What Really Causes Piriformis Syndrome – And How To Fix It For Good

December 12, 2022Dr. Grant Radermacher

How to fix the cause of piriformis syndrome!

Ah, the piriformis: a small muscle that can cause BIG pain. It’s a muscle located deep inside your buttock that runs from your sacrum (or tailbone) to the outside of your hip. And as a Brookfield chiropractor and myofascial specialist, it’s also a muscle I often spend a good amount of time digging into on my patients every day.

When your piriformis muscle is tight or in spasm, it can be a real pain in the butt – both figuratively and literally.

…He’s going to talk about butts again, isn’t he?

The main symptoms of piriformis syndrome are an achey pain and/or numbness deep in your buttocks that radiates down to the upper part of the hamstring. It usually isn’t an abrupt pain – it’s not like you’re running and suddenly experience a jolt of pain. The pain that comes with piriformis syndrome is a slower, more progressive type of pain.

Even worse, because your sciatic nerve runs underneath (and in about 15% of people, through) the piriformis, it can actually cause shooting sciatica-like nerve pain down your leg to your foot.

It’s a stubborn and annoying problem, especially amongst runners, cyclists and office workers who spend the majority of their day sitting. Women tend to be especially susceptible to piriformis syndrome, experiencing it at a rate 6x more than men.

But if you’re dealing with piriformis syndrome pain, don’t lose hope: it’s a fixable problem. Here’s everything you need to know about pirformis syndrome and what needs to happen to correct the root of the problem.

First things first: what is the piriformis?

The piriformis is a small muscle that lies deep beneath the gluteus maximus, beginning at the edge of your sacrum and connecting to the greater trochanter of the femur – the part of your hip feel you can feel poking out on the side of your leg. It assists in stabilization of the pelvis and rotation of the hips, turning the leg and foot outward.

So what causes piriformis syndrome pain?

If you’re a patient at Ascent Chiropractic or if you’ve read this blog enough, you probably know that muscles get blamed way too much for musculoskeletal problems. Muscles don’t just tighten up for no reason; in most cases, they’re simply functioning the best they can given the position and movement of the nearby joints they control and support.

A tight piriformis is actually just a symptom of biomechanical dysfunction going on elsewhere.

While there are some universal stretches that will help everyone dealing with this problem (at least temporarily), if you really want long-term relief from that annoyingly painful, tight, achy butt, you have to address the root cause.

How do you fix piriformis syndrome?

That means fixing piriformis syndrome pain is a two-part process:

1.) Directly treating the piriformis muscle itself to relieve pain, reduce spasm, improve blood flow and halt the inflammation cascade. A few days of rest and ice are almost always the first step towards recovery, usually followed by some combination of stretching, myofascial release therapy, dry needling, IASTM/Graston therapy, Rock Taping and working with a foam roller and/or lacrosse ball.

And, even more importantly:

2.) Correcting the biomechanical dysfunction that caused the problem in the first place. Unfortunately, Dr. Google isn’t a ton of help here. While most people are able to identify pain originating from the piriformis if they know what to look for, it’s a lot more difficult to identify exactly what needs to happen biomechanically to take tension off the piriformis muscle without the help of a professional.

Any treatment needs to be customized to specifically address what’s going on in your body – and that can mean correcting joint dysfunction and muscle imbalances in your pelvis, hips, knees, ankles and even your feet.

The list of possible root biomechanical problems is long (and often a combination of multiple problems). But by far the most common cause of piriformis syndrome pain is sacroiliac (SI) joint dysfunction.

The role of the SI joints in piriformis syndrome

If you put your hands at the base of your lower back, you’ll feel two “bumps” on either side of your tailbone. These bumps are where your sacrum connects to the ilium bones to form the sacroiliac joints.

Few structures are more important than the SI joints when it comes to stability in the body. They’re essential for supporting your body weight and distributing external forces to reduce torque on spine, and they absorb most of the shock and impact caused by walking, running and jumping, helping to efficiently transfer energy between the lower extremities and the rest of your body.

And because they take care of transferring all of the forces between your upper and lower body, the SI joints are especially prone to problems. In fact, it’s estimated that up to 25% of cases of lower back pain are actually caused by dysfunctional SI joints.

