An aching, gnawing pain deep in your buttock when you walk or run. A tingling feeling together with pain spreading down the back of your thigh. Even when you’ve been sitting for a while, you feel your buttock pain getting worse. This is what piriformis syndrome feels like. You can literally call it a ‘pain in the butt’, because piriformis is a buttock muscle. With piriformis syndrome, this muscle gets overworked or stretched too far, causing muscle pain and sometimes symptoms of sciatica-like pins and needles together with a burning pain down your leg.

It is really important to find out what is causing your piriformis muscle to get overworked and tight. That will be the only way to prevent piriformis syndrome from simply returning.

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The structure of your piriformis muscle

The piriformis muscle can be found deep in your buttock, underneath other layers of muscles. Its name (piriformis) has a Latin meaning, describing the pear shape of the muscle. The fat end of the piriformis muscle attaches to the sacrum (sitting bone) and the thin end attaches to the top of the thigh bone (femur). You have a muscle like this on both sides.

The surrounding anatomy

You have to look at the structure of your lower back to fully understand how your piriformis muscle works, because it attaches directly onto your spine.

The lowest part of your spine is where your lumbar vertebrae connect to your sacrum (sitting bone) and coccyx. Each bone is numbered according to the level it is on. Your lower back is numbered L1-L5 and your sacrum (sitting bone) S1-S5.

Between each vertebra there is a disc and a nerve root that exits on each side. Discs play an important role to absorb the shock of forceful movements of your spine. Whereas nerves are like the power cables giving the right kind of impulses to your muscles, so that you are able to move. The nerve roots running from level L4 – S3 in your spine merge together to form the sciatic nerve.

The sciatic nerve

The sciatic nerve runs all the way from your spine, deep through your buttock, down the back of your leg and into your foot. It is the thickest and longest nerve in your body. This nerve gives muscles in your leg the ability to move and gives the skin around your leg the ability to feel different sensations like pain, pins & needles and different temperatures.

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Your sciatic nerve and piriformis muscle cross paths along the way

As the sciatic nerve passes deep through the buttock, it passes underneath the piriformis muscle. They directly cross paths. Some people actually have an anatomic variation where the sciatic nerve runs through the Piriformis muscle instead of underneath it. In either case the contraction of the piriformis muscle can irritate the sciatic nerve. A ‘spasmed’, tight or shortened piriformis won’t allow normal movement of the sciatic nerve and this leads to sciatic nerve compression. Ultimately leading to symptoms of burning pain and pins and needles spreading from your buttock down your leg.

What does your piriformis muscle do?

The piriformis is involved in the following movements of your hip:

  • External rotation of the hip (rotating your hip, thigh and toes to face outwards)
  • Assists with abduction of the hip (lifting your leg up sideways – away from your body)
  • Helps to stabilise your hip when you stand on one leg

Your piriformis muscle can contract and shorten (concentric contraction), but it can also lengthen with control (eccentric contraction). This eccentric kind of contraction is very important when it comes to hip stability. Other buttock muscles like your gluteus medius end minimus will rotate your leg inward, which puts your hip joint in an uncomfortable position. The piriformis muscle will oppose this, by contracting eccentrically, keeping the hip joint in a neutral position.

You use your piriformis muscle during the following activities:

  • Walking (especially walking uphill)
  • Climbing stairs
  • Running (especially uphill)
  • Getting in and out of your car
  • Sitting and standing up
  • Balancing on one leg
  • Lifting your foot up to put on shoes and socks
  • Crossing your legs
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I think I have piriformis syndrome. How did it happen?

It starts with a muscle injury

While running uphill one day you feel a muscle ‘pull’ in your buttock. Initially, you only feel a deep, aching muscular pain in your buttock and luckily it seems to go away when you rest. This is the start of piriformis muscle pain.

An injury to the piriformis muscle, be it a direct fall, strain, stretch or repetitive overuse injury lead to inflammation in the muscle tissue. This will cause a deep, dull ache in the back of your hip/buttock area. It will feel worse when you try to contract or stretch your piriformis muscle.

Now the pain starts to spread down your leg

Inflammation is a normal part of the healing process. However, if you take an already tight and shortened piriformis muscle and add swelling and inflammation to the area, it is a recipe for more problems. It leads to irritation of your sciatic nerve, which runs directly underneath your piriformis muscle. The sheath around your sciatic nerve gets compressed and the friction between the piriformis muscle and the nerve is higher than usual. Your sciatic nerve is literally getting ‘rubbed the wrong way’. This causes a burning type of pain together with a sensation of pins and needles that travels down the back of your thigh at times. These symptoms are supposed to be a warning sign that your sciatic nerve is irritated and not getting enough blood supply.

