Piriformis Syndrome

The hip is a complex joint that requires sufficient mobility and stability to enable us to function in our daily tasks as well as perform athletic activities such as running. Having too little or too much mobility or not enough stability can cause problems. The key is to find the balance between the two.

 The hip can be affected by many different factors such as the way the foot strikes the ground, poor sitting posture, core weakness, and muscle imbalances. Even the act of running itself, since it is a repetitive motion, can contribute to hip pain if other exercises are not done to counteract the overuse of the muscles used during running.

As you can see, a lot of things can go wrong in the hip. For the next couple of weeks, I will be focusing on different aspects of the hip and how it relates to running injury and performance. Today, the focus will be on a common condition known as Piriformis Syndrome.

If you have ever had a pain in your butt, literally, then you probably have experienced some degree of piriformis syndrome. The piriformis is a small muscle located deep within the gluteal region of the hip. Its main function is to externally rotate the hip. The piriforimis’ close proximity to the spine and the fact that a major nerve, the sciatic nerve, runs right next to it (right through it in a small percentage of people), can be problematic. 

The sciatic nerve is the largest nerve in the body. It travels down the leg to the feet and supplies sensation and strength to the lower extremity. Irritation of this nerve can range from a dull achy pain that is localized to the lower back or gluteal region to a sharp, tingling, radiating pain down the leg that can be debilitating. There are a few underlying conditions that can cause sciatic nerve irritation, however, when the piriformis muscle becomes tight or is in spasm, it puts pressure on the sciatic nerve, resulting in piriformis syndrome. Pain from piriformis syndrome is generally localized to the buttocks.

The piriformis muscle isn’t the only culprit in piriformis syndrome. Something else has to cause the muscle to spasm and become tight. This condition often becomes chronic and recurring because many people will only treat the symptoms (pain and burning in the posterior hip region) and don’t correct the underlying cause. Stretching the area will only temporarily relax the muscle. As soon as the runner runs again on an unstable hip, the piriformis will become tight, causing irritation.

Going back to the balance between hip stability and mobility, stability needs to be addressed here. The piriformis plays a large role in stabilizing the hip and femur during the action of running. If the femur is allowed to wobble all over the place during dynamic movements (i.e. running) the muscles that work to stabilize the hip will become overworked.

Here’s an exercise to try at home; the narrow-based, half kneeling rotation. Start in a half kneeling position with a narrow base (less than shoulder width), hold your hands up over head (or hold a broom stick or golf club). Slowly rotate your trunk towards the side of the leg that is in front of your body. Come back to center and rotate the other way. As you rotate, you should feel your core and your hip muscles working to stabilize the femur from moving out of line. Repeat this 10 times. Runners who are also golfers will get a bonus on this exercise of improved thoracic spine mobility, so it might help your swing too!

The narrow- base half kneeling rotation is a fundamental exercise and should be perfected before progressing to standing, more difficult hip rotation exercises. Performing exercises that are too advanced for you will create poor movement patterns, encourage compensation, and result in inhibited performance and potential injury.

As you work to improve hip strength and stability, you still might be feeling the effects of a tight piriformis muscle. Stretching and massaging the muscle is important to help with overall healing, tissue mobility, and return to normal function. Massage prior to stretching is a great way to break up adhesions (scar tissue) that have formed within the muscle and fascia. Stretching alone will not address adhesions, and they must be broken up for normal muscle function to return.

Self- massage tools such as The Orb or the Trigger Point Ball are effective in applying deep pressure and massage to the piriformis and gluteal muscles. Sitting on these tools with the hip in a figure four position will help to expose the piriformis and make the trigger points easier to fine. You’ll know when you’re on one! Once you find a trigger point, hold that position for at least 30 seconds. As the pain decreases, you can slowly rotate your leg and you will feel the tissue move under whichever massage tool you are using. This will be slightly uncomfortable, but it will break up the scar tissue and improve the mobility of the tissue. The pain is temporary, but the positive effects of the massage are long lasting.

If you have been diagnosed with piriformis syndrome, taking the time to correct the underlying cause will help to prevent it from coming back. Proper stretching, massage, and strength training should be a regular part of your routine to prevent piriformis syndrome from occurring.

Stay tuned to future editions of the Sports Medicine Corner as I will be discussing more specifics on hip mobility, flexibility, and other potential injuries in the coming weeks.