Get rid of your Piriformis Syndrome; Spinal specialist tell you how

Piriformis syndrome relief for hip pain and sciatica 

What is the best treatment for a piriformis syndrome?

To understand the piriformis syndrome it is necessary to understand the piriformis muscle.  The piriformis muscle is a long, flat and narrow muscle found deep in buttock region that runs horizontally and lies immediately on top of the sciatic nerve that runs vertically.  It is small compared to other hip and pelvic muscles, and works to rotate the leg outward (externally rotate) so that the toes point away from you.  Most piriformis syndrome treatment consists of some variation of a piriformis stretch exercise or massage of the area.  Several simple piriformis exercises presented here are easy to do, effective, and work well for sciatica exercises.

What is piriformis syndrome?

Piriformis syndrome is physical disorder that occurs when the piriformis muscle goes into muscle spasm and in turn compresses or irritates the sciatic nerve – the longest and largest nerve in the body. When a piriformis syndrome compresses this area it can cause a variable amount of sciatic nerve pain, as well as tingling or numbness anywhere along the pathway of the sciatic nerve but especially buttock and hip pain; sometimes the leg pain follows the distribution of the sciatic nerve all the way to the great toe.

Since this muscle enables us to walk, shift our weight from one foot to another, as well as lifting and rotating the thighs, a characteristic sign of a piriformis syndrome is that the sciatic nerve pain is relieved by rotating the leg outward, another way to do a piriformis stretch.

Piriformis syndrome causes

Causes of a piriformis syndrome tend to be related to its complex relationship to other muscles in the low back and pelvis.

The syndrome can simply be due to an anatomical variation of the individual that results in the piriformis muscle being closer to the sciatic nerve than most people so that a person is prone to this problem.  In 17% of the adult population the sciatic nerve does not pass below the piriformis muscle, but it passes through it; in this situation the sciatic nerve is much more vulnerable to compression and entrapment if the muscle spasm occurs, accounting for the frequency of sciatica pain in the general population.

It is also proposed that anyone can develop a piriformis syndrome from overuse or strain of the hip and buttock muscles.  Strain developed by excessive running, walking or stair climbing can start or aggravate a piriformis syndrome.  Simply falling on the buttock can injure the piriformis muscle and initiate the syndrome.

Prolonged sitting can cause a piriformis syndrome by causing the gluteal muscles to so weaken that the piriformis muscle must enlarge and work harder to compensate and so apply pressure to the sciatic nerve.

Piriformis syndrome can arise due to lack of movement in one or both sacroiliac joints.   When this happens the body compensates by changing the way a person walks so that a shearing force is applied to where the piriformis starts on the pelvis, irritating it and making it likely to go into spasm and compress the sciatic nerve.

A flat foot posture, or overpronation of the foot, can lead to a piriformis syndrome.  As a foot overpronates it causes the knee of that same to rotate inward or medially.  When this happens the piriformis muscle is required to work to prevent excessive inward turning of the knee on that side.  Over time this causes overuse, fatigue and eventual strain of the piriformis, eventually causing a piriformis syndrome to develop.

Lastly, piriformis syndrome has been called “fat wallet syndrome” or “wallet sciatica” because it can be caused or aggravated by prolonged sitting on a thick wallet.  Treatment is to put the wallet in the other back pocket.  This simple maneuver often provides prompt sciatic nerve pain relief.

Symptoms of piriformis syndrome

Typically the piriformis syndrome is described as sharp and deep pain that starts in the buttock near the sacroiliac joint and travels down for a variable distance along the pathway of the sciatic nerve.  There is great tenderness to deep pressure along the sacroiliac joint, and buttock pain near the gluteal crease and in the deep groin muscles.  It is common to experience pain while walking up stairs (but not down stairs) as well as walking up inclined surfaces like a hill.  Prolonged sitting will often start or aggravate an episode of hip pain or leg pain associated with piriformis syndrome; sciatic nerve symptoms and back pain are often relieved by lying down with the leg rotated toe-out.

Piriformis syndrome treatment

Chiropractors tend to treat this problem in its most basic and direct form, using primarily piriformis syndrome stretches, rest and massage.  Additionally, as indicated, strengthening of the core abdominal and back muscles to reduce strain on the piriformis is used, along with ice/heat applications, and gait training if the sacroiliac joint is thought to be a source of instability of the pelvis.

Piriformis syndrome treatment with acupuncture or acupressure directly into the buttocks and upper thigh can be extremely effective, especially when combined with soft tissue stretching and spinal manipulation.

Medical doctors prefer to prescribe anti-inflammatory drugs or corticosteroid injections near the point where the piriformis muscle and sciatic nerve overlap. Botox injections are sometime performed to inactivate the spastic piriformis muscle.  In some cases, surgery is recommended.

How to use a cold pack for a piriformis syndrome 

Piriformis stretch for sciatic nerve pain: Stretching exercise for piriformis syndrome

There are many treatment options to used, but by far the most common and effective single therapy used in piriformis syndrome treatment is the piriformis stretch.  Classic stretching exercises for the piriformis, hamstrings and hip extensors muscles may help decrease the painful symptoms along the sciatic nerve and return the patient’s range of motion without pain.

  • Lie on your back with both feet flat on the floor and your knees bent.
  • First piriformis stretch is done on the side with that has hip and leg pain.
  • Pull the knee of the painful leg up to your chest, grasp the knee with both hands and slowly and gently pull it toward the opposite shoulder.  If you are stretching for right low back and hip pain, the right knee is bent and flexed toward the left shoulder; if you are stretching for left low back and hip pain, the left knee is bent and flexed toward the right shoulder.
  • Do not “bounce” the hold; use only slight gentle force that produces a pleasant feeling as the piriformis muscle stretches.
  • Hold this position for 30 seconds, repeat 3-5 times and stretch 3 times a day during the acute state.
  • Repeat for other side, although you will probably want to do more piriformis and sciatic nerve exercises on the side of greatest pain.


What are the best piriformis syndrome and sciatica exercises?
A variation is:

Piriformis stretch also a sciatica treatment – Sciatic nerve stretches

  • Lie on the back with both knees bent and feet flat on the floor.
  • Place the outer foot of the leg you wish to stretch on the lower thigh/knee of the other leg.
  • Grip behind the thigh and pull this knee in towards your chest.
  • You should feel a stretch in the buttock.
  • Hold this position for 30 seconds, repeat 3-5 times and stretch 3 times a day during the acute state.

Sciatic nerve location in relation to piriformis syndrome

Piriformis syndrome is a painful disorder that is often misdiagnosed because of the complex physical problems that cause it.  Usually drugs and invasive treatment are not necessary for this problem that usually be handled rather well by simple at-home measures.  It is strongly advised that you first consult with your family doctor, chiropractor or orthopedist for examination and diagnosis to know exactly the cause of all low back and hip/leg pain.

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