Are you having buttock pain that sometimes travels down the back of the thigh? You might have piriformis syndrome. Sometimes this problem can come from starting a new walking or exercise program.  Marked by a dull ache and tightness in the gluteal muscles and oftentimes pain radiating down the back of the leg, it can range from a low-level irritation to a ‘stop you in your tracks’ injury.

One of the more difficult injuries to diagnose, piriformis syndrome results from injury to or inflammation of the piriformis muscle. Located in the hip region, the piriformis is an important stabilizer muscle. “It keeps your pelvis and sacrum stable and prevents your hips from internally rotating,” explains Jarrett Shavitz “If you have weakness of the piriformis and gluteal muscles, that increased rotation of the hip can lead to issues and irritate the piriformis.”

The difficulty in diagnosis is usually related to the similarity in symptoms between piriformis syndrome and sciatica. While sciatica is commonly caused by a herniated disc or spinal degeneration, it can also be a result of an irritated piriformis muscle compressing the sciatic nerve. Since the nerve runs close and sometimes through the piriformis, dysfunction of the piriformis can actually cause sciatica. With that said, the pain and numbness down the back of the leg that comes with sciatica isn’t always a result of piriformis syndrome. There can be nerve irritation associated with piriformis syndrome, or the nerve can be irritated from the spine. To further confound the situation, long standing pain creates trigger points which can refer pain to the back of the leg as well, even referring pain to the foot.

While each case is different, Jarrett will examine each case and pinpoint the origin of your pain to best manage your underlying symptoms and problem.

One of the main issues with piriformis syndrome is that can be frustrating for the patient. Just as people are getting good at a exercise program, you get this injury and have to take time off to let the injury heal. But if you don’t rebuild and balance your core strength, many people get a recurrence as soon as they ramp up activity again. “You need to develop a good balance between core and extremity strength,” he adds.

We use a variety of myofascial techniques to decrease pressure on the sciatic nerve, and calm down the piriformis,” he says. These therapies allow the clinician to be more exact in targeting the area of interest. While foam rolling can further irritate the sciatic nerve if you compress it as you work to stretch and massage the hip and glute region, trigger point therapy and Iastm allow for scar tissue and muscle dysfunction to be pinpointed more accurately.

Dry needling can also be quite effective in management of trigger points of the lateral part of the piriformis. The gluteals are most easily managed with dry needling which can reduce pressure on the piriformis muscle. Most true piriformis injuries are now successfully managed with physical therapy, as well as a commitment to strengthening and stretching. Optimum therapy will have you back on your feet in no time!

To be sure, since this is a complicated injury, if you’re having persistent pain in your backside that is preventing you from doing “YOU”, it’s time to see a therapist.

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