The pain gets so severe it stops you in your tracks

You tried to push through the pain by continuing to exercise. Maybe you even tried to stretch out your piriformis and buttock muscles or tried to roll it out with a foam roller. Nothing is helping. Instead, it seems like it is getting worse. That is because your piriformis muscle has gotten even more overworked and stretched too far. And the irritation of your sciatic nerve has gotten worse. Now, it is getting compressed and strangled. Your buttock pain is severe and constant. Even sitting down to rest gives you pain. The pain spreads down the back of your thigh leaving your leg feeling weak and clumsy. 

At this stage, you can not exercise, climb stairs or even walk without pain shooting down your leg. You don’t know which one is better, to rest or to move, because sitting is just as painful. This pain has literally stopped you in your tracks and brought your life to a standstill.

Nerves are very sensitive structures and if the compression on your sciatic nerve is not somehow relieved, it can lead to nerve damage. The pain that you are feeling is a warning sign that your sciatic nerve is getting strangled and not getting enough oxygen.

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Piriformis syndrome is not just a muscle injury

Piriformis syndrome can be described as a collection symptoms coming not only from your piriformis muscle, but also from your sciatic nerve. It can easily be confused with sciatica, because many of the symptoms overlap.

That is why it is so important to find out what exactly is causing your piriformis muscle pain and where exactly your sciatic nerve is getting irritated. Treatment for piriformis syndrome should aim to look at the bigger picture and aim to find the reason for your piriformis muscle injury that started everything in the first place.

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Causes of piriformis syndrome

Piriformis syndrome is caused by any one or combination of these problems. It can affect the piriformis muscle and can affect the adjacent sciatic nerve.

Weakness of the piriformis muscle

Not getting enough exercise is the main reason for muscle weakness. A weak piriformis muscle won’t be able to give a strong contraction and will easily be overworked. Even if you are active during your day at work by climbing a few flights of stairs everyday or walking a lot, it is not enough to count as exercise. Doing exercises that specifically targets your buttock muscles will be the only way to get your piriformis muscle stronger.

Weakness of other buttock muscles

Your gluteus muscles make up the most of the shape of your buttock. They are big muscles capable of doing strong hip movements and giving your hip joint the stability it needs. However, if they are not strong enough, your piriformis muscle is the next muscle to activate to try and take over. This will cause your piriformis muscle to do double the work and get overworked and fatigued in the process.

Postural problems

Your piriformis muscle attaches to your spine in your lower back and also to your hip. Your posture will influence the way you stand or sit or exercise and this will influence the way you use your piriformis muscle. An example of this is if you have a very hollow lower back. This puts your pelvis in more of an anterior tilted position. Your buttock muscles and especially piriformis muscle is put in a lengthened, stretched position the whole time. Eventually leading to more tension and tightness in the muscle as it has to work harder. Now, imagine you try to exercise or run where you need your buttock muscles to contract forcefully and repeatedly. You simply end up in pain due to overuse of your piriformis muscle.

‘Pulled’ piriformis muscle

Let’s say you were doing an exercise to work on buttock muscle strength. You stepped it up and added an extra weight or added more resistance. But this time when you did the exercise, you felt something ‘pull’ in your buttock. This is what we call a muscle strain. Your piriformis muscle got overstretched and had to contract under so much pressure that it lead to a muscle injury and muscle tear. This is a type of injury that needs time to heal. The inflammation and scar tissue that forms during this healing process can cause irritation of your sciatic nerve.

Lower back problems

Injuries like a herniated disc or osteoarthritis in your lower back will decrease the stability of your spine. Your lower back muscles will already be hard at work trying to stabilise your spine. Even your buttock muscles will have to work harder and do double the work. This can lead to your piriformis muscle getting overworked and shortened.

The only effective treatment for piriformis syndrome is to look for the exact cause of why your piriformis muscle is causing you pain. Posture, habbits and wrong movement patterns are often the biggest culprits when it comes to piriformis syndrome.  

