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Piriformis Syndrome: How To Get Rid Of This Pain For Good

Written by: Nick Jack
Category: 2014
on 03 April 2014
Hits: 65119

Piriformis syndrome is an irritation of the sciatic nerve caused by an inflammation of the piriformis muscle. This often feels like a deep aching pain in the buttock, or a radiating sharp nerve pain that extends along the middle of the hamstring muscle in your leg. Some people even feel numbness and tingling right down into the calf and toes. These symptoms can be accompanied by low back pain and worsen after prolonged sitting. This is where it can often by misdiagnosed as a different injury and left untreated. The symptoms of often mimic those of many other injuries such as a herniated disc pressing upon the sciatic nerve, and various other hip or back problems. To be sure you have piriformis syndrome, the problem should be properly investigated by a medical professional to rule out more serious possibilities. You must also understand that this condition will become chronic if left untreated, so getting started with a treatment program straight away is critical. Rest and anti inflammatory medication may help in the beginning to reduce pain, but will not provide the solution to getting rid of it for good. A very carefully designed exercise program, that focuses on treating the cause, is the only effective way to deal with this injury. Even surgery will not address the real problem, which you will see in this article has a lot to do with your glutes (buttock muscles), your hips and most importantly how you move!

GET A COPY OF OUR FULL PIRIFORMIS SYNDROME REHAB & PREVENTION PROGRAM

Before I get into our article I would like to make a note of caution. Due to the complexity of this condition it is impossible to have a one size fits all program that works every time. You need to assess your condition and then use the results of those tests to determine what is needed for your body. This article I will share some of those tests, and basically the process of working through this injury but understand to keep the article to a reasonable size I have left a lot of exercises and stretches out.

You can get all the tests, exercises and stretches in a detailed video and book format below. Without a doubt the most detailed of all of our programs, as it is so difficult to work with. We had to document over 200 programs and real life case studies in order to put this program together. Included is over 60 different exercises along with 25 different assessments to identify where to start. This has been simplified down so that a person who has no gym background or equipment can still execute this program effectively. Most of the people who completed this program were everyday people, not gym junkies or athletes, although there were many runners and a few dancers who helped us put this program together.

My advice to you is to read this article and then go straight to our online shop and get your copy of the full program because this article cannot explain exactly what you need to do. I just don't have enough room on the page to explain it, and it is easier in video to show you than with text. For more information about what is inside this click here on the images below.

 

DOWNLOAD YOUR FREE PIRIFORMIS SYNDROME CHEAT SHEET

If you want to have a simple sheet to remind you of what to do we created a cheat sheet to stick up on your wall. I find these simple tools very useful for reminding my clients of the importance of daily activities. This cheat sheet will provide you with the '7 Steps To Overcome Piriformis Pain' and help you on your way to overcoming endless pain and expensive medicine bills. Download this right now and stick it up on your wall. It is FREE with no strings attached!

 

Simply click here to download your free cheat sheet now.

WHAT IS PIRIFORMIS?

The piriformis is a muscle that lies deep within the buttocks, covered by the massive gluteal muscles ( your butt). It’s job is to externally rotate the hip when it is extended, and abduct the hip when it is flexed. Just about every ballet dancer or dancer of any kind for that matter has heard of the Piriformis muscle, as it is the muscle that rotates the thigh, giving the ballet dancer the ability to turn their feet outwards to opposite walls. This can only be done with maximum contraction of the piriformis.

Many runners are also very aware of this muscle, as the act of running involves being on one leg 100% of the time. So if you have trouble stabilizing your leg in a single leg stance there is likelihood that the Piriformis muscle will become overworked, short and tight. Now we all know it is not good to have short tight muscles, this muscle is particularly bad due to it’s location. It is located right near the sciatic nerve, which comes from the spinal cord and is the largest nerve in the body.  When the Piriformis overworks it begins to thicken and shorten, developing trigger points but even worse it may compress the large sciatic nerve. The compression  feels like a deep aching pain in the butt or a radiating sharp nerve pain that extends along the middle of the rear thigh. Occasionally numbness and tingling can continue to the calf and toes. These symptoms can be accompanied by low back pain and worsen after prolonged sitting.

HOW BEST TO TREAT IT WHEN IN SEVERE PAIN?

I mentioned in the intro that this injury mimics symptoms of other injuries like a disc bulge or sciatica which is a back injury and not piriformis syndrome. So make sure you are dealing with the right problem before moving forward as I have seen many cases where it was a herniated disc injury.

For more information about knowing what you are dealing with you can read our article - How Do You Know If You Have Sciatica or Piriformis Syndrome?

You can safely say in almost 95% of cases Piriformis syndrome all starts as a response to Poor Posture, overuse and repetitious movement. In some cases it can be due to a severe knock such as in a football game but in most cases it is poor posture that has set you up for the injury. If the inflammation is severe, impingement of the sciatic nerve results. Treating the pain with anti-inflammatory can reduce the pain and decrease inflammation which is one method we use with clients when it is at its worst. But as a long term course of action it is not ideal as who wants to be stuck on anti inflammatory for the rest of their life? And of course when it is at it’s worst, rest is essential. Trying to implement a rehab program when you are in significant pain is not wise as you will develop new movement patterns to avoid pain, that could hang around after the pain has gone, which in turn can create new problems.

