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"Before PT, I was a pain in the butt!" - Piriformis

Writer's picture: katieperronedptkatieperronedpt

TLDR: The piriformis muscle is in the buttock area, near your glutes. It runs from your tailbone to the top part of your femur bone, running on an angle in a pyramid type shape, and it sits above your sciatic nerve. The piriformis helps to rotate your hip, helps to move your hip away from your body, and also helps to stabilize your hip joint. When the piriformis nerve is not functioning properly (which can happen for a number of reasons), you will often get pain and symptoms that feel similar to sciatica - and can run all the way down your leg! There are many ways to help this pain go away, including manual therapy from a physical therapist, strengthening, stretching, mobility, and core stability as well. It’s a balancing act of finding the right things to keep yourself from having pain! If you don’t keep your piriformis happy, you will be dealing with a real pain in the butt!


The piriformis muscle is one that I work with a lot for people, because it is a common one to get aggravated and cause really painful symptoms, which then causes difficulty with your ability to participate with what you love!


Let’s start with the basics. You have one piriformis on each side of your butt. It starts from the front of your sacrum (tailbone) and runs horizontally/slightly diagonally and attaches at the greater trochanter of your femur (which is the big bump at the top of your thigh bone). Its’ job is to help with external rotation (turning your leg outward), abduction (moving your leg away from the center of your body) and helping to stabilize the femur in the acetabulum (where the thigh bone sits in the hip bone, making the hip joint). It is underneath the glute muscles and sits above the sciatic nerve.


The piriformis is a critical muscle with many things we do, especially because it has more than one function, and helps with stabilization, so it is often working when we are standing and moving. It is also one of the most common reasons that people have what feels like “sciatica” or pain down the leg. Sometimes it even causes people to feel like they have low back pain as well. Sometimes, people will notice that they have pain right in that buttock area, but more often than not, they usually have symptoms somewhere else and then when they come to PT and we do an evaluation, with pressing into the piriformis, people then realize how sensitive it is, and we often find weakness and/or tightness in that muscle.


The reason that many times people don’t realize that the pain is starting in that buttock area, is because of how the piriformis can bump into the sciatic nerve because of where it sits. Since the piriformis is above the sciatic nerve, when something goes wrong with the piriformis, it can often bump the sciatic nerve, causing irritation and inflammation, and then symptoms that are related to the sciatic nerve - such as the pain in your leg or the pain in your low back. Piriformis pain and piriformis syndrome can often be misdiagnosed as low back pain or sciatica being caused by a disc herniation or some other reason.


Complications and symptoms can arise because of the piriformis when it is not functioning properly. Different things that may cause the piriformis to not perform properly can include: a specific injury to the muscle, weakness, tightness, muscle fatigue, overuse, muscle strain, compensatory mechanisms causing the piriformis to be used improperly, poor body mechanics, prolonged sitting or pressure on the muscle, prolonged positioning, scar tissue, joint deformities, and poor care of your muscles (stretching, strengthening etc). These are not all of the different things that can cause your piriformis to be a pain in the butt, but they are some of them! No matter what the cause of it is, the symptoms are generally very similar for people - and again, this is primarily because of the positioning and the function of the piriformis itself.


So what do we do about this pain in the butt? Keeping yourself overall strong and flexible can help to prevent symptoms and injuries like this one! Full body strengthening, that focuses on all of the muscle groups and allows the body and all of the muscles and joints to function the way that they are designed to. If muscles, like the piriformis, are functioning the way they are designed to, and are not being used incorrectly, overused, or used for compensation of other weaker muscles, they are less likely to get injured. So strengthening and flexibility is key to prevention!


If you do end up with symptoms related to the piriformis muscle, the best bet is to see a physical therapist! They can evaluate you and make sure that is what the primary issue is and then determine what the cause of it is! They will give you the appropriate exercises to complete, that will include strengthening, stretching, and even core stabilization work! They will help you by giving you the correct exercises to target the piriformis and the muscles surrounding it, without irritating it more in this process! They can also do manual therapy to that piriformis and the tissues and muscles around it to help to relieve your symptoms!


When we are talking about strengthening the piriformis - you want to complete the movements that the piriformis does (rotation, abduction and stabilization) and provide resistance against it to further challenge it and strengthen it. When we talk about stretching, you want to do the opposite of those movements that it does, and stretch into the opposite direction until you feel a pull in that muscle. The key to this, and why it is a great idea to work with a physical therapist for the prevention of injuries and recovery, is finding the balance. You don’t want to have a muscle that is too weak or too strong and you don’t want to have one that is under-stretched or over-stretched. It’s a balancing act! And in the middle of all of that, you don’t want to neglect your core either - because having a strong and stable core can help with a lot of things, including piriformis pain prevention and recovery!


So what’s the moral of the story here? The piriformis is a very important muscle! And it can also be a HUGE pain in the butt (and back, and leg)! You have to keep stretched and strengthened properly and a physical therapist can help you to find the best ways to do this!


Reach out with any questions or concerns or if you are dealing with piriformis syndrome or pain or symptoms right now!


If there is anything specific that you would like to learn about, comment or email me and I am more than happy to talk more about it!


Thanks for being here!


Follow us on Instagram to learn more about it now, or email us at livewithoutlimitspt@gmail.com and let us know if there is anything else that you would like us to talk about!


  • Dr. Katie




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