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What The Heck Is Piriformis Syndrome?

The diagnosis is tricky and can easily be confused with sciatica—and it's one of the most common running injuries.

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A common injury among runners, piriformis syndrome usually is tingling, pain or numbness in the butt region. It can often confused with sciatic nerve pain because the piriformis muscle is right next to the sciatic nerve.

The piriformis muscle is a small muscle located behind the gluteus maximus—aka deep in that rear end muscle of yours. It begins at the lower spine and connects to the upper thighbone. It assists in rotation of the hips, turning the leg and foot outward—all things runners use constantly.

common injury

Symptoms of this Common Injury

When the piriformis muscle gets a little irritated, swollen or inflamed, the sciatic nerve—an innocent bystander—gets beaten up. As a result, you get sciatic symptoms.

“Runners go to the doctor and say, ‘I’ve got this weird ache in my butt. Sometimes I feel this electricity going down the back of my leg. I try to stretch it out, and it seems to get worse when I run.’ That is the typical history of common injury, piriformis syndrome,” explains Dr. Daniel Vigil, a sports medicine specialist at UCLA.

It’s not an abrupt pain; you’re not running and suddenly have this twinge. It’s more of a slow, progressive, insidious type of problem. Dr. Vigil explains how many runners try to make sense of the pain and think it’s usually from running hills. They ignore it, continue to push through it and stretch it out—but the pain doesn’t go away.

“Electrical shocks go up and down the leg. That’s textbook of piriformis syndrome. Slow onset, progressive,” says Dr. Vigil.

Treatment of Piriformis Syndrome

Once diagnosed, the first approach is to calm down the piriformis. The muscle is tight, so it needs to relax. Taking time off is the first step to healing. Dr. Vigil says there are two categories to treatment: stretching and running mechanics modification.

“The reason the runner got this common injury in the first place is probably related to their running mechanics. You need a running coach. Someone that can watch you run. See how long your strides are, look at the way you carry your arms and how you run to find any flaws in your running style. So, piriformis stretching and running mechanics modification is necessary,” Dr. Vigil shares.

Foam rolling is usually a good solution to loosen up muscles. However, the foam roller is really good for superficial muscles—meaning your quads, hamstrings or tight larger muscle groups. Since the piriformis is beneath the gluteus maximus, it’s going to be hard to get down to the piriformis.

“I would recommend not so much a foam roller, but more of a tennis ball. A poor man’s way of accomplishing the same task,” says Dr. Vigil. A tennis ball is not hard like a rock—it has a little give to it—but it’s firm enough to get deep into the piriformis to loosen it up. Simply sit on the tennis ball, roll around for a bit until you find that spot and sit there for a bit.

Recovery Timeframe

If you can diagnose it early and figure out what brought on this common injury, it’s pretty quick resolved problem—meaning a few weeks. “I am not talking a couple minutes or a couple days, but it’s also not months to years either. Several weeks, two to four or four to six, would be the length of a typical case,” suggests Dr. Vigil.

Depending on severity of pain, your working out doesn’t have to completely stop. You should stop running, but you can do other forms of exercise to keep your training intact: swimming, biking or the elliptical are less traumatic to the piriformis and still keep your cardio health up. “Of course, weight lifting is fine because you can isolate muscles,” says Dr. Vigil.

As with any injury, it’s important to pay attention to the pain. If it worsens it could be something else in your back. “All seriousness, if you have tingling down your leg that is not going away and it’s getting worse, then it’s a reason to go to the doctor and get it sorted out. Hopefully it’s just piriformis syndrome, but on the other hand, yeah, it might be a slipped disc, bone spur or something worse on your spine,” says Dr. Vigil.

Before beginning any recovery program, it’s recommended to speak with your doctor if you have any pain to get proper diagnosis.