The piriformis is a gluteal muscle that can certainly be a pain in the butt… and your knee and even all the way down your entire leg! It’s probably best known for being correlated to the sciatic pains a lot of us can say we’re familiar with, known as piriformis syndrome. Less known but still very relevant of an issue is that the piriformis can contribute to knee pain if tight or injured. Surprisingly, the way we use our bodies in todays developing world, it’s very likely that most people actually have a tight piriformis.
The piriformis originates inside the pelvis and extends out to your femur bone near your hip. It’s a very deep muscle, (deep to your gluteus maximus) so you can’t feel it if you tried to touch it, however it is still a big player in your anatomy. The piriformis is part of a group of deep gluteal muscles that work to externally rotate the thigh (turning your leg outward). It’s such a key muscle because what passes just underneath the piriformis to run down your leg is the famous sciatic nerve. You can see in our picture here that if the piriformis was to tighten and press down, it would be squeezing the sciatic nerve, creating what can be debilitating pain, numbness and tingling.
What type of person do we typically see having problems with this muscle?
· People who perform repetitive, vigorous activity, such as runners or cyclists
· People who sit a lot, especially with their leg(s) rotated outward
· Anyone who experiences trauma to the gluteal region
· And so on...
You can’t be exactly sure that your piriformis may be tight or injured until you get an examination from a health professional, since the piriformis works with other muscles in the gluteal region to perform similar tasks. This makes self-diagnosis very unreliable and possibly harmful. It is also quite common to mistakenly assume you have piriformis syndrome when you really have a lumbar spine issue causing your sciatic symptoms. In this case, stretching the piriformis will not solve your problem, and may even exacerbate your spine condition.
To identify the true cause of your sciatic pain or knee pain, you really need a full assessment of all of the muscles of your lower extremity, including an assessment of your lumbar spine and your movement patterns. At Nashville Physical Therapy we have specialists who can perform a Total Body Wellness Assessment and/or a Running Analysis in which we can identify any weak muscles, tight muscles, joint restrictions and movement pattern issues and then provide the specific exercises needed to address the true cause of your pain. For more information on running analysis, piriformis and knee issues, check out one of our previous blog posts about piriformis syndrome.
Other facts about the piriformis:
· In the majority of people, the sciatic nerve passes underneath the piriformis, however in approximately 12.2% of the population, a portion of the sciatic nerve actually passes through the piriformis muscle, piercing the muscle itself (Moore, Dalley, Agur, 2014). You can imagine that sciatic issues due to the piriformis can be much more likely in this population.
· A tight piriformis can also contribute to knee pain from a misaligned kneecap during movement, especially in runners and other athletes!
· Strengthening the external rotators (this includes the piriformis) can be done with a seated external rotation exercise using a resistance band. (Stay tuned for our Workout Wednesday post on social media).
· A tight piriformis makes it difficult to rest your ankle on top of the opposite knee as you’re sitting in a chair (most people notice this putting their left leg up since they’re less used to doing it on that side).
· The piriformis stretch is an excellent and satisfying way to help get some tension released, but again, it isn’t a fix-all solution, especially if part of the problem is related to the lumbar spine.
· The piriformis is supplied by the nerve to the piriformis (S1-2)…a very creative name for a nerve.
· The piriformis can be related to pelvic floor dysfunction. To learn more about the pelvic floor, download our free e-book by clicking HERE
If you suspect you might have a piriformis problem and want a professional to look at it, click HERE to set up an evaluation with one of our physical therapists.
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