Run Well! : Piriformis Syndrome
We are excited to kick off a new series in partnership with Sports Injury Clinic. www.sportsinjuryclinic.net This site has been a well used site by me over the last year as I have worked through various injuries. It provides the right amount of detail about the injury and tips on treatment as well. And while we hope you don't have the need for the resources, we are pleased to offer articles in tips in the event you are dealing with a running injury.
Piriformis is a small muscle located deep in the buttocks. It originates from the lateral aspect of the sacrum and crosses the buttock horizontally to insert into the greater trochanter of the femur. It is responsible for externally rotating and abducting the hip joint.
Piriformis syndrome is often the cause of sciatic pain in runners. The Sciatic nerve emerges from the vertebral column via the lumbar and sacral plexi at levels L4 –S3. From here it passes through the buttock and down the posterior thigh, before branching out into several smaller nerves. [Picture at right from SportsInjuryClinic.com]
The course of the sciatic nerve runs just below the piriformis muscle. If the piriformis muscle becomes tight then this can lead to the muscle impingeing on the nerve. Also, in up to 20% of the population, the sciatic nerve actually passes directly through the muscle belly. This predisposes the individual to developing this condition.
The symptoms of piriformis syndrome usually include:
Ø Dull pain in the buttocks and (or) down the back of the leg
Ø Pain gradually comes on over a period of time
Ø It is often aggravated by running and sitting for long periods
Ø The piriformis muscle is usually tender to palpate (touch)
Ø Numbness or tingling may be felt in severe cases in the posterior thigh and calf
Ø The range of motion at the hip may be limited, especially into internal rotation
What causes piriformis syndrome?
Piriformis syndrome results most regularly through muscle imbalances caused by repetitive movement with poor biomechanics. The most common scenario in runners is that the hip adductors (groin muscles) are very tight, and the hip abductors (including gluteus medius and piriformis itself) are not strong enough to counteract this problem. This causes them to become overworked and ‘tight’.
The treatment of piriformis syndrome is usually quite striaghtforward and results can be seen relatively quickly.
Treatment should focus on:
Ø Rest from the aggravating activity
Ø Startching of the tight muscles – piriformis, adductors and sometimes hamstrings too
Ø Self-massage using a foam roller or tennis ball to the piriformis muscle can be effective
Ø Strengthening the hip abductors
In order to stretch the adductor (groin muscles) effectively, you should stretch both components – the short and long adductors. To stretch the long muscles, stand with a wide stance and bend the knee of the leg you DO NOT wish to stretch. Put your weight on this leg and tilt your hips to the side until you can feel a stretch on the inner thigh of the straight leg.
To stretch the shorter muscles, sit on the floor with the soles of the feet together (knees bent). Use the elbows to apply a gentle pressure on your knees (push down) until you can feel a stretch in the groin.
Hold both of these stretches for 20-30 seconds each and repeat them 2-3 times each. Try to go through this routine at least 3 times a day.
To stretch the piriformis muscle, lay on the floor on your back with the feet flat on the floor. Lift the foot of the leg you want to stretch and place the ankle on the other thigh. Hold this position as your grasp behind the non-stretching thigh, pulling the knee towards the chest until you can feel a stretch in the opposite buttock. Again hold this for 20-30 seconds and repeat 2-3 times, 3 times a day.
We always advise seeking professional treatment in order to return to fitness as soon as possible and free from pain! A professional sports injury specialist may also:
Ø Use sports massage techniques on the piriformis, other hip abductors and groin muscles.
Ø Use other treatment modalities such as ultrasound or intereferential.
Ø Perform a gait analysis so that they can determine if there are any other factors which may be contributing to your injury.
Ø Devise a full rehabilitation programme.
For more information on Piriformis Syndrome treatment and rehabilitation, including a sports massage demonstration, rehabilitation programme and further stretching and strengthening exercises, please visit: