How to Treat and Prevent Piriformis Syndrome

If you have ever felt pain in your butt while running then chances you have some degrees of piriformis syndrome.

This condition is pretty common regardless of your training experience and background.

In today’s post, I’ll be discussing some of the common causes of piriformis syndrome in runners, the right treatment course, as well as some of the prevention measures for protecting against re-injury.

What is Piriformis Syndrome?

Piriformis syndrome is a condition in which the piriformis muscle spasms or contracts, causing chemical and/or mechanic infiltration to the pain receptors on the sciatic nerve, causing pain along its path.

This might sound like a lot to unpack so let’s start with defining the piriformis.

What is The Piriformis Muscle?

The piriformis is a triangle-shaped gluteal (buttock) muscle located deep within the gluteal region—behind the Gluteus Maximus.

This muscle originates on the front surface of the sacrum, extends through the greater sciatic foramen and attaches into the greater trochanter of the femur (upper thighbone). Check image.

The piriformis muscle carries many key functions. It supports the external rotation of the hips, ensures pelvis stabilization, and keep the hips level while performing all sorts of movement—running is no exception.

This why your piriformis muscle must be strong to withstand the repetitive forces of running.

What Causes Piriformis Syndrome?

Repetitive movement, especially when it’s a high impact (think running), can drain the piriformis muscle and irritate the nerve enclosing it. This, over time, results in pain and eventually injury.

Factors that could contribute to the onset of the condition include :

  • Sleepy glute syndrome—or simply having weak glutes.
  • Weak hamstrings
  • Prolonged sitting
  • Weakness in the deep hip stability muscles
  • Overpronating feet
  • Bad running form

Symptoms Of Piriformis Syndrome

According to my research, piriformis syndrome is one of the more challenging injuries to diagnose.

Initially, the condition may manifest as soreness or tightness in the middle of the buttock area or tenderness along the back of the hip joint.

Typical piriformis telling sings may include

  • Sciatica-like pain down the back of one or both thighs, calves, sometimes extending to the feet.
  • Limited range of motion in the hip joint, especially internal hip rotation.
  • Tenderness and pain in the buttock
  • Pain is worse when landing and pushing off during the running gait.
  • Pain is worse with prolonged sitting or lying on the back.

Don’t Confuse It

Since the sciatic nerve runs right next to—or through—this muscle and down the leg, an affected piriformis muscle can cause pain that shoots down the length of the leg and down to the foot.

For this reason, this condition is often confused with a host of other ailments—most notably sciatica.

The Treatment Of Piriformis Syndrome

Piriformis syndrome is a condition that can sideline you for weeks or months at a time. I know that’s the last thing you want to hear if you’re dealing with it now.

Treatment options for piriformis syndrome revolve around managing the irritated piriformis muscle.

Here are some of the recommended options.

Rest

The first thing you need to do on the onset of pain is to rest the piriformis muscle.

Stepping back from running—and high impact exercise in total—can grant the piriformis muscle time to recover.

It’s okay to keep training as long as you can do pain-free but avoid more-intense and/or longer-than-usual runs. These will only increase the risks of overload on the muscle.

Ease the Pain

Apply ice on the affected area a few times per day for 10 to 15 minutes. Or take an over-the-counter anti-inflammatory medicine during acute phases—when the affected region feels tender to the touch.

Visit a Doctor

Seek medical help in case the above treatment options prove futile.

One of the most common treatment measures is injecting a drug straight into the muscle to reduce the swelling.

In some rare cases, surgery might be required to cut directly through the muscle and relieve the pressure, therefore easing the tension that contracts the sciatic nerve.

Preventing Piriformis Syndrome

The best way to minimize re-injury risk is to reduce the piriformis muscle’s vulnerability.

External factors, such as poor running form, excessive mileage, overtraining, running on banked surfaces, or wearing improper shoes, can all over-tax this muscle, leading to trouble.

Stretching

Regular stretching helps reduce inflammation, stiffness, and pain along the sciatic nerve.

Research has concluded that yoga is effective for patients with piriformis syndrome and sciatic nerve pain.

Foam Roll the Piriformis, Quadriceps and IT-Band

Leg Slides

Knees to the Side

Improve Your Form

Faulty running mechanics can also be blamed for piriformis pain. That’s why you should invest more time into improving your form.

Lucky for you I’ve extensively covered the subject of proper form. Here are a few posts to check out:

Post 1

Post 2

Post 3

Post 4

If you can afford it, hire a running coach who can watch you run and assess your form.  Have your running technique assessed and evaluated and check for any muscle strength imbalances and leg-length discrepancies.

Strength Train

Strength training is also recommended in a few research papers.

One example is research published in the Journal of Orthopaedic & Sports Physical revealed that strengthening the adductor muscles of the hips can reduce symptoms and relieve pain in patients with piriformis syndrome.

Best exercises include:

Clams

Toe Touch Drill

Squat

Deadlift

Run On proper Surfaces/ No slanted Surface

Avoid running on slanted surfaces. This increases the likelihood of pelvic misalignment, and that puts you at a higher risk for an overuse injury.

If you must, then make sure to switch up which direction you run on the track.

Conclusion

There you have it! The above treatment options and training guidelines are all you need to relieve piriformis syndrome symptoms and keep training pain-free so you can reach your running goals as soon as you can. The rest is up to you.

Please feel free to leave your comments and questions in the section below.

In the meantime, thank you for reading my post.

Keep Running Strong.

David D.

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