At this stage it would be wise to see a Physiotherapist or Osteopath to discuss further treatment. Massage therapy is excellent as it can help break up myofascial tightening and trigger points. Unfortunately one visit to a massage therapist won’t fix you. You must adopt a consistent approach of stretching and loosening what is tight, quickly followed by strengthening what is weak And once you are in a position to start your rehab program avoiding the activities that aggravate it such as sitting for too long, running, lunges and squats is also essential for your program to work.

IDENTIFY THE CAUSE

The two videos above give you some great insights into firstly how this injury is created, and secondly what happens when it is left unattended. One reason why getting massage to address piriformis will give you a fairly poor result is that loosening this tight muscle has only a small impact on hip bio-mechanics, because it is such a tiny muscle, and a fairly weak muscle at best. It is also hard to get to unless you move the big glute muscles out of the way by crossing your legs over each other.

So how does this little tiny muscle become such a pain in the bum? Some of this has to do with your anatomical genetic make up, but as mentioned earlier in most cases it is due to Poor Posture, overuse or repetitive movements coupled with poor strength in the muscles that stabilize the pelvis and hip, being mainly the abdominal muscles and glutes. As the primary muscles of the hip become fatigued, the smaller muscles, like piriformis, work harder to maintain form. Trying to compensate for stronger muscles is how the piriformis becomes strained. So before starting any kind of exercise program, stretching program, booking in for regular massage, find out what repetitive movements you are doing and change them.

Get a thorough Postural Assessment from a qualified Personal Trainer, CHEK Practitioner or Osteopath and the work out what factors are contributing to your postural concerns. This is the MOST IMPORTANT STEP in succeeding in getting rid of your pain.

1: TRIGGER POINT RELEASE, MOBILITY & STRETCHING!

Trigger point release and restoring mobility to tight joints must be priority number one. Stretching may not always be the best way either. With dancers and hyper-mobile people this can be why the got piriformis syndrome in the first place as the joints are too unstable! To know if you need to stretch you must assess your body. I suggest reading our articles below with great detail on specific stretching and mobility drills to use.

It is important to loosen areas around the hips as you will find that this is one big reason as to why you continue to have problems. Your hips are becoming your stabilizers! If you skip this stage or do not spend enough time restoring range of motion to the joint you will encounter problems later!

Trigger point release can be difficult to explain so below is videos of how to release some common areas of tightness in the hips and how we might loosen them up in preparation for exercises to stabilize and strengthen.


2: Learn How To Stabilize

Before going to straight to strengthening which is what most personal trainers would do, you MUST encourage great movement and range of motion with perfect stability. Stability is one of those topics that people get very confused with. The use of planks and other so called "core" exercises really contribute to people's problems and in some cases are a real reason why they got the injury. Make sure you read our comprehensive article "Stability Training What Is It Really & How To Do It Right" for more detailed information and a stack of ideas on getting this right.

Below I have provided examples of exercises like the hydrant, horse stance and lower abdominal strengthening which are some very simple low level drills to encourage stability of the hip, shoulder and spine. All of these are great at integrating the core with the legs in movements needing stability for movement. And they are very gentle on the body meaning you can complete them without pain! Often a step missed in the rehab process, but absolutely critical if you want to guarantee long term success. You need to ensure the body can maintain perfect pelvic alignment and stability before you try to move.

   

These exercises are great for a starting point as there is a lot more you may need to try, especially around the hips. If you watched the videos about hip stiffness earlier you will see how this is so important. Below is a video of a great stability drill I like to use for teaching stability in the lunge which you will need to do later.

3: Use Isolate Strength Drills

Again this is dependent on your postural assessment but in most cases we find the glutes and lower abdominal muscles to be the most dysfunctional. Which is where your strength training must focus on in the beginning.

We like to use the "isolate to integrate" approach to strength training. Patience and adhering to the Form Principle here is crucial. The Form Principle means only complete as many reps that are with good form. Once the muscles have begun to show signs of improving strength in an isolated movement such as the Bridge and the Clam (pictured below) you must begin to develop full body integrated movement patterns in a standing position. Read our article on how to improve Glute Strength for more ideas and information on isolated glute strength.

To get the most out of these exercises you must use slow tempo and sets of 2-3 with reps of 15-20. Once you begin to feel these muscles are firing the way they were supposed to you are ready for integrated strength.

 

4: You Must Strengthen In A Standing Position

Learning to squat, lunge, deadlift walk up stairs to eventually run, jump etc are all parts of the rehab process that must be learned properly to complete your program. Again without sounding like a record, this is where many programs fail as they do not progress people to standing positions. Pilates is a perfect example of this where all of the training is performed sitting, lying and kneeling. But the pain, dysfunction, cause and ultimately all of the problems will be found in the standing position. So how can you learn how to get rid of your condition if you spend all of your training time in a completely different position?

