Piriformis Syndrome – Symptoms, Causes, Prevention and Treatments

If you walk with your feet turned outward you may also be at risk for Piriformis Syndrome. See why.

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Piriformis syndrome is a pain in the butt but treatable. Have you felt pain in the hip? Pain in the center of your butt? Or even pain down the back of the leg? You may be suffering from a condition called piriformis syndrome. The piriformis is a muscle that runs from the middle of your sacrum (or tailbone) to the outer hip bone (trochanter). This muscle may be working overtime on your body. From athletes to the workaholic this muscle gets overused.

The muscles in and around the gluteal region help with three areas

  • rotation of the hip and leg
  • stability of the pelvic region
  • balance while one foot is off the ground

Needless to say, all of these characteristics are highly needed by runners (and everyone else, when you really think about it).

Causes of Piriformis Syndrome

Where is this tiny muscle located and what are the risk factors for this sometimes very annoying muscle? The piriformis muscle lies deep in the buttocks, below the gluteus maximus muscle and attaches from the tailbone to the thigh bone. It functions to assist in

  • rotation of the hip and leg
  • stability of the pelvic region
  • balance while one foot is off the ground
sciatic nerve through piriformis

In a good-sized group of people, the sciatic nerve runs through the piriformis muscle, making it vulnerable to muscle spasms. It is important to get properly assessed by your chiropractor if you are in this group. Needless to say, all of these characteristics are highly needed by runners (and everyone else, when you really think about it).

When it becomes tight it can spasm, become inflamed, and put pressure on the sciatic nerve, causing pain, tingling, or numbness. The inflammation may cause scar tissue and adhesions, which can trap and irritate the sciatic nerve. The most common symptoms are pain in the lower back and if it gets severe enough, pain that radiates from the glutes into the leg.

The discomfort may get worse after Sitting too damn long, climbing stairs, walking, running, performing weight-bearing activities, or sitting with a large wallet in your back pocket (Fat Wallet Syndrome).

“If you walk with your feet turned outward you may also be at risk for Piriformis Syndrome.”

Dr Supreet Shah

It is not too far fetched to say that foot dysfunction is the most common cause of piriformis syndrome. Dropped arches lead to overpronating and excessive rolling-in of the feet. This occurs when the piriformis muscle, which is designed to prevent the legs from collapsing inward during walking, has to work overtime to counter the overpronation of the leg. The result is that the piriformis muscle is fatigued from overwork.

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Injuries to the Piriformis

This muscle is a prime suspect for repetitive stress injury (RSI). RSI occurs when a muscle is asked to perform beyond its level of function, not given enough time to recover, and asked to perform again. The typical response from a muscle in this situation is to grip hard. This is a defensive response of the muscle. This tightness, however, presents itself in several ways to an athlete.

  • The first symptom suggesting piriformis syndrome would be a pain in and around the outer hip bone. The gripping of the muscle produces increased tension between the tendon and the bone which produces either direct discomfort and pain or an increased tension in the joint producing bursitis. Bursitis is an inflammation of the fluid-filled sac in a joint caused by an elevation of stress and tension within that joint according to medicinenet.com.
  • The second symptom suggesting piriformis syndrome would be pain directly in the center of the buttocks. Although this is not as common as the other two symptoms, this pain can be elicited with direct compression over the belly of the gluteal area. A tight muscle is a sore muscle upon compression due to reduced blood flow to that muscle
  • The third symptom suggesting piriformis syndrome would be a sciatica nerve pain from the buttocks down the back of the leg and sometimes into different parts of the leg.
sciatica from piriformis spasm

The sciatic nerve runs right through the belly of the piriformis muscle and if the piriformis muscle contracts from being overused, the sciatic nerve now becomes compressed, producing pain, tingling, and even numbness.

Treatment for Piriformis Syndrome

chiropractic side posture adjustment

Chiropractic Care

A very big contributing factor for piriformis syndrome is sacroiliac (SI joint) dysfunction. SI joint dysfunction may lead to neuromuscular issues causing weakness in the muscle itself and other muscles in the region. The chiropractic treatment is aimed at restoring the function of the pelvic, sacral and spinal joints, which is often the cause.

Massage Therapy

Can you massage piriformis syndrome? The answer is yes, however, the severity of your condition determines whether you may need more than one therapy. Massage therapy can provide fast relief for piriformis pain by relaxing the muscle itself. More specific trigger point massage therapy can help reduce inflammatory aspects of the muscle reducing muscle spasms and pressure on the sciatic nerve.

facial rejuvenation acupuncture


Acupuncture care will involve the discovery of trigger points along the GB 30 to midline region of the body. GB 30 is connected to 2-4 trigger areas on top of the piriformis muscle. Chinese acupuncture needles are used at areas of origin of the pain.

To experience the benefits of acupuncture or discover if another treatment might better support you, schedule an initial consultation for evaluation and first treatment.

Shockwave Therapy

This example includes treatment for both myofascial release and trigger point therapy using Extracorporeal Shock Wave Therapy (ESWT). Shockwave therapy to the trigger points uses the concept of focused sound waves to break up knots, improve circulation and promote healing at the injured site.

shockwave therapy

The piriformis muscle is pretty important for all of us. If you’ve been diagnosed with piriformis syndrome and require treatment, we would love to meet you. To get to the root cause of pain and discomfort, schedule an initial consultation, including a comprehensive evaluation and first treatment.