Piriformis Syndrome - A Real Pain in the Butt

If you have been reading here for awhile, then you know how injury prone I used to be.  After a lot of physical therapy, backing off (less is more!) and more stretching and cross training, I consider myself a reformed injured runner.  There is one injury, however, that rears its ugly head every once in awhile - usually when I've become complacent in my injury management.  For years, I noticed a persistent shooting pain down my right leg, coupled with sharp pains in my general hip/glute/lower back area.  Finally, I went to a physical therapist.  I thought for sure I had sciatica.  I thought for sure that someday I was going to need surgery to relieve the pain- it was that bad.    When I went to the PT, her diagnosis shocked me a bit, but with some relief.  The verdict? A plain old really tight muscle, also known as piriformis syndrome.

What is the Piriformis?

The piriformis is a small, flat muscle that lies within the glute region, hiding under and around other muscles, making it a bit difficult to find.  Foam rolling this area can be interesting, as it always feels like you are close to the source of pain, but can't quite get there. This is when a massage comes in handy.  The piriformis is a hip rotator, so is an important stabilizer in walking and running.  It also happens to sit really close to the sciatic nerve.  

What is Piriformis Syndrome?

Piriformis Syndrome is a fancy way of saying "a really, really tight muscle".  The issue is its proximity to the sciatic nerve. According to the Cleveland Clinic, "sciatica" is simply a symptom of pain caused on the sciatic nerve, which can be caused by piriformis syndrome.   When the piriformis becomes extremely tight, it can press on or irritate the sciatic nerve, causing pain that shoots down the nerve into the leg.  There are various symptoms of sciatica, such as numbness and tingling.  My main issue has always been a sharp, shooting pain that radiates down the leg.  It becomes extremely uncomfortable to sit, to stand, to walk, or do just about anything. Additionally, sciatica pain is only one of the symptoms.  Often (as in my case), this pain is also accompanied by lower back pain and general pain in the glute area.  In short? It sucks. 

Treatment:
Depending on the severity, it can be treated with stretching and foam rolling or massage (or both). If your pain is very persistent or bad, seeing a physical therapist or a doctor are your best bet.  In my case, seeing a physical therapist completely, 100% alleviated my pain.  I still get it, but now I know how to treat it.  And when it acts up, I know I've been slacking in my stretching.  My main sources of relief come from stretching, foam rolling, and massage.  I like this foam roller:

Stretches:

Stretches like side twists and pigeon pose can help target this hard-to-reach muscle.  My personal favorites are these:

In this particular stretch, I find I am able to get deeper into the muscle if I use my elbow to gently push the knee out more, rotating everything just a bit more.

Source

Pigeon pose is another great stretch for this area:

Step by step pigeon pose instructions

Side twists can also target the irritated or tight piriformis.  This video has a fantastic explanation of the above stretches as well as how to do a side twist to target the piriformis.

In general, I find any type of glute stretch definitely helps, however sometimes targeting that hidden, tight piriformis can be as much of a pain as the tightness itself.  These stretches may help. Of course, in the event of any significant pain, see a doctor or physical therapist.

What glute or piriformis stretches do you do?