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Symptoms of piriformis syndrome

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Tests you can do to see if you have piriformis syndrome

  • Sit on the side of your bed or on a chair with both feet on the ground
  • Cross one leg over the other by putting your foot/ankle on your opposite thigh (like you would sit to put on socks or shoes)
  • Repeat the movement with your other leg as well and compare what you felt
  • If you felt a piriformis muscle stretch, buttock pain or stiffness in your hip, it could be a sign that you have piriformis muscle pain causing piriformis syndrome.
  • Stand in front of a chair or countertop surface that you can hold on to
  • Hold on for balance
  • Now lift one leg up sideways
  • Lift the same leg up backwards (without arching your back)
  • Repeat the movement with your other leg and compare what you felt
  • If you felt a piriformis muscle stretch, buttock pain or stiffness in your hip, it could be a sign that you have piriformis muscle pain causing piriformis syndrome.
  • Lie on your side with both of your knees bent
  • Keep your feet together and lift your top knee, rotating your whole leg outward
  • Turn onto your other side, repeat the movement with your other leg and compare what you felt
  • If you felt a piriformis muscle stretch, buttock pain or stiffness in your hip, it could be a sign that you have piriformis muscle pain causing piriformis syndrome.
  • Lie on your back with your knees bent
  • Using your arms, pull your knee to your chest
  • Now, slowly straighten your knee and pull your toes up
  • Don’t push too hard if you feel a severe stretch or pain
  • Repeat the movement with your other leg and compare what you felt
  • If you felt a piriformis muscle stretch, buttock pain, stiffness in your hip or pain spreading down your leg it could be a sign that your sciatic nerve is irritated causing piriformis syndrome.
  • Sit on the edge of your bed or on a chair with both legs pointing straight ahead
  • Put your hands behind your back
  • Slump forward with your body (like you are sitting with bad posture)
  • Slowly straighten one leg, pulling your toes up towards your kneecap
  • Don’t push too far if you feel a severe stretch or pain
  • Do the same movement with your other leg and compare what you felt
  • If you felt a piriformis muscle stretch, buttock pain, back pain or pain spreading down your leg it could be a sign that you have piriformis muscle pain causing piriformis syndrome
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How bad is it?

It starts out with a deep aching pain in your buttock that you are constantly aware of. For a while you feel like you can still push through it and you still try to exercise in the hopes that it will go away. However, with time it gets worse. Now, your pain bothers you throughout your whole day. You can’t go for a run, you can’t sit for too long and even something simple like putting on shoes is becoming hard to do.

This is where nerve irritation starts 

With time, you start to feel other symptoms as well. Instead of only pain in your buttock, you feel your pain spreading down the back of your thigh. Previously it was an aching, gnawing pain. Now, it is becoming sharper and it burns. Together with the spreading pain you feel a tingle, like pins and needles, running down your leg, especially when you have been sitting for a while.

This is what we call intermittent irritation of the sciatic nerve.  In certain positions, like bending, your piriformis muscle and sciatic nerve gets stretched and irritated, causing you pain. Whereas a position like sitting puts more pressure directly on your buttock muscles and sciatic nerve. The moment you try to to walk fast or even run, you feel the familiar tingle down your leg. When your piriformis muscle is contracting it worsens the irritation. Whenever you lie down, the irritating symptoms down your leg seems to improve. This is why we call it intermittent nerve irritation, because it comes and goes.

It gets serious

Now, the intermittent irritation that only bothered you at times, has progressed to sciatic nerve compression. You start to feel like you’ve lost power in your leg and hip and there are some patches of skin on your leg that feels completely numb. Weakness or clumsiness of your leg may not be as excruciating as the burning pain, but is more serious.

If you’ve gotten to this point, your sciatic nerve is suffocating and cannot properly conduct impulses. This will lead to nerve damage if you do nothing about it. Your piriformis muscle have gotten so overworked, tight and shortened that it cannot do its job anymore. Now, other buttock muscles and even lower back muscles are taking over and this leads to other areas of muscle spasms. Prolonged dysfunction of your piriformis muscle may cause the muscle tissue and tendons to become scarred, making a normal, smooth contraction of the muscle so much harder.

Your piriformis syndrome symptoms has gotten so severe that it is is affecting your life, sleep, work and exercise. The pain from this is so severe, you will feel like you don’t want to move at all. You’ve gotten to a point where the pain you are experiencing is a warning. A warning that you are damaging your piriformis muscle and sciatic nerve. Do something about it!