You will also find more about the following exercises in our article The 4 Best Exercises For Piriformis Syndrome

Here are the key movements you must firstly develop as a perfect movement and second improve the overall strength and stability with.

Deadlifts

This would be one of the best postural retraining exercises, targeting the glutes that you can do. It also is very tricky to get right and can produce severe injuries like disc bulges if performed poorly. Watch the videos below of ideas on how we teach it.

Squats

Watch the videos of how to do Squats below to get an idea of what a perfect squat would look like and how you can teach your body to integrate muscles from the core, glutes, quads and hips to work together as a well balanced team.

Lunges

Lunges are one of the most difficult exercises to use for it involves a significant amount of hip mobility, which as we already have seen this is really lacking in this condition. This pattern is very important for runners and really walking for this is where motion and forward movement is going to be generated. You MUST spend a lot of time trying to improve this to get on top of your pain.

Read this article "Why Lunges Are Essential For Fitness Success" to see just how important they really are!

Single Leg Stance

I saved the most important and also the most difficult for last. If you get to this stage and are able to effectively perform weighted single leg squats and single leg deadlifts without pain and you feel just general glute soreness you are DONE! This exercise is the one that is most likely to aggravate your symptoms, but it is also the same one that if you get it right is going to get rid of it for good. You must be trying to get to this stage. Everything up to now has been getting you ready for this movement. When you think about how much you need single leg movements in daily life, walking for one, you will see how easy it is to aggravate your injury if you have a poor movement strategy and mechanism for doing this.

Again a massive topic in it's own right and I suggest you read our comprehensive articles below about this for more information

  1. Single Leg Squat Is The Best Exercise
  2. How To Improve Walking
  3. Sensa Mat & Foot Stability

Below is two videos to watch about how to execute single leg movement.

Do Want Proof That This Works?

Here is a great story of a client who had been experiencing chronic pain for many years and using the methods just discussed she is now able to move pain free and without discomfort.

"Four years ago I was faced with unexplained and debilitating hip pain. Never being one willing to suffer, I commenced searching for help. It seemed to me that I always had the condition in which the particular practitioner was specializing in. My gut feeling was, that if these conditions were correct why was I not healing?As a final straw I went to Queensland to a highly recommended doctor for some treatment. This was a positive yet expensive move, the doctor informed me that I had issues with my Piriformis, my what??? Never heard of this before, but apparently, this was my problem. I trusted this guy, especially as it was the first time in 4 years that I was pain free. I was told however, that I needed to strengthen my hip area in order to heal completely, but who do I trust? History spoke for itself. My faith was, at this stage non-existent but I had to do something. A future life of pain was not a consideration. For weeks I researched as to where I could get some help. Hitting a brick wall with every effort, my morale was low. One day I decided to research my condition on YouTube. I came across this trainer with an Australian accent (what a refreshing change) and I watched his video on piriformis. I did the stretches he recommended and I felt relief. This was enough for me to seek action. I sent Nick an email that day hoping that I might hear from him in about a week or so. To my amazement Nick called that day and the rest is history. I have been coming to No regrets for about 12monthsnow, my strength has improved dramatically. The Piriformis does flare up at times but not as often and certainly not as long as before. The main point is that I trust Nick and Nathan completely. If I am in pain, they will target the stretches I need for relief and I always feel better after a session. The future looks positive now and I have the No Regrets staff to thank for that. A truly unique gym with great staff." - Sue Tutic.

You can read many other success stories just like Sue's by going to our Testimonials page of our website.

FIVE POINT PLAN OF ATTACK TO GET RID OF PIRIFORMIS PAIN ONCE AND FOR ALL

So in conclusion you want to attack your condition in the following order:

  1. Establish what repetitive movements you are doing and change them. Find out what postural corrections required by getting a thorough postural assessment from a qualified therapist.
  2. Stretch all tight muscles first, use massage therapy, foam rollers etc to break up trigger points and overworking tonic muscles.
  3. Learn how to stabilize
  4. Isolate weak muscles and strengthen
  5. Lastly learn how to strengthen and integrate full body movements like squats, lunges, step ups into your program to prevent any further injury and enjoy all the things on life without that “Pain in the Butt”.

This is not going to be a fast process, it will take time and you will most likely experience a few setbacks on the way. But I encourage you to stick with it and apply all that I have discussed here for I know it works, I have proven this hundreds of times for over 12 years now.

References: Unbeatable Buttocks by Peak Performance, Trigger Point Therapy by Donna Finando

For information on movements and various topics I discussed here you can get additional information from our FREE Reports below you can download instantly by clicking the image below of the report you like.

 

And if you live in Melbourne Australia and would like to schedule a Free Postural & Movement Assessment fill in the form below and I will get back to you within 24 hours to arrange a time.