What is Piriformis Syndrome?

Piriformis Syndrome:
 
Pain in your hips, buttocks or leg can be limiting and frustrating. Piriformis syndrome is a common condition that can cause pain in your buttocks, hips and hamstrings and is often misdiagnosed.

What is Piriformis Syndrome?

Often called pseudo-sciatica and misdiagnosed as nerve pain from a lower back disc bulge, piriformis syndrome is a condition causing pain in your hips, hamstring and buttocks. The piriformis muscle starts at the sacrum (sacral spine) and ends at the greater trochanter (part of the femur before the ‘ball’ that sits inside the pelvis) and helps to rotate the hip.

Piriformis syndrome occurs when the sciatic nerve becomes compressed or irritated by the piriformis muscle as it runs through the gluteal muscles. This compression or irritation can be caused by:

​

• Overtraining
• A dysfunction in the sacroiliac joint (the place where the ilium of the pelvis and the sacral spine meet)
• Weakness in the deep hip stabilizing muscles
• Over-pronating when walking or running

Treating Piriformis Syndrome:

​

After the initial phase of treatment for pain and inflammation, treating piriformis syndrome focuses on strength and stability. Like other injuries and conditions affecting the hip or sacral spine, strong muscles to support and stabilize the joint are essential.

​

Treatment of piriformis syndrome includes:

• Exercises and rehabilitation techniques to realign the pelvis and spine (these will be prescribe and supervised by a physical therapist)
• Exercises to restore normal joint mobility, function and range of motion such as rotational exercises
• Stretching to increase flexibility in the hip, buttocks and hamstrings
• Massaging the hip, buttocks and hamstrings to reduce pain
• Exercises to strengthen the hip, pelvis, spine, and abdominals to build stability
• Orthotics to reduce over-pronation and pressure on the hip

Preventing Piriformis Syndrome:

​

Preventing piriformis syndrome involves stretching, strengthening and stabilizing your hip. These exercises all help to build strength and stability in your hips, buttocks and hamstrings. This helps to reduce compression and inflammation of the sciatic nerve.

​

Exercises that can help stretch and strengthen your hip include:

​

• Hip raises (Lie on your back with your knees bent and feet on the floor. Raise your hips off the ground, keeping your body in a straight line from your knees to your shoulders. Hold and lower your hips back to the ground.)
• Reverse hip raises (Lay on an exercise ball so that your torso is on the ball but your hips aren’t. Place your hands on the floor for stability and rest your toes on the floor. Lift your legs so your thighs are in line with your torso and your body forms a straight line from your toes to your shoulders. Lower your legs back to the starting position.)
• Back extensions (Lay on your stomach on the floor with your legs together and hands by your shoulders. Keeping your legs straight and on the floor, lift your chest, arms and torso of the floor, arching your lower back. Hold and lower your chest to the ground.)
• Deadlifts – straight leg (Stand tall and hold barbell in front of you with an overhand grip – palms facing down. Keep your knees slightly bent and hips shoulder width apart. Bend from your hips without changing the position of your knees, until your torso is parallel to the floor and your back is straight. Return to the starting position.)
• Step ups (Step up onto a bench with your right foot, bringing your left up to meet it. Step down – backwards – with your right foot and repeat on your left leg.)
• Hip adductions (Stand with your feet hip width apart. Lift your right foot off the ground keeping your leg straight. Keeping your hips square – don’t rotate them – cross your right leg in front of your left leg. Return to the starting position. Repeat on your left leg)
• Hip abductions (Stand with your feet hip width apart. Lift your right foot off the ground keeping your leg straight. Keep your hips square and raise your right leg out to the side, away from your body. Return to the starting position. Repeat on your left leg.)
• Fire hydrants (Kneel on all fours so your knees are under your hips and your hands are under your shoulders. Raise your right knee of the ground and keeping your knee bend, raise your leg out to the side so your knee and thigh are in line with your hip. Return to the starting position. Repeat on your left leg.)
• Side planks (Lie on your side with your legs straight and your elbow under your shoulder. Contract your abdominals for support and raise your hips off the ground so you are supported by your feet and arm. Keep a straight line between your toes and shoulder. Hold and lower. Repeat on the other side.)
• Mountain climbers (Start in the full push up positon on your toes with your hands under your shoulders. Bend your right knee and pull it into your chest. Return to starting position and repeat on your left leg.)
• Cable chops (Attach the rope handle to the high pulley on the cable station. Hold the rope with both hands. Standing tall with feet hip width apart and your abdominals contracted for support, pull the rope down across your body without twisting your hips. Return to the start and repeat on the other side.)

Wearing orthotics is a great way to reduce pronation as you walk or run. Pronation creates an imbalance in the muscles leading to a greater risk of compression of the sciatic nerve.

Like many other hip injuries, piriformis syndrome can be successfully treated and prevented with strength and stability exercises. Taking time to strengthen, stretch and stabilize your hips, hamstrings, buttocks and core will help you avoid hip pain in the future.

iACHE is a platform solution for the coordination of care in pain management and addiction disorders. These two conditions require long term and coordinated care that currently does not exist.