Chronic, recurring piriformis syndrome

Chronic flare-ups of piriformis syndrome is very frustrating and debilitating. You never know when you’ll feel it again, and it always stays in the back of your mind, leaving you afraid of the pain you know too well. You can never run or exercise to your full ability again, because you know that you don’t want to push yourself too far. Finding the true cause of your piriformis syndrome is the best way to clear it up. The longer you have piriformis syndrome, the higher your chances become of having muscle and nerve damage.

Diagnosis

Physiotherapy diagnosis

Our physiotherapists are experts in human anatomy and movement with the necessary experience to diagnose piriformis syndrome very easily. We fully understand how muscles and nerves work and can accurately diagnose what is causing your piriformis muscle pain. A clinical assessment and getting the necessary information about your pain is the starting point.

During your physiotherapy evaluation, we will stretch and stress your piriformis muscle & sciatic nerve, as well as structures in your lower back, hip and knee. We also look at the mechanical interface, which is all the layers of tissue and muscles surrounding the nerve. Your sciatic nerve should be able to glide and move between these layers of tissue.

Movement and sensation:

If your piriformis syndrome has gotten to such a point where you are feeling referring pain, pins and needles, numbness or weakness, your evaluation will include further testing for sciatic nerve function. Your sciatic nerve is responsible for two important things. Movement and sensation. Testing movement (motor function) will involve testing all muscles surrounding the sciatic nerve, by looking at muscle strength, length, reflexes and range of movement. To test your sensation, we will test your ability to feel soft touch, sharp pain and different temperatures.

Thorough evaluation makes our physiotherapists the best at diagnosing this type of problem.

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X-rays

Soft tissue, like muscles and nerves cannot be seen on x-rays. However, x-rays show the integrity and alignment of the lumbar spine and vertebrae. This will enable us to see if something is wrong with the structure of your hip or lower back. This way, we can see if the source of your piriformis syndrome could be coming from your hip or lower back.

Your physiotherapist will refer you to get x-rays taken if deemed necessary.

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Diagnostic ultrasound

Diagnostic ultrasound is effective in showing different layers of soft tissue. It will show areas of muscle involved in a possible muscle strain or compression on your sciatic nerve, but it is not as effective as an MRI to image deeper areas. If deemed necessary, your physiotherapist will refer you to get an ultrasound.

MRI

An MRI will show all of the structures of your lower back and pelvis, including soft tissue like muscles and nerves. It will show exactly where the sciatic nerve is being irritated.

An MRI is an expensive test and you need to be referred by a specialist to get one. If you have already had an MRI done, please bring it along to your first consultation. If your physiotherapist feels it is necessary for you to get an MRI, you will be referred to a specialist.

Why is my buttock pain not going away?

Let’s say you have had piriformis syndrome before and even tried treatment like medication and rest. Previously it helped, because your pain got better. However, each time you try to really get back to running or exercising at your full capacity, your pain comes back. Now, you’re always aware of pain in your buttock and you wonder if it might trigger that familiar burning pain down your leg. It has literally become a ‘pain in the butt’, because it never fully goes away.

Finding the root of the problem

It is important to not only get treatment for the pain that you’re feeling, but to find out exactly what is causing your piriformis syndrome. That way, you will know what is causing your pain and what you can do about it. Years of bad habits, poor posture or lack of exercise will lead to weakness of the entire hip. If you do not take the time to complete your strengthening and rehabilitation, your pain will always return.Without a proper evaluation and treatment plan, your piriformis muscle dysfunction won’t simply improve.

Better to rest or to move?

If you focus on resting, it will probably help the inflammation and irritation settle. However, now you get weaker and when you start to get active again, your buttock muscles won’t be able to cope with the load. Now, your piriformis muscle gets overworked again and the repeated muscle contractions flare up the point of irritation and inflammation in your sciatic nerve again. This leaves you in a cycle of pain, not knowing if it is better to rest or move. Trying to push through the pain to get back to exercising will simply cause you to injure your piriformis muscle and sciatic nerve, leading to damage if it is repeatedly injured.

Patience is key with piriformis syndrome

What NOT to do

  • Continuous use of anti-inflammatory medications are not recommended as they are thought to delay healing

  • Stretch your piriformis muscle and other buttock muscles through the pain

  • Walk, run, jog or exercise through the pain

  • Do not ignore buttock pain that gets worse (it could be a sign of a deeper problem)

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

  • Be reckless and try to exercise if your leg or hip has become weak, clumsy and gives way underneath you

What you SHOULD do

  • Make a physiotherapy appointment to confirm the diagnosis and determine the severity of your problem.

