Ever experienced that nagging ache in the bottom, which gets worse when you sit or get out of the car?
Or lower back pain, tingling and numbness that radiates down the side of one leg?
Chances are, you have piriformis syndrome, an annoying problem that is, literally, a pain in the bottom. However, the condition is completely curable.
The piriformis muscle is a flat, tiny muscle located in the buttocks near the top of the hip joint. It is an important muscle in lower body movement because it stabilises the hip joint when we move the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance.
As an external rotator (turning the leg outward), the piriformis muscle contracts every time we take a step. Functionally, it prevents the leg from collapsing inward as we walk, so the piriformis muscle is working all the time when we are moving.
All muscles shorten and contract, and the piriformis is no different. It can get short and tight from prolonged sitting or from certain repetitive exercises. Because it sits on top of the sciatic nerve, the longest and thickest nerve in the body, a short, tight piriformis muscle can easily pinch the nerve, causing pain and discomfort.
In 10% of us, the Sciatic nerve actually passes straight through the muscles fibres, which, according to some researchers, leaves these individuals more susceptible to piriformis syndrome.
However, if the sciatic nerve is not impinged, then the discomfort or pain is usually confined to the buttock area. And it is irritating.
There are a number of reasons why the piriformis muscle becomes tight.
It could be due to a direct injury to the lower back or tailbone, which then causes the muscle to reflexively contract to brace and protect your back from further damage.
It could also be from poor exercise technique, especially when lifting heavy weights or running on uneven terrains. Climbing stairs can also aggravate the problem.
Piriformis syndrome is extremely common among ballet dancers as they work in the turn out position (externally rotating the hip out), which forces the muscle to work overtime.
If you are someone who walks like a “duck”, this throws your body out of whack and you could end up with piriformis syndrome.
Weak gluteal (Bottom) muscles also forces the piriformis to work harder and tighten. Lack of stretching is another factor.
The problem can easily be diagnosed, but finding out the cause behind it can be a challenge.
Unfortunately, if you treat the condition without detecting the cause, the pain might only be relieved temporarily. If untreated, the problem can become chronic.
What can you do about it?
No amount of medications is going to banish the pain, so seek medical advice first.
Anti-inflammatories and muscle relaxants may help in the beginning to reduce pain, but will not provide a long-term solution to getting rid of piriformis syndrome.
Rest, ice, and heat may help relieve symptoms.
Sitting on a tennis ball or spikey massage ball and slowly gliding the bottom forward and backward may help.
To do this effectively, you will need some guidance on exactly where the piriformis is.
Be warned that this manoeuvre is painful, so do it gently.
Stretching the bottom muscles always works as stretching releases spasms in the muscle, and therefore, pressure on the sciatic nerve, whilst strengthening ensures the muscle is strong enough to cope with the demands placed on it, preventing the injury from recurring.
One of the best stretches to do is the static piriformis stretch.
Adopt the four point kneeling position, and bring your knee under your body, resting against your stomach, while your leg turns inwards. Now slowly lean forwards to create a stretch in the buttock muscle. Hold this position, and when you are ready, come back to the start position. Alternate each side. This will stretch your piriformis muscle. Hold this position for 30 seconds, repeat three to five times, and stretch up to three times a day.
Once the pain reduces, work on strengthening the muscles surrounding the hip area.
Remember, warm up properly before any activity and increase intensity gradually.
Always ensure your posture is good when exercising or walking.
If pain occurs, stop the activity or avoid it until the pain subsides.