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Where does this excruciating buttock pain come from and what can we do to help it?

The piriformis is a relatively small muscle in the buttock region. It’s main function is to externally rotate (laterally rotate) the hip. It does this along with quadratus femoris, gemellus inferior, gemellus superior, obturator externus and obturator internus (whoa! mouthful I know). It also has a weaker role with hip abduction (lifting the leg out to the side).

To help you to understand what lateral rotation of the hip actually is – sit on the edge of a chair and place one foot onto the opposite knee. The leg you have lifted is now positioned in lateral hip rotation. This is important to understand later for some of the stretches that can help. 

Anatomy

The Piriformis originates from the Sacrum (the buttock bone just below your lumbar spine). From here, it travels across the buttock before attaching onto the greater trochanter. The greater trochanter is the medical term used for the ball of the hip ball and socket joint. See the picture below to visualise this (the image shows a right hip, looking at it from the back!).

Variations

In the majority of the population, the sciatic nerve passes behind the Piriformis muscle. In small percentages of the population, the sciatic nerve can actually pierce partially or fully through the Piriformis. In some, it runs in front of the muscle. Whilst we do not fully understand the implications of this anatomical variance, it is thought those with a nerve that pierces the muscle may be more susceptible to sciatic nerve compression and therefore pain.


What is Piriformis Syndrome?

Piriformis Syndrome is a term that has been around for many decades. It remains a widely debated diagnosis in the medical world, mainly because we are still trying to decide on a concrete symptom classification system. 

For now, what we do know is that the Piriformis can cause compression of the Sciatic nerve as it passes near the muscle. This leads to “Sciatica”. Sciatica is an umbrella term referring to any pain, weakness, numbness, pins and needles or cramping that an individual experiences through the buttock, the legs and even as far as the foot and toes. 

How do I know if I have Piriformis syndrome?

If you are experiencing a lot of pain around the buttock region, it is worth seeing a trained professional to ensure you receive the correct diagnosis. 

Typically the pain is worse with;
– Prolonged sitting
– Palpation (pressing) of the area directly over the muscle
– Stretching the muscle

What else can cause buttock pain?

It is also possible for the cause of the pain to be from the lumbar spine. Issues surrounding the discs, joints or muscles in the back can cause very similar symptoms. This is classified as “referral pain”. In this case, the sciatic nerve is being compressed as it exits the spine. it is already irritated by the time it reaches the Piriformis and so can lead to pain and spasm in the muscle. 

Damage to the actual muscle itself can also lead to pain. Overuse, trauma or injury to the Piriformis are the primary reasons. This may help to understand why sitting can be so painful!

A detailed history and physical examination from your Physiotherapist will help to identify the cause of your buttock pain. This will then lead to an appropriate course of treatment. 

What can I do to help my buttock pain?

There are things you can do to help…

It is important to try and calm down the spasm in this area. Some simple steps may include;
– Adapting your activities to reduce any aggravating factors (e.g. running, gym exercises, work environment)
– Avoiding prolonged sitting
– Sitting on something with more padding
– Gentle stretching
– Strengthening the surrounding Gluteal, Hamstring and Lumbar spine areas. 
– Keeping active within your pain limits
– Pain relief (to be discussed with your doctor)
– Heat to reduce spasm (wheatbag, hot water bottle, hot baths)

Stretches for the Piriformis

Below are two examples of useful stretches for the Piriformis. Ideally, aim to do these a few times per day with a 30-60 second hold at a time.
In the first image, the left hip is being stretched. In the second, the right hip is being stretched.
Please note, this blog entry is for educational purposes only. If your symptoms seem to be getting worse or not settling with any of the above advice, it is important to seek medical advice and receive the correct treatment.  

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Our clinic is based at 5 Upper Wimpole Street in Marylebone and we can be reached on 0207 935 7344 weekdays from 8am - 6pm.

Wimpole Street Physiotherapy Clinic

5 Upper Wimpole Street
Marylebone, London
W1G 6BP

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