  • Rest from activities that aggravates your pain

  • Follow through with your rehabilitation programme for better long-term effects

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Making piriformis syndrome WORSE

  • Walking up a ramp or uphill

  • Climbing stairs

  • Running uphill

  • Stair running drills

  • Sprinting

  • Jumping

  • Wearing high heels

  • Squats and lunges

  • Driving

  • Sitting behind your desk for hours

  • Walking through the pain

  • Sitting cross legged

Problems that pop up when we see patients with piriformis syndrome

Waiting too long and not getting a proper diagnosis

A common problem we see is that patients wait too long before they seek help. By the time patients come to see us, they have had piriformis syndrome for months. If you don’t get a proper diagnosis from the start, it will waste time. If anyone treating your pain is not also looking for the cause of your piriformis muscle dysfunction, they will keep on treating the incorrect thing. This is ineffective. Now, the pain becomes unbearable, it holds you back from doing normal day to day activities and it will take so much longer to heal.

No pain, no gain

People tend to try some home treatments like foam rolling or piriformis stretches, without much success. Going at it with an approach of ‘no pain, no gain’ or ‘pushing through the pain’ is actually not a good idea when it comes to piriformis syndrome. There is a big chance that you will simply flare up your pain, irritating your sciatic nerve.

Trying out, but not completing different forms of treatment

Often, patients try to get relief by taking anti-inflammatory medication or getting a cortisone injection in the hopes of easing their pain. This, however, only slows the process of healing. You are not addressing the root of the problem by simply taking medication. And then, a lot of people tend to get impatient and they stop taking their medication. Or on the other hand, if they feel better they stop their physiotherapy treatment. Patience is key with piriformis syndrome. It is important to complete your rehabilitation to the end.

Resting too much or too little

Resting too much leaves you weaker than before. Moving too much causes extra inflammation and irritation. Finding the balance between resting and doing safe movements is key!

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Physiotherapy treatment for piriformis syndrome

We are confident that we can provide the best treatment for piriformis syndrome. We understand that patients are often anxious to get back to their daily routine and exercise and that is why we are here to provide guidance and answers. Physiotherapists can implement a very effective and structured plan of action that treats all the aspects of the problem and gets you back on to where you want to be living your best life. Our physiotherapy treatment plays a vital role to restore the normal smooth contraction and stretch of the piriformis muscle without irritation of your sciatic nerve. 

The basic structure of our treatments:

  1. Determine what is causing your piriformis muscle dysfunction
  2. How badly is your piriformis muscle injured?
  3. Protect it from further injury
  4. Give the piriformis muscle and sciatic nerve time to heal
  5. Strengthen surrounding muscles
  6. Re-evaluate to monitor progress

Your treatment will aim to restore the normal movement of your piriformis muscle, as well as its ability to be stretched into the end of its range, without causing irritation to the sciatic nerve. Both the muscle and nerve should be able to move and glide without any obstructions to give you full flexibility. Your physiotherapy treatment will involve working on muscle strength, range of motion, flexibility and stability. Treatment techniques will include: soft tissue massage, joint mobilisations, dry needlingstrapping, laser therapy, nerve mobilisations and guiding you through a rehabilitation program of gradual strengthening, control and conditioning. It’s important that you commit to the treatment plan, as this improves your chances of successful long-term recovery.

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Phases of rehabilitation

1st Phase: Protection and initial healing

Protect

We have found that patients tend to push through their pain, even walking with a limp. Piriformis syndrome can cause such severe pain that it is painful to simply take a step with your sore leg. The piriformis muscle is compressed and stretched each time it has to contract and each time you take a step.  Rest and use crutches to keep the load off of your buttock and hip. The main concern is to prevent continuous inflammation and pain.

Avoid anti-inflammatory medication

Avoid using anti-inflammatory medication continuously, it delays healing by delaying inflammation. If you have severe pain, try to rather use medication for pain without an anti-inflammatory component. That way, your pain will be under control, you’ll be able to get enough sleep and won’t have pain that constantly bothers you. Once the pain is under control, you can decrease the use of your medication and eventually stop taking it completely.

Strapping

By using strapping or elastic bandage, inflammation and swelling can be relieved. It gives support, which also helps for your pain.