The piriformis muscle lays directly over the sacroiliac joint and plays an integral role in its movement, so it’s usually first in line to tighten up in reaction to any instability or abnormal motion.

Naturally, the next question is “why is my sacroiliac joint not working like it’s supposed to?” There are a ton of possible contributing factors, but these are some of the most common:

• Stiff, inflamed facet joints at the lumbosacral junction (where your spine meets your tailbone).
• An anatomical difference in leg length.
• Foot problems such as flat, collapsed arches or high-arched, rigid feet.
• Anterior pelvic tilt and tight hip flexors.
• Prolonged periods of sitting – particularly if you add the extra pressure of sitting on a wallet.
• Pelvic instability due to pregnancy.
• Knee injuries or dysfunction.
• Prolonged or sudden high-intensity exercise.

And finally:

• Weakness or imbalance in the muscles supporting your hip joints, particularly the glute medius.

Briefly, these are the two main warning signs of weak gluteus medius muscles:

You notice your knees going inwards: especially during squat exercises. You may even see your knees internally rotating when walking.

Trendelenburg Gait: This is a movement pattern where the hips drop and hike as you walk because the glute medius is not doing its job of preventing the pelvis from sagging.

Trendelenburg Gait (weak glutes) vs. Normal Gait

Granted, that’s a lot to sort through, so it’s important to see a pro who can diagnose what’s actually going on biomechanically. You don’t want to keep rolling, stretching and grinding your backside into a lacrosse ball if you aren’t getting to the root of the matter.

This much is for sure: the faster you get corrective treatment after symptoms appear, the faster you can expect to get back to living pain-free.

Exercises & Stretches For Piriformis Syndrome

Need relief right now? Here’s a stretch to help relax the piriformis, a ‘nerve floss’ to help open the space around the sciatic nerve, and a simple glute exercise that helps activate the pelvic-stabilizing glute medius muscle.

Disclaimer: This is not a substitute for medical care. Please consult a doctor or healthcare professional to get a medical diagnosis, rule out any serious complications and get advice on a treatment plan for your particular condition.

The Figure 4 Stretch

1. Start on your back. Bend your knees and plant your feet on the floor, roughly hip-distance apart.
2. If your right side is the affected side, cross your right leg over your left thigh, placing the outside of your right calf just above your left knee. Allow your right knee to open outward.
3. Lift your left foot from the floor, use both hands to grasp the back of your left thigh and pull towards your torso until your left hip and knee are at 90º. Your right knee should be pointing to the right side of the room.
4. Hold for 30 to 60 seconds before releasing and repeating.

Sciatic Nerve Flossing

1. Lie on your back and straighten your non-affected leg. Flex your hip on the affected side to 90º, keeping the knee bent.
2. Straighten this leg as much as you can while maintaining a neutral spine (do not arch or round your back).
3. From here, alternate between pointing and flexing your toes for a total of 20 repetitions.

Single-Leg Isometric Glute Bridge

1. Lie on your back and bend both knees to bring your feet directly under your knees. Press your heels into the ground to lift your hips as high as you can while maintaining a neutral spine.
2. Once at the top of the bridge, lift one leg off the ground while keeping your pelvis level.  Hold for 5 to 10 seconds, or as long as you can without letting one hip drop or feeling your hamstrings take over for your glutes.
3. Switch sides. Perform 8-10 reps on each side.

Brookfield Chiropractor Ascent Chiropractic

The bottom line? You can stretch and dig into your piriformis all day, but better digging really needs to be done to find the root of the problem and correct it long-term.

There’s a reason why so many patients choose us: we utilize both chiropractic and myofascial rehabilitative therapy treatments to correct biomechanical problems in everything from your head to your toes. If you’ve been self-diagnosing, living in the pharmacy aisle, or being ignored by physicians, trainers, and therapists who aren’t interested in truly figuring out what the problem is, it’s time to get the relief you deserve.

Ready to get started?

Make an appointment at Ascent Chiropractic in Brookfield by calling 262-345-4166 or using our online scheduling app.

About the Author

Dr. Grant Radermacher

Dr. Grant Radermacher is a Brookfield, WI chiropractor providing unmatched results through gentle, evidence-based chiropractic care. Our mission is simple: get you out of pain so you can get back to being you, only better.

See author's posts