Piriformis Syndrome: The Best 6 Exercises To Help Your Hip & Butt Pain
Do you have a pain in the butt that gets worse with sitting?
Does your buttock pain turn into sciatica or leg pain occasionally?
Have you been diagnosed with a disc herniation or piriformis syndrome?
In this article I show you the difference between herniated discs and piriformis syndrome then at the end show you the 6 exercises for piriformis syndrome.
Piriformis muscle is deep inside your buttock which gets very tight and irritated when there is pressure on it, like when you are sitting. Your piriformis muscle ‘s job is to rotate your hip outward away from the body so you can shift your weight from one foot to another. The problem is it often get mixed up with herniated discs.
Both herniatied discs and piriformis syndrome can cause buttock pain and sciatica. It’s so easy to mix up that many doctors and chiropractors mix the two very similar diagnosis up. Most of them will diagnose a disc herniation, sacroiliac syndrome, and facet syndrome but rarely piriformis syndrome.
The problem is the treatment for disc herniation is different from piriformis syndrome treatment.
Piriformis Syndrome is not that rare. Today I will show you a couple tests that you can do yourself so that you can keep your chiropractor or medical doctor on the ball when they are diagnosing you.
Picture of sciatic nerve and piriformis muscle
Most of you (96%) have your sciatic nerve come out underneath the piriformis muscle as shown in the picture above.  You can see the sciatic nerve but you can’t see that it is actually formed by 5 nerves that join together. The picture below shows nerves from the lower back and pelvis joining together to form the the sciatic nerve.
For the unlucky few though the sciatic nerve passes right through the piriformis muscle. This makes your piriformis muscle more vulnerable to pain. The piriformis muscle often gets tight naturally from sitting too much. We weren’t really designed to sit for so long and put so much pressure, on this muscle. When the muscle gets tight the nerve get irritated and causes a vicious circle of pain.
Tight Piriformis ->> Nerve Irritation->>Tighter piriformis ->> More Nerve Irritation
This vicious circle whatever the cause will likely make you feel pain in the buttock especially the hip area (2nd picture above) and right near the sacrum (2nd picture above). You might even have difficulty walking.
Tests For Piriformis Syndrome
The first key test to look for with piriformis syndrome is when you sit down. Lift your bad side foot onto the seat of the chair then bring your bad leg toward the opposite chest. You might feel some pain if you have another problem like a disc bulge. With piriformis syndrome this maneuver will give your buttock agonizing pain, or at least a lot more pain. [3-4] You might have pain in the hip area or right in the middle of the buttock or more toward the center of the pelvis, and even sciatica. This sign along with a number of other positive signs increases the likelihood that you have piriformis syndrome.
See Also: MRI, CAT Scans & X-rays Your Guide
This minor test although not a key sign is, if you push on your own buttock and feel pain in the above areas it maybe a sign that you have piriformis syndrome. It is easier to lie down on your back with a tennis ball underneath your buttock.
The second key test is when you lie down on your back. Both of your feet should point upwards. If you find that on the side of your painful butt, your toes are going outward more you have a tight piriformis muscle. The piriformis’ job is to turn your hip out. When it’s really tight your foot will be forced to turn out. The real key is when you try to bring your toes back toward the center you will be faced with some pain. This further increases the chance that you have piriformis syndrome.[5-6]
The second minor test. Your tight piriformis can cause the sacrum to rotate and cause a short leg on the tight piriformis side.[7-8] Do you have a short leg on the side of your painful piriformis? This is a difficult one to tell but you can try by sitting on the floor with your legs straight out in front of you. Try to have your body straight and your arms in the exact same spot. Even your head should be looking straight ahead.
In the picture below you can see that the left foot is short.
X-rays and MRI For Piriformis Syndrome
X-rays and MRI won’t tell you if you have piriformis syndrome. They usually do more to persuade medical doctors and chiropractors that you have something other than piriformis syndrome. In other words X-rays and MRI can often mislead your health practitioner.
After finding a lot of the above tests that we talked about positive your chiropractor should have piriformis syndrome as one of the number of possible diagnosis. Your chiropractor will do other tests to determine if the piriformis muscle is involved. Then they take an X-ray or MRI or a CAT Scan. That’s when things go wrong.
