What Is The Piriformis Muscle & Why Does It Hurt So Much?

By December 1, 2020 January 19th, 2021 Educational Videos, Piriformis Syndrome
Medical illustration of the Piriformis Muscle. Why does it hurt so much?

You may not know it from its name, but you definitely know it from the movements it facilitates. It’s a small muscle that’s attached at the sacrum, close to the base of the spine. It runs behind your gluteus muscles and attaches to your femur (leg bone) head. 

Even though it’s a small, deeply-buried muscle, it plays a large role in leg and hip movement. The piriformis muscle helps you “open” and “close” your legs. It helps you sit down and stand upright. It’s also critical for walking, as it keeps you balanced while your weight is in one leg.1

If this muscle gets injured, overused, or stretched too much, it can get tight and chronically hurt. The piriformis muscle is right next to the sciatic nerve, and the pain from that area is often the piriformis compressing the sciatic nerve.2 This nerve starts in the lower spine and goes all the way down the back of the leg, ending in the foot. 

This is why sciatic pain from piriformis compression can show up in the back and lower buttocks, or all down the leg. Since the muscle helps with both sitting, standing, and walking, you can have piriformis pain both in motion and at rest.

Do you experience any of these common ways piriformis muscle pain shows up?

Pain/spasms in the buttocks

When the sciatic nerve gets pinched, it can cause or lead to a number of different sensations.

  • You have buttock muscle pain when sitting. 
  • There’s a burning sensation in the buttocks.
  • There’s “pins and needles” in the buttocks, a feeling it’s “fallen asleep” or buzzing.
  • You get a spasm in your buttock on one side. 

Pain above and below your glutes

The sciatica is a long nerve. That’s why it’s not uncommon to get pain above and below your piriformis muscle. Here are common pain presentations.

  • You get pain in the back of the upper thigh. 
  • You feel lower back pain or tingling, just above your glutes. 
  • You have sharp pain above your buttocks on both sides. 
  • You get pain in both your glute and groin area.
  • You have muscle pain only on one side.

Pain with certain activities

Several specific activities increase the pressure on the muscle. This in turn compresses the sciatic nerve.

  • You have pain climbing stairs.
  • You have pain when you squat lift something.
  • You find you can’t sit for long periods of time.
  • It hurts when you run or bike.

What can make piriformis pain flare-up?

Frequent running and cycling

Exercise is good for muscles but frequent repetitive motion puts a strain on the small muscles. This pain may show up under the buttock when you’re running or biking.3 It can also show up as tightness later in the day.

Injury 

Movements that raise your legs or hips can involve your piriformis. One common piriformis injury comes from lifting something heavy, especially from a squatting position. You can also injure it if you climb lots of stairs or hike up a steep incline. This motion of stepping up particularly increases pressure on the muscle and nerve. 

Your piriformis can suffer injury if it’s engaged, then hit or stretched directly. This is frequently seen in car accidents, a twisted hip from a fall, or a direct hit during a sport.3

Desk and seated jobs 

Seated jobs keep your piriformis compressed for long periods of time. It’s worse when you sit in a flexed position (letting your spine curve like a C).4 If you’ve noticed pain in your right buttock, or the pain is worse on the one side, check your pockets. If you keep a phone or wallet in a pocket, you can be adding to the pressure. 

If you have a job that requires lots of driving, you’re also at risk for sciatic pain. This seated position while engaging your right foot can add to the pain on your right buttock. 

Wheelchair confinement

If you spend most of your waking hours in a wheelchair, then you’re in a sitting position most of the time.5  It’s often hard to maintain good posture while sitting throughout the entire day. Also, if you’re confined to a wheelchair, you may already struggle with muscle weakness. The problem is compounded if you also sleep in a recliner. At that point, you’ll be spending almost 24/7 in a seated position.

Prior hip surgery 

Hip surgeries, like replacements, can put the muscles around them at risk.6 If the muscle was cut, it may not have healed appropriately. The inflammation from the surrounding muscle can also exacerbate the pain.

Uneven or misaligned bones

Your piriformis is a key player in your leg/hip movement. If something makes your hips uneven, you’ll likely feel it in your piriformis muscle. Uneven leg length and spine discrepancies, like scoliosis, can significantly pinch that nerve and cause pain.7

What piriformis muscle pain treatments are available?

It’s important to remember that different situations and levels of pain will likely have a different treatment approach. Piriformis irritation, piriformis syndrome, and sciatica can overlap, but they aren’t the same.

First, your doctor will want to give you an assessment and perform some piriformis tests. Be sure to talk about particular activities that increase your pain or are too painful to do. Your doctor may talk about strategies to alter activities that cause your pain to flare up.

The gold standard for non-emergent sciatic pain is piriformis muscle stretches. You can do them at home or at work. Several easy piriformis exercises include:

  1. The figure 4 seated fold
  2. The standing figure 4 stretch
  3. The supine figure 4 stretch

Your doctor may also consider pain medication or muscle relaxers.

If you have chronic pain or pain from circumstances out of your control, you may find relief through surgery. Many people who are wheelchair-bound, have had an accident, or have a profound pain altering their quality of life experience relief from a piriformis release surgery or a piriformis removal.

Dr. Tollestrep specialized in piriformis removal and can testify to how much it improves his patients’ life. If you or your doctor is considering a piriformis surgery, please give us a call at 702-666-0463. If you’re ready to start the intake process, you can fill out our New Patient Form here.

References:

  1. https://www.ncbi.nlm.nih.gov/books/NBK519497/#:~:text=The%20piriformis%20muscle%20is%20an,during%20flexion%20of%20the%20hip
  2. https://www.webmd.com/pain-management/guide/piriformis-syndrome-causes-symptoms-treatments#1
  3. https://www.healthline.com/health/piriformis-syndrome#causes 
  4. https://www.coachsofiafitness.com/how-to-sit-to-reduce-lower-back-and-neck-pain/  
  5. https://journals.sagepub.com/doi/pdf/10.1177/136140969300700204
  6. https://pubmed.ncbi.nlm.nih.gov/9521528/ 
  7. https://www.health.harvard.edu/back-pain/ask-dr-rob-about-piriformis-syndrome 
[This article is not meant to replace medical advice or diagnosis. Exercise videos linked in the article are not owned by Dr. Tollestrup.]