By Lindsay Kent
If you (or your client) has ever had sensations like sharp pain, numbness, or tingling in your lower back and buttocks (glute) region that travels down the back of your leg, you’re not alone. And, a muscle called the piriformis could be to blame.
This small muscle plays a big role in keeping lower body movements smooth and balanced, particularly during extension, abduction, and external hip rotation. And, when you know how it affects movement and pain, you can help clients avoid what’s called avoiding piriformis syndrome. Simple mobility and flexibility exercises can help alleviate the symptoms and stay pain free.
What is Piriformis Syndrome?
The piriformis is a small, flat, band-like muscle that originates on the anterior surface of the sacrum and connects the most inferior part of the vertebrae to the upper part of your leg. A simple reference point for this muscle is the back of the hip, because it sits on top of the hip joint.
The sciatic nerve, on the other hand, runs alongside or through the piriformis muscle, traveling down the back of the leg and branching into smaller nerves that end in the feet. Much of the pain as described above that many of your clients’ experience is from the interaction between the piriformis muscle and the sciatic nerve.
When people have symptoms of piriformis syndrome, sometimes they assume it to be a herniated disc. But, an alternative cause, proposed by Freiberg and Vinke and developed by Robinson who coined the term “piriformis syndrome,” is compression of the sciatic nerve from a tight piriformis muscle.
How Does Piriformis Syndrome Happen?
Reciprocal inhibition is a common phenomenon that happens when muscles on one side of a joint contract and opposing (muscles on the other side of the joint) relax. This allows movement to take place. So, tight hip flexors will cause the glute max to become inhibited, or “silent.” This doesn’t mean movement at the joint can’t occur. Instead, another muscle must pick up the slack and in this instance it’s the piriformis. Since the piriformis is small and not intended to do all this work, it can get overactive and spasm easily in these cases. When this happens, it can compress the sciatic nerve, leading to pain, numbness, and tingling sensations. Because it’s an overactive muscle, spasming from too much work, it just needs a break. By doing hip flexor and piriformis flexibility exercises, these symptoms of tightness and pain subside, restoring normal movement and function.
The pain from piriformis syndrome can occur during many movements since this muscle is so integral in lower body mechanics. But when it’s over-activated, and nerve compression is happening, you or your client might feel pain just sitting at a desk, in the car, or even while standing.
Clients who are extremely active and prone to developing this condition include soccer players, track and field athletes, runners, and triathletes. This is due to the constant lifting and rotation of the thigh away from the body. Including piriformis syndrome stretches into their exercise programming is essential.
Special Considerations with Clients
According to Harvard Health, it is also important to have a full health history on your clients, as other medical issues will also accelerate the pain associated with piriformis syndrome. Some of these conditions include:
- Previous Injury
- Abnormal development of sciatic nerve or muscle
- Postural deviations
- Leg length discrepancy
- Unusually vigorous exercise
- Excessive bouts of sitting
- Previous foot issues
Prevention and Pain Management
Piriformis syndrome doesn’t have to sideline your clients’ goals and successes. Simple mobility exercises will help keep this tiny muscle from tightening and causing pain and dysfunction. Keeping the body’s strength work balanced will help to avoid overcompensation issues, and including strengthening work specifically on the hip adductors is essential.
Check (and share!) out this great resource of the best ways to deal with pain in the buttocks- piriformis syndrome. And, if you want to be an expert at working with clients who have these types of symptoms (and so, so much more) then you should be a Corrective Exercise Specialist. Get this advanced certification and bring even more value to the clients you work with.