Most of you that are 40 years of age an older have degenerative disc disease. It might be mild or moderate. The report says degenerative disc disease, disc herniation or even osteoarthritis. The problem is these problems that are visible on X-ray don’t necessarily cause any pain.
Your X-ray report says you have moderate degenerative disc disease and you have sciatica that matches the pinched nerve from degenerative disc disease. The X-rays have found your diagnosis right? Pictures of degenerative disc disease in some cases influence your medical doctor or chiropractor. Some may even disregard your exam finding or more commonly, they don’t do the other tests to begin with, letting the X-rays become the overriding factor instead of confirming a diagnosis that they previously had in their head. Your chiropractor or doctor in that case will miss the diagnosis.
If your chiropractor doesn’t think about a possible diagnosis they can’t do the test.
Keep in mind there are orthopedic tests that your chiropractor will use to help diagnose you. Since you can’t do them yourself I won’t go over those tests here.
Treatment for Piriformis Syndrome
#1 Piriformis Stretch: Seated
- Sit in a sturdy chair.
- Cross your affected leg over your knee, resting your foot on top of your knee.
- Keep your back straight, and slowly lean forward until you feel a stretch in your hip.
- Hold for 30 seconds.
#2 Piriformis Stretch: Laying Down
- Lay down on your back.
- Cross the affected leg over other bent leg.
- Pull the unaffected leg towards you until you feel the stretch.
- Hold for 30 seconds 3 times.
#3 Stretch Your Hip Stabilizer: Gluteus Medius – Pigeon Pose
- Start on all fours like a crawl position.
- Bring your right leg forward and bent with the other leg straight back.
- Reach out forward with your body till you feel it in your hips.
Do this for 30 seconds 3 times.
#4 Bridge Exercises: Strengthen your Gluts
This exercise is for those that are not quite ready for the next two exercises.
- Get on your back with your knees bent and hands down by your side.
- Lift up until your torso is straight like in the picture above.
- Go back down and as when you touch the floor, go back up again.
Do this exercise 15 times for 3 sets.
#5 Strengthen Your Hips: Squats
- Stand in front of a chair with your knees shoulder width apart.
- Turn your toes out slightly
- Go to sit down leading with your buttock until your butt touches the chair.
- When your buttock touches the chair get back up again without resting.
Advanced: Don’t use a chair and go to 90 degrees.
# 6 Strengthen Your Hips: Lunges
- Stand with your legs together and arms at your sides
- Step two to three feet (60-90 cm) forward with your left foot.
- Bend both of your knees to lower yourself into a lunge.
- Each knee should be 90 degrees. Keep your knee directly over your ankle so you don’t strain your knee.
- Push off with your left leg and return to the starting position.
- Repeat with your other leg.
Do this 10X on each leg. 3 sets should be fine.
If you have trouble doing this you can do a more shallow lunge by not going down as deep.
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1. 15. Beason LE, Anson B.J. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Record. 1937;70:1-5.
2. Lori A. Boyajian-O’Neill, DO et al, Journal of the American Osteopathic Association, Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach
3. Chaitow L. Soft Tissue Manipulation: A Practitioner’s Guide to the Diagnosis and Treatment of Soft-Tissue Dysfunction and Reflex Activity. 3rd ed. Rochester, Vt: Healing Arts Press;1988 .
4. Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999;81:941-949
5. TePoorten BA. The piriformis muscle. J Am Osteopath Assoc. 1969;69:150-160.
6. DiGiovanna EL, Schiowitz S, Dowling DJ, eds. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2005 .
7. Retzlaff EW, Berry AH, Haight AS, Parente PA, Lichty HA, Turner DM, et al. The piriformis muscle syndrome. J Am Osteopath Assoc. 1974;73:799-807
8. Grant JH. Leg length inequality in piriformis syndrome. J Am Osteopath Assoc.1987;87:456
9. Kevork Hopayian et al., The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. Dec 2010; 19(12): 2095–2109.
Piriformis is a pure abductor at 90 degrees knee flexion-Test resisted abduction
Piriformis at 60 degrees is external rotator - test resisted external rotation.
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