Piriformis syndrome

The symptoms

Pain in the lower back and/or buttocks, sometimes feeling as if it’s deep inside the glutes. It may be too painful to sit on the affected buttock. The pain and/ or tingling can radiate down the backs of the legs as well.

What’s going on?

The piriformis muscle runs behind the hip joint and aids in external hip rotation, or turning your leg outward. The catch here is that the piriformis crosses over the sciatic nerve. The piriformis muscle can become tight from, for example, too much sitting (a problem many WFH/office folks can relate to). The muscle can also be strained by spasm or overuse. In piriformis syndrome, this tightness or spasm causes the muscle to compress and irritate the sciatic nerve. This brings on lower-back and buttock pain, sometimes severe. The diagnosis is tricky because piriformis syndrome can very easily be confused with sciatica.

The difference between these diagnoses is that traditional sciatica is generally caused by some spinal issue, such as a compressed lumbar disc. Piriformis syndrome becomes the more likely diagnosis when sciatica is present with no discernible spinal cause.

Runners, cyclists and rowers are the athletes most at risk for piriformis syndrome. They engage in pure forward movement, which can weaken hip adductors and abductors, the muscles that allow us to open and close our legs. Throw in some weak glutes, and all those poorly conditioned muscles put extra strain on the piriformis. And you’ve got a painful problem.

Another risk for runners: Overpronating (when your foot turns inward) can cause the knee to rotate on impact. The piriformis fires to help prevent the knee from rotating too much, which can lead to overuse and tightening of the muscle.

Fix it

Employ dynamic rest: Stop the offending activity (if your pain is moderate to severe, you’ll want to anyway). Use upperbody workouts to maintain fitness. Core work will probably be a problem, because your lower back and glutes will hurt. Let the pain be your guide and make sure that you back off immediately if you do anything that hurts.

Try an NSAID: An antiinflammatory like ibuprofen or aspirin can help with swelling and inflammation. Stretch your hip rotators: As pain allows, try to gradually open up your hips by stretching your hip flexors and rotators. These two stretches can help... Seated piriformis stretch: While sitting in a chair with your back straight, rest your ankle on your opposite knee. Then gently press down on your knee until you feel a stretch in your hip. Hold for 10 to 15 secs. Repeat several times for each hip.

Lying piriformis stretch: Lie on your back with your knees raised and your feet flat on the floor. Put your right ankle on your left knee. Raise your left foot while pressing down on your right knee until you feel the stretch in your hip and buttock. Hold for 10 to 15 secs. Repeat several times, then reverse the leg positions to stretch the left side and do a few reps. You can find additional hip flexor stretches in the ‘Hip flexor strain and/or tendinitis’ section on page 24.

Prevent It

Many of the interconnected muscles in this region – piriformis, glutes, hip flexors, hamstrings, quads – support one another, and weakness in one area can mess up the works. In short, if you want healthy piriformis muscles, you need to prioritise total-body fitness. The stretches and exercises here build powerful glutes, hamstrings, quads and hip flexors and can be added to any workout.

You can also work these effective leg-building activities into your routine: uphill walking and sprinting; sprints with directional change, such as figures-of-eight, shuttle runs or cone drills; stairs; pool running or aerobics; cycling.

FIRE HYDRANT IN-OUT

Get down on your hands and knees with your palms flat on the floor and shoulder-width apart. Relax your core so that your lower back and abdomen are in their natural positions. Without allowing your lower-back posture to change, raise your right knee as close as you can to your chest (your knee may not move forward much). Keeping your right knee bent, raise your thigh out to the side without moving your hips. Kick your raised right leg straight back until it’s in line with your torso. That’s one rep.

STANDING HIP ABDUCTION

Secure a resistance band to a sturdy object – a table leg, for example – then loop it around your left ankle. Start with your legs as close to each other as you can while keeping resistance on your working leg. Raise your left leg straight out to the side, as far as you can. Pause, then return to the starting position. Be sure to perform equal reps for each leg. Note: this can also be done at the cable machine in the gym.

LATERAL BAND WALK

Put a resistance band around your legs and position it just above your knees. Take small steps to your right for six metres. Then sidestep back to your left for six metres. That’s one set.

JUMP SQUAT

Place your fingers on the back of your head and pull your elbows back so that they’re in line with your body. Perform a body weight squat until your thighs are parallel to the floor, then explosively jump as high as you can (imagine you’re pushing the floor away from you as you leap). When you land, immediately squat and jump again. Hold dumbbells at your side to make it more challenging.