Information

Make sure that you get information from the person that is treating you. Its important to understand what you should and shouldn’t do. You can make better decisions if you are informed. Your body knows best, so avoid too many types of treatments at once.

Load

Let pain guide you to gradually return to your normal activities. Initially, it is tricky to know if it is better to rest or to move, but finding a balance between the two is the best you can do. Letting your back, hip and leg carry some of the load is a good way to keep muscles and joints moving, without overdoing it.

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2nd Phase: Establish pain free range of movement

During your examination, it will become clear what you are able to do, and what you should avoid. We identify factors that contribute to cause your pain, specific to your case and will address these factors as your treatment progresses. When doing a movement, like crossing your legs to put on socks and shoes, you will be able to move to a certain point, before your pain starts. This is your pain-free range of movement. You are safe to move in this range and our exercises will be targeted between these boundaries of your pain.

The aim is that, with time, your pain-free range of movement improves and painful movements become less intense.

3d Phase: Tissue healing

We monitor the progress of the healing of piriformis muscle and sciatic nerve and track the formation of scar tissue at the site of irritation. On a cellular level we’re able to accelerate tissue healing using dry needlinglaser and ultrasound. As healing takes place, we want to see not only improvement of your pain, but also improvement in the piriformis muscle’s ability to contract and stretch and a decrease in sciatic nerve irritation.

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4th Phase: Soft tissue and nerve stress

During each session we will re-evaluate to see if you are achieving the necessary targets for the piriformis muscle and sciatic nerve to be able to handle tensile, elastic and compression forces. The piriformis muscle should be able to take load and contract harder without causing further irritation to the sciatic nerve. We start with small movements and minimal load and gradually get you used to more. We use isometric muscle contractions to start with. These are muscle contractions without much movement. This is to prevent further flare-ups of inflammation and irrtiation to the sciatic nerve.

5th Phase: Full range of movement and nerve mobility

To regain full range of motion of your hip, back and leg will be a very important component of your rehabilitation. The piriformis muscle should be able to stretch to the end of its range and the sciatic nerve should be able to glid smoothly underneath the piriformis muscle. Any scar tissue that might have formed in the muscle tissue can cause irritation of your sciatic nerve again. The mechanical interface and scar tissue must be lengthened and orientated to allow a smooth contraction and stretch of the piriformis muscle as well as the sciatic nerve. We will help you to stretch more, move deeper and work into your pain. For this we use massage, stretches and joint and neurodynamic mobilisations to achieve full range of movement.

At the end of this stage of rehabilitation, you should be able to comfortably lift and turn your leg and hip, making it easier to do a typical piriformis stretch in a cross-legged position.

6th Phase: Muscle strength

During this phase of your rehabilitation, you will work on strengthening not only your piriformis muscle, but your hamstrings, lower back muscles and buttock muscles. Repeated contraction of muscles, improves their strength. Stronger muscles have the capacity to work harder and can help to carry the load while keeping your hip stable. If your piriformis muscle doesn’t have to do all the work and become tight and overworked, there won’t be as much irritation on your sciatic nerve. We will progress your exercises more and more, adding resistance, doing more repetitions and building your overall strength.

Now, you should be able to walk, sit and get in and out of your car with ease.

7th Phase: Muscle control and stability

It is one thing to feel your muscles get stronger, but another thing to feel like you have control when you move. The type of muscle contraction we use during this phase of rehabilitation is called eccentric muscle contractions. Muscles are able to contract and shorten concentrically, but they are also able to slowly lengthen eccentrically. Climbing up and down stairs or standing on one leg when you put on pants are some of the things that require control and stability coming from your hip and buttock muscles.

8th Phase: Testing for return to activity

A big part of your recovery is to gradually return to your routine again. This way, we can determine if you are ready to return to fully working and training without any flare-ups of piriformis syndrome. Your physiotherapist will guide you to re-engage in safe increments, and make adjustments where necessary.

9th Phase: Balance, high speed and power

Now that you’ve worked through the different phases of your rehabilitation, we want to improve the power and speed of your piriformis muscle contractions. You need to be able to do activities with precise balance, high load, and speed to ensure that your buttock muscles are able to keep up with the demands of your body.

Your physiotherapist will guide you to return to normal activities but will also challenge you past your normal boundaries to determine how your body reacts to different forces. Ultimately we prepare you to return to participating in your sport.

Whatever must be done – we’ll get you there. Running, sprinting or jumping and much more.

