How to address the painful piriformis syndrome.
Running injuries can be a pain in the butt—sometimes literally. Such is the case with piriformis syndrome, a stubborn condition characterized by pain deep in the buttocks and, in some instances, down the leg or up into the lower back.
The exact cause of piriformis syndrome is controversial and may vary from case to case, but we know that most cases involve both the piriformis muscle and the sciatic nerve, says Ellie Somers, a physical therapist who works with runners in Seattle, Wash. Treatment typically involves addressing both the nerve and the surrounding musculature while making modifications to your running program.
A Lot Of Nerve
The piriformis is a small muscle that lies deep beneath the glutes and helps externally rotate the hip joint. In about 15 percent of people, the sciatic nerve passes through the piriformis; in others, it runs adjacent.
Pain deep in the buttocks is thought to be a result of a too-tight or spasming piriformis compressing the sciatic nerve. But pain could also be originating from the nerve itself. “In someone with piriformis pain, I always screen the spine to try to determine if there’s tension through the nerve that could be causing the symptoms,” Somers says. “If the sciatic nerve is irritated, it can lead people to subconsciously grip through the area of the glutes and piriformis, contributing to more compression of the nerve.”
Factors that can increase the likelihood of piriformis syndrome include training errors, such as overdoing it with speedwork and being inconsistent with runs, as well as lack of variability (especially long periods of sitting) in your everyday routine. Somers recommends following a training program for measured, consistent progress in your running; getting up and moving throughout the day; and strength training, which helps build tissue tolerance and reduces your overall injury risk.
Banish Butt Pain
If you’re already dealing with piriformis syndrome, your first action should be to address the sciatic nerve. Somers recommends nerve flossing (see exercises below), which helps to open space around the nerve. Stretching and massaging the piriformis can help with pain relief, but it’s important to be gentle, as too much of either can compress the sciatic nerve even more.
It’s also important to strengthen the muscles in the hip area. “When a nerve is irritated, it changes how the surrounding musculature fires. We want to keep things sharp in that region so we don’t end up with disuse,” says Somers, who recommends exercises such as single-leg glute bridges (see below) and single-leg squat and step-down variations.
Whether you can continue to run with piriformis syndrome really depends, but Somers encourages her patients to stay active. If you can tolerate some running, she suggests cutting out speedwork and switching to run/walk intervals until your symptoms resolve. If running provokes pain, try using a bike or an elliptical to keep moving and build tissue tolerance. If your symptoms don’t seem to be improving, seek help from a physical therapist who can provide more specific guidance for your situation.
Exercises For Piriformis Syndrome
Sidelined by piriformis syndrome? Physical therapist Ellie Somers recommends practicing nerve flossing and simple exercises that mobilize the nerve comfortably and strengthen the glute muscles.
Sciatic Nerve Flossing
- Lie on your back and straighten your uninjured leg. Flex the hip of your injured side to 90 degrees, keeping the knee bent.
- Straighten this leg as much as you can while maintaining a neutral spine (do not arch or round your back).
- From here, alternate between pointing and flexing your toes for a total of 20 repetitions. Repeat several times throughout the day.
Single-Leg Isometric Glute Bridge
- Lie on your back and bend both knees to bring your feet directly under your knees. Press your heels into the ground to lift your hips as high as you can while maintaining a neutral spine.
- Once at the top of the bridge, lift one leg off the ground while keeping your pelvis level. You should feel your stance-side glute working. Hold for as long as you can tolerate without letting one hip drop or feeling your hamstrings take over for your glutes.
- Switch sides. Perform 8–10 reps on each side.
Note: If you immediately notice your pelvis tilting or feel a spasm in your hamstring when you come to a single-leg bridge, first practice bridging with both legs on the ground.