Piriformis Syndrome – Pain in the Buttock

By Dr Guy Ashburner | March 9, 2020

The piriformis muscle lies deep in the buttocks

“The mechanical principles on which Osteopathy is based are as old as the universe” - Philosophy of Osteopathy

The piriformis muscle lies deep in the buttocks, below the gluteus maximus muscle. Piriformis originates on the lower part of the spine called the sacrum and attaches to the thigh bone. It aids us to walk, shift our weight from one foot to another, and maintain balance. Tension in the piriformis muscle may manifest in a variety of pain symptoms.

The sciatic nerve runs underneath and sometimes through the piriformis muscle making it vulnerable to muscle spasms. Spasm to the piriformis muscle and adhesions in the associated fascia can cause the sciatic nerve to become irritated and compressed and it usually starts with dull and aching pain deep in your buttocks, typically only on one side, pain down the back or side of your leg that can extend to your calf and foot (sciatica). Symptoms usually begin mild and include tingling along with mild pain in the hip and buttocks. If piriformis syndrome is left untreated, however, it can lead to debilitating pain and limited mobility.

A common cause of piriformis syndrome is sitting for prolonged periods of time, which can cause tightening of the muscle. Sitting with a large wallet in the affected side’s rear pocket may be a causative factor. Usually prolonged sitting or driving can be unbearable. Symptoms can be aggravated by stair or hill climbing with poor biomechanics. Other causes of piriformis syndrome may come from accidents and injuries to the buttocks that may occur during a fall, sports injuries or a car accident.

Poor sitting posture, lack of appropriate physical activity, muscle imbalance, weak muscles in the pelvis (inability to do hip dominant squats), sitting with legs crossed, poor flexibility, poor gait (walking, running, stair climbing with your foot turned out for extended periods of time), sports injuries that are left untreated, a history of and or underlying back, hip, knee and foot problem can all lead to or contribute to this condition. This makes it a common malady for runners, dancers, water polo players and squatting with feet turned out. Athletes with poor biomechanics are at a greater risk for developing piriformis syndrome due to the constant movement of the piriformis muscle. Foot over pronation is another common cause of piriformis syndrome. This forces the knee to turn to inwards, which in turn places a greater strain on the piriformis muscle.

One of the only effective ways to treat this condition is through osteopathic care. From an osteopathic perspective, the entire body is an integral whole of interrelated moving parts. For this reason, when an osteopath works to heal a certain part of the body he will also focus on other parts that may at first not appear to have a connection. For example, by treating a foot or a leg, the pelvis, or even the spine, an osteopath can help to loosen up the piriformis muscle and allow it to heal naturally.

Osteopathic treatment for piriformis syndrome may include myofascial release, along with passive stretching, massage, joint articulation, spinal manipulation and cranial osteopathy. Posture and ergonomic advice and appropriate biomechanical exercises may be prescribed as well as to avoid the activities and habits that have led to this imbalance in the first place. In a fallen arch or another foot dysfunction foot orthotics may be advised.


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