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Piriformis Syndrome? Read This First

You Should Read This Post If:

  • You have pain through your lower back and down the back of one (or both) of your legs
  • You’ve been diagnosed with piriformis syndrome
  • You want to learn more about piriformis syndrome
  • You love the movie The Muppet Christmas Carol
  • You’ve been wondering if gorillas get piriformis syndrome too (answer below!)

It must officially be the holiday season because I’ve already had one dose of The Muppet Christmas Carol. If you’ve never seen it, I’m implore you to go find it on sale in one of those $5 DVD bins at Wal-Mart – it will be well worth your time.

Buy Muppet Treasure Island too, if you can.

This post, though, is not holiday-related. Instead, I’ll be talking about a pain in your butt (well, I guess it is holiday-related). The pain in your butt is your piriformis. And it’s less fun than Black Friday shopping wading through a mass of nutjobs in a Target at 2 am on a cold Friday morning the day after Thanksgiving in order to save $50 on a television that you probably didn’t need in the first place.

Piriformis syndrome is an umbrella term to describe pain, tingling, or numbness through the buttocks and down the leg(s) secondary to the irritation of the sciatic nerve.

This happens when the piriformis is overused. It may spasm or shorten, but just know that it bumps into the sciatic nerve and causes a whole lot of pain. (For the record, other conditions can explain sciatic nerve pain including disc issues like herniations.)

But the most important thing you can do when trying to alleviate piriformis syndrome is to learn why your piriformis is acting up in the first place.

As a function of general weakness

The glute family serves many useful purposes in our daily lives: walking, standing upright, attracting potential mates. So yes, glute strength is pretty important.

Glute max (the big one) not only extends the hip, but also abducts and externally rotates the femur. As I mentioned, this is important for both maintaining an upright posture and walking on two legs. Otherwise, as I’ve alluded to before, we would be apes.

And wild male gorillas often weigh between 300 and 400 lbs with an average top-end running speed of 20-25 miles per hour. Imagine Vince Wilfork winning the 100 m sprint at the next summer Olympics. Thank god they aren’t as intelligent as humans or Planet of the Apes would be real.

Regardless, when the glutes are not functioning optimally, the piriformis will try to pick up the slack, leaving the piriformis overworked and frustrated. So it spasms. It then knocks the nerve next to it and boom, leg pain.

Logically, this glute weakness could also be secondary to poor overall pelvic position caused by a weakness throughout the core and an inability to keep the pelvic in neutral.

Explained by the assumptions of the Postural Restoration Institute

If you aren’t familiar with the Postural Restoration Institute (PRI), the basic premise is that biological asymmetries in the human body can lead to a chain-reaction of improper position within the musculoskeletal system. This can lead to everything from pain to deficits in performance.

Except for those with situs inversus, the heart is on the left side of your body and the liver is on the right. Due to numerous other internal asymmetries, the pelvis finds itself in an asymmetrical position as well. This leads to uneven rotation at the legs, through the lower back, and up to the shoulder girdle.

For all these reasons, piriformis syndrome on the left and the right have completely different causes!

On the right, our glutes become weak as an external rotator and abductor. Instead of fixing our position, our piriformis attempts to pick up the slack for this shortfall. It gets frustrated, it spasms, and you get pain.

On the left side however, the glutes function extremely well as external rotators and abductors. In fact, the entire left leg is “stuck” in a semi-externally rotated state. Therefore, all of the external rotators (including the piriformis) become short. This excessive muscle tone irritates the sciatic nerve and boom, pain again.

What can you do?

As outlined above, piriformis syndrome is pretty simple to understand and equally straightforward to fix.

Your first job is to foam roll the affected area. The piriformis is a tiny little troll sitting underneath various other muscles, so it may take a second to find it. Use a lacrosse ball as the smaller surface area makes for better rolling.

Next, look at your body from a “lower crossed” standpoint. For those that sit a great deal, “lower crossed syndrome” is common. The glutes and abdominals become weak due to underuse and the hip flexors and lower back can become short and/or hypertonic.

Aside from general pains through the hips and low back, this glute and abdominal weakness could ultimately funnel itself into a piriformis problem.

The solution here is simple:

  • Squat and deadlift
  • Direct tri-planar core work

It’s a little more complicated than that, but you get the picture. Lower body work, both unilateral and bilateral, coupled with direct core work in the sagittal, frontal, and transverse planes (think: front planks, side planks, and Pallof presses) should do the trick.

This will all help you become strong in your core and posterior chain, allowing the piriformis to relax a bit.

The last thing you can do is look at yourself from a PRI standpoint. Is one of your shoulders higher than the other? Do you always stand on one leg? Maybe you have nagging, recurring pain on one side of your low back?

This could all indicate an asymmetry in your body. If you’re familiar with the PRI methodology, work on resetting the hips and building more symmetrical strength throughout your body. If not, find a qualified professional and see if they can help.

As with many other issues, a comprehensive program that improves the strength levels of your core and lower body will help.

Chalk that up as another victory for strength. I’m sure that 400 lb gorillas don’t have piriformis syndrome.

(Because gorillas don’t have a piriformis.)

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