10th Phase: Sport specific training

This is the final stage of rehabilitation. Depending on your sport, your physiotherapist will tailor specific exercises to further improve your strength and endurance. A successful outcome is when you understand your condition, know how to prevent flare-ups and can participate at full power and speed, not to mention the benefits of minimizing your chance of future injury.

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How long will it take for me to recover?

Treatment of piriformis syndrome will address the piriformis muscle itself, but also the sciatic nerve. A piriformis muscle strain/stretch should heal within 6 weeks, given that you follow your physiotherapy treatment protocol and finish your rehabilitation. Whereas sciatic nerve pain could take longer to improve, depending on the severity of the nerve irritation/compression. Nerves are very sensitive structures and could take months to heal and even longer if there is nerve damage. Patience is key here.

Some days will feel better than others

Recovering from piriformis syndrome will have its ups and downs. You might feel better for a few days and then feel worse for a few days. Nerves are very sensitive structures so they tend to flare up easily, causing further inflammation and irritation. Just be prepared that your recovery process will be more of a cycle with ups and downs than a constant improvement from day 1.

Physiotherapy should start while your nerve is healing and if you have followed through with your physiotherapy treatment protocol, you should be able to recover completely and be able to return to your sport. Depending on the severity of your symptoms and initial inflammation, you will need physiotherapy treatment twice a week for the first two weeks. After this, your treatment sessions can be spread out to once a week or once in two weeks. You only spend an hour at a time with your physiotherapist. How fast you recover will greatly be up to you.

Other forms of treatment

  • Your doctor will probably prescribe anti-inflammatory medication or give you a cortisone injection or nerve block as treatment for piriformis syndrome and sciatic nerve compression. Both of these medications will give temporary relief to the pain and inflammation that you are experiencing. However, it will not be the solution to your problem. And once the effect of the medication wears off and you try to get back into your normal routine, your pain could simply return.
  • Getting your lower back or hip ‘aligned’ or ‘clicked’ in the hopes of easing your pain will not change your pain. An alignment cannot change the strength of your piriformis muscle or the way it contracts. It could even worsen the irritation of your sciatic nerve. You need to look at the bigger picture.
  • biokineticist will be able to help you in the final stages of your rehabilitation or to get you back to actively training for your sport.
  • Foamrolling and stretching your piriformis muscle might give you some momentary relief. However, you can easily overdo it and irritate your sciatic nerve even further. Stretching your piriformis muscle will not change the muscle strength. So, if a weak piriformis muscle is the cause of your pain, then you need to look at rehabilitation and strengthening.
Piriformis muscle, Piriformis syndrome, Piriformis buttock pain, Piriformis Sciatic pain
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Is surgery an option?

Surgery for piriformis syndrome will only be an option if you have had persistent and severe pain with severe sciatic nerve compression that lead to weakness, numbness and clumsiness of your leg. And it will only be an option if non-surgical options of treatment were not successful. Even with persistent nerve compression, a neurologist will help to decide if there is a chance that your sciatic nerve could be damaged. Then our focus will shift from preservation to protection of the nerve and surgery will be your next step.

Surgery is performed with the goal of relieving the compression on your sciatic nerve injury and depending on the type of surgery done and on your surgeon’s orders, recovery from surgery can take you anywhere between 6 weeks or 6 months. Physiotherapy can still help you during the time of your post-operative recovery.

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What else could it be?

  • Herniated disc: A herniated lumbar disc will cause pain in your lower back. It feels worse when you bend forward, sit or drive.
  • Lumbar osteoarthritis: Degeneration of the joints in your spine happens as you age. It causes a loss of disc space and bone spurs to form, which leads to pain when you move. It feels worse in cold weather and your back feels stiff in the morning.
  • Sciatic nerve pain: Irritation or compression of the sciatic nerve causes pain in your buttock and down your leg. You could also feel pins and needles, numbness or weakness of your leg.
  • Gluteus Muscle StrainA muscle tear in one of your gluteus (buttock) muscles. Painful to climb stairs or walk uphill.
  • Hip Bursitis: Pain over the side of your hip bone. It feels especially worse when you lie on your side.
  • Lower back muscle spasm: Painful, ‘pulled’ muscle in your lower back. Worse when you bend over or try to pick up something heavy.

Also known as:

  • Piriformis muscle pain
  • Pulled buttock muscle
  • Overstretched piriformis muscle
  • Deep buttock pain
  • Deep gluteal syndrome
  • Sciatica
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