nerve runs relative to the muscle differs from person to person:

• Nerve below the muscle: in most people, the sciatic nerve runs just below the piriformis. A cramped muscle then presses on the nerve from above.
• Nerve through the muscle: in a small group, (part of) the nerve runs straight through the muscle. They are more prone to entrapment.
• Split nerve: sometimes the nerve has already split into two branches in the buttock, each following its own route past the muscle.
• Other structures in the deep buttock: smaller muscles, such as the obturator internus and the gemelli, or the attachment of the hamstrings can also irritate the nerve. This is called deep gluteal syndrome.

Common symptoms of piriformis syndrome

Does this list sound familiar? Then book an appointment, so we can check whether the piriformis is the culprit.

• A deep, dull pain in the middle of the buttock, usually on one side.
• Pain that increases after twenty to thirty minutes of sitting, especially on a hard chair.
• Radiation to the back of the thigh, sometimes into the lower leg.
• Pain when crossing your legs or turning your hip inwards.
• Tingling or a sleepy feeling in the leg after sitting for a long time.
• A tender spot deep in the buttock that you can point to with your fingers.
• Symptoms when climbing stairs, walking uphill or getting up from a chair.

Do you notice loss of strength in your foot, for example foot drop, or is the leg becoming increasingly numb? Then consult your GP at short notice. Call 112 if you have numbness in the seat area and around the genitals or lose control over your bladder or bowels. With a fever and a red, warm swelling in the buttock, also see your GP straight away.

Piriformis syndrome or radiation from the back?

Piriformis syndrome closely resembles sciatica from the lower back, which is usually caused by a herniated disc. Yet there are differences. With piriformis syndrome, the pain is mainly in the buttock, the lower back itself usually does not hurt and the pain increases when sitting and rotating the hip. With a trapped nerve in the back, coughing and sneezing are often painful and the pain more often radiates into the foot. During the assessment, we use tests such as the FAIR test, in which we flex, tilt and rotate the hip inwards.

How De Fysio Man treats piriformis syndrome

Treatment focuses on relaxing the muscle, relieving the nerve and making your hip stronger.

Reducing muscle tension and giving the nerve space

• Explanation of the piriformis and the route of the sciatic nerve through the buttock.
• Dry needling of trigger points in the piriformis and the surrounding gluteal muscles.
• Trigger point therapy and deep tissue techniques for the deep hip rotators.
• Nerve gliding exercises to let the sciatic nerve move freely again.
• Stretching exercises for the hip rotators, dosed so the nerve is not irritated further.
• Advice on sitting, such as a soft cushion and no wallet in your back pocket.

Strength of hip and trunk

An overloaded piriformis often takes over work from weak glutes, especially the gluteus medius and maximus. That is why we strengthen these muscles with exercises such as side steps with a band, bridges and lunges. For runners, we also look at cadence and pelvic position while running.

Piriformis syndrome, sit bone pain and overloaded glutes

Pain deep in the buttock can have different causes. If the pain is mainly on the bone you sit on and you feel it when sprinting or running uphill, it is more likely to be sit bone pain from an irritated hamstring tendon. If the pain develops after a period of intensive training, glute pain from overuse may be the cause. You can read more about pain in the buttock region under buttock complaints.

Runners, cyclists and sitters: relieving the piriformis

Piriformis syndrome often develops in people who do a lot of the same thing. If you work seated all day, stand up briefly every half hour and vary your sitting position. Runners do well to build up their training volume gradually and include hip-strengthening exercises in their schedule. Cyclists benefit from a properly adjusted saddle height. This way, you prevent the piriformis from becoming overloaded again and again.

How we work at De Fysio Man

1. Intake and assessment

We ask when the pain occurs, how long you sit and which sport you do. We then examine your lower back, hip and buttock, test the sciatic nerve and feel for tender points in the piriformis.

2. Tailored treatment plan

You receive a plan that combines muscle treatment with exercises for strength and mobility, tailored to your work and your sport.

3. Sitting and exercising without pain again

We gradually build up your sitting time and sports load and give you exercises to relax the piriformis yourself and keep your hip strong.