Piriformis Syndrome is Literally a Pain in the Butt!
By Christi Williams, PT, DPT, OCS, Cert. MDT
Do you find that exercising or running is a royal pain in the butt?
I mean like exercising is causing you actual butt-pain?
If you haven’t already heard of the term piriformis syndrome, it is a condition that causes someone to feel pain in their butt or gluteal region and sometimes further down the leg like sciatica.
Review of the gluteal region:
We have several muscles in this area. We have the gluteus maximus which is one of the strongest muscles in the body (or should be) and deep to it we have the gluteus medius and the gluteus minimus. Many people have heard of these three gluteal muscles before, but there are actually six other, much smaller and lesser known muscles that are very deep within the gluteal region and we often forget that these little guys exist until they literally become a pain in the butt! 😊
Anatomy lesson #1:
The deeper muscles in the gluteal region that help to control rotational movements of your thigh are collectively called external rotators. They consist of the piriformis, the superior gemellus, the inferior gemellus, the obturator internus, the obturator externus and the quadratus femoris. The one we will focus on today is the piriformis and when someone has pain in their gluteal region or in their leg somewhere because of this muscle, we call it “piriformis syndrome.”
Anatomy lesion #2:
The sciatic nerve exits your pelvis and travels into the gluteal region right beneath the piriformis muscle (as seen in the photo above). The sciatic nerve is the largest nerve in the body and it travels all the way down the back of your thigh to the back of your knee, where it then splits and continues to travel (as two nerves) all the way to your foot. You’ve heard of the term “sciatica”, which is when someone has pain or numbness & tingling that follows the pattern of this nerve and is caused by irritation of the nerve itself. The cause of irritation can be from a spine issue (which is most often the case) but it can also be caused by piriformis syndrome, hence the discussion today.
Cause #1 of piriformis syndrome: A tight piriformis muscle (or as your friends might refer to it as you being a “tight-a**”)
Since the sciatic nerve exits the pelvis and enters the gluteal region directly below the piriformis, it makes sense that if this muscle was very tight, it could place pressure across the nerve and cause irritation, especially when we put the muscle on a stretch. The common treatment of choice when we suspect this is happening, is to stretch the piriformis so that it is no longer “tight” and therefore it should no longer place pressure on the sciatic nerve. Makes sense, right? But then why does this issue continue to recur for some individuals? Despite what your friends might say, maybe the cause of a piriformis syndrome is not due to being a “tight-a**” after all…
Cause #2 of piriformis syndrome: An over-stretched/over-worked piriformis muscle
The purpose of the piriformis is that when it contracts, it performs external rotation of the thigh, in other words, it rotates your thigh so that your kneecaps point outward. But it’s a little tiny muscle so it can only do so much. And remember, it lives deep underneath the very large, very powerful gluteus maximus muscle, which just so happens to also perform the movement of external rotation. The gluteus maximus is so large, that it also performs the movement of extension of the thigh (moving it back behind your body) and abduction of the thigh (moving it out to the side) in addition to external rotation.
When someone has a weak gluteus maximus, they tend to develop a movement pattern in which the knee moves inward (medial collapse), which is a combination of flexion, adduction and internal rotation – yes, the exact opposite of the movements that the gluteus maximus muscle performs when it contracts and does it’s job like it’s supposed to. So, you can imagine that if the big dog isn’t doing it’s job like it should, the little guy underneath has to try to work extra hard to pick up for the big dog’s slack. Hence the reason he gets overworked!
Now going back to the movement pattern that someone exhibits when they have a weak gluteus maximus – the medial collapse positioning which consists of hip flexion, adduction and internal rotation…..this positioning is exactly how we would stretch the piriformis.
So not only is this little muscle working overtime when someone is running or doing various activities in which the gluteus maximus is supposed to be doing the majority of the workload, but it’s overworking while it’s being placed on a stretch! This just in….muscles have to work MUCH harder when they try to contract while undergoing a stretch at the same time. In other words, this little guy we refer to as the piriformis, while acting as a “hard-a**” in this situation….doesn’t stand a fighting chance!
So, who cares?
Well, I promise you that anyone dealing with chronic butt pain cares a whole lot! They may have even tried physical therapy in the past but found that it didn’t help. We see this happen a lot. If this is you, I’m asking you to please TRY AGAIN! Contact us at Nashville Physical Therapy & Performance where we will do a detailed evaluation on you which includes a movement analysis!
What’s a movement analysis?
It’s the really, really important part (in fact, the KEY component to solving this problem) of an assessment that often times clinicians who work in high-volume settings do not have the appropriate time to conduct. So the actual cause of the condition gets missed and someone performs stretches for a while and takes time off from running or working-out, they feel better and are discharged from PT but once they return to the activity they love, guess what happens? The pain in the butt returns! And this vicious cycle continues. Movement analysis involves a trained eye (your physical therapist) looking at your particular movement pattern in a variety of positions which may include things like squatting, balancing on one leg, lunging, bending, and many more.
Physical therapy IS the fix for this condition…
But the type of therapy and exercises that you do must be the ones that will address the cause of the issue…not the result of the issue. At Nashville Physical Therapy & Performance, we are experts at finding the true cause because we spend 75% more time with our patients in an entirely one-on-one session. Yes, you read that right, we do not split our time between patients. Only one. At. A. Time. EVER. It’s different. It’s way more effective. It’s worth it.
Ready for the best part?
We can do this type of assessment while social distancing! Movement analysis can be done via a “virtual visit.” So don’t let a pain in the butt drag you down. Do something about it now, while you have the time to focus on it. No lost time driving to an appointment, getting stuck in traffic, finding parking, etc. Just connect via your computer in the comfort of your home. We will take care of the rest.
Contact us today at 615-428-9213 or visit us at www.nashvillept.com. We can’t wait to be the fix for your pain in the butt! 😊