PIRIFORMIS SYNDROME (PAIN in the BUTT)

The Piriformis muscle (piriformis; “pear shaped“) is a tiny muscle located deep in the buttocks, underneath the gluteal muscles.  This little muscle is the most well-known of a group of muscles known as the “Hip Rotator Cuff” and is frequently the source of the pain in the butt.

Piriformis Syndrome is a miserable condition in which the Piriformis Muscle becomes overly tight.  Although there are almost always underlying biomechanical issues to deal with (valgus / varus knees, high / low arches, etc) this pathological tightness of the Piriformis is usually the result of FASCIAL ADHESIONS) or TENDINOSIS. 

Piriformis Syndrome can be aggravated by bending, lifting, sitting, sports, and even driving (foot on the gas pedal).  Contrary to what your M.D. might tell you, there are no drugs or surgery that are effective for treating Piriformis Syndrome. I will warn you, in 20 plus years of practice I have never one time seen a person whose Piriformis Release Surgery actually worked. 

OUR PIRIFORMIS SYNDROME PATIENT TESTIMONIAL VIDEOS

Photo by Beth Ohara

Piriformis Syndrome is an extremely common condition, and is far more likely to be found in women than men (about 12-15 times more often).  Although I can only speculate on the reason for this, I suspect that it is a child-bearing issue. It probably also has to do with the naturally wider shape of a woman’s pelvis. This is the most likely explanation for my finding it much more frequently in women than men —- even in women who have not had children. 

As I stated earlier, Piriformis Syndrome is a major cause of sciatica (leg pain, numbness, tingling, or weakness, in any combination), hip pain, and buttock pain.  Because sciatica is so often involved, it is often misdiagnosed as a slipped disc, herniated disc, or a chronic low back or sacroilliac problem.

The sciatic nerve is both the largest and longest nerve in the body, and at its largest point is about the thickness of one’s thumb.  The sciatic nerve originates in the low back (lumbar spine region) and angles toward the middle of the buttock.  It then extends down through the leg, passing underneath the piriformis muscle.  Be aware that in as much as half the population, the sciatic nerve travels through the Piriformis Muscle, passes over the Piriformis Muscle, or splits in two and passes directly around the Piriformis Muscle. 

Be aware that much of what is called Piriformis Syndrome is actually a Piriformis Tendinopathy.  TENDINOSIS PAGE.

Note the triangle in relationship to the butt crack (pardon my lingo). If you have a constant pain in this triangle, odds are you have Piriformis syndrome. Be warned. Piriformis Syndrome is frequently mistaken for a disc-based sciatica. although their symptoms can be similar, they are two very different things.

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Piriformis Syndrome causes sciatica. The sciatic nerve runs all the way to the foot

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Note the biggest part of the sciatic nerve near the top of the picture. The muscle that runs across the page just above the sciatic nerve is the Piriformis Muscle.

The symptoms of Piriformis Syndrome usually begin as a deep aching in what women like to refer to as their “hip” area.  This pain will be found along an imaginary line that runs from the very tip top of the butt crack, to the greater trochanter of the hip bone (the bony knob on the upper and portion of the outer or lateral thigh).

People most predisposed to chronic contracture and microscopic scarring of the piriformis muscle, are people who wear cruddy or improper footwear for their foot type (high-arched people wearing a “stability” or “dual-density” shoe), those with faulty spinal or lower limb mechanics, overweight, poor posture, too much time sitting, too much time on concrete, not enough activity (or occasionally too much exercise — overtraining).  And of course, the biggie — just being female. 

Due to mechanical stresses causing chronic tightness / contracture, the Piriformis Muscle can actually become shortened over time.  This often results in microscopic scarring of the fascial sheaths that tightly surround the muscle itself.  Piriformis Syndrome is most commonly worse at rest (sitting or lying down) and is often (but not always) relieved temporarily, by moderate activity (particularly walking or stretching).

Visit our MICROSCOPIC SCAR TISSUE & FASCIAL ADHESIONS page.

For years, I did not really understand why I had such good clinical results with so many cases of buttock / hip pain and sciatica, while other seemingly identical cases were largely unresponsive to chiropractic adjustments.  Frequently these “problem” cases would get fantastic short-term results from their adjustment, but these results never seemed to last more than a few days at the most (and often no more than a few hours).  It was not until I started doing “TISSUE REMODELING” in 2001, that I truly began to understand what was going on. 

Over the past decade I have come to realize that Piriformis Syndrome is literally “epidemic” in the female portion of our society (it is Destroy Chronic Pain.com’s #1 webpage by far — see our PATIENT TREATMENT DIARY); with the medical community being largely mystified about what it really is, or how to treat it effectively.  Again, drugs and surgery do not constitute “effective treatment” for Piriformis Syndrome.  Never assume that a “Piriformis Release Surgery” will solve your problems!

As you have read on our FASCIAL ADHESIONS PAGE, scar tissue is normal, elastic tissue (think nicely combed hair here) that has been disrupted from its organized structure, into a balled-up and tangled wad of inflexible and hyper-sensitive, micro-gristle (think of a hair tangle that cannot be combed out).  This kind of microscopic scar tissue is not typically in the muscle itself, but in the fascia.  Fascia is the thin, but very tough, yellowish white membranes that cover muscles.  In my neck of the Ozarks, deer hunters call these membranes, “Striffin“.

Fascia is arguably the single most pain-sensitive tissue in the body!  Fascial Adhesions will cause pain and dysfunction.  Destroy Fascial Adhesions and Destroy Chronic Pain!

Because most of these scar tissues are in the fascia as opposed to the muscle itself, they do not image on MRI.  It is my opinion that microscopic scarring of the Piriformis Muscle is the single most common cause of chronic, long-standing, Sacroilliac or buttock pain (the Sacroilliac Joints are the bony bumps that lie just up and lateral to the top of the butt crack).  It is also the most common cause of what I was calling a “butt-based” sciatica twenty years ago.

Photo by Anatomist90

Photo by Anatomist90

P.S. If you have extra-high arches or “fallen” arches, or if you have abnormal lower body biomechanics of any sort; you probably need arch supports (orthotics).  We carry some nice, generic orthotics that will work for many people.  However, some of you will require custom orthotics.  Allow me to give you an example:

High arches can be a big contributor to Piriformis Syndrome.  The higher the arch, the more you get “pushed” onto the outside of your foot.  To see what this does to the Piriformis Muscle; stand up, put your hands on your upper buttocks in the area of the Piriformis Muscle.   Now, roll your weight out onto the outsides of your feet.  Notice how the Piriformis Muscle instantly becomes tight as a drum?  This is what is going on all day long if you have improperly supported high arches.  And there is only one company on the planet that I am aware of that specifically specializes in shoe inserts (orthotics) for people with high arches……. XF

The only custom orthotic company that I recommend for my patients is Xtreme Footwerks out of Idaho Springs, CO. Because of old basketball injuries (several broken ankles), I have had both Piriformis Syndrome and Plantar Fasciitis. I very much understand how painful and debilitating they can be.  I also have an arch that is ridiculously high.  Because I get constantly solicited by companies that sell orthotics, I have tried about 30 pairs of orthotics made by other companies.  Then, by an act of God, I met Shawn. 

Shawn Eno is a biomechanical genius!  Xtreme Footwerks builds custom orthotics for all foot types, but, is the only lab on the planet that actually specializes in orthotic devices for high arches.

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