Piriformis Syndrome

Piriformis Syndrome – A Pain in the Butt
as published in the Onteora Runner's newsletter January 2007

During one of my long runs, the topic of conversation was “pains in the butt”. We discussed those pains in detail: relationships, family responsibilities and household chores, and quite literally that vague annoying pain that seems to originate in our rear ends and goes down the back of the leg. More often than not this pain occurs when we run and can be quite debilitating.

This “pain in the butt” is also known as piriformis syndrome. Some athletes experience deep pain in the gluteals; others a pain in the hamstrings or an elusive annoying discomfort down the back of the leg. It’s important to have a health practitioner rule out that these symptoms are caused by a herniated or bulging disk, sciatica or other musculoskeletal problems in this area. Since many of the symptoms experienced overlap with a variety of other problems, piriformis syndrome is known as a diagnosis of exclusion.

The sciatic nerve (the nerve that runs down the back of the leg) passes immediately below the piriformis. The piriformis muscle works in conjunction with four other deep gluteal muscles (superior & inferior gemeleus and internal & external obturator). Its function is to externally rotate the femur (thigh bone) in the hip and slightly extend and abduct the hip when the hip is flexed. Weak and/or tight musculature and biomechanical compensations contribute to piriformis syndrome.

Anatomical Contributors Include:
• Weak abductors
• Tight adductor muscles (inner thigh) and medial hamstrings
• Tight ITB (iliotibular band)
• Leg length discrepancy
• Foot pronation

Running Flaws/Biomechanical Contributors Include:
• Running on canted surfaces
- the leg on the “high side” of the road tends to pronate more.
- The adductors of the leg on the “high side” are under more tension during midfoot and toe-off.
- The external rotators and abductors are working harder to maintain stability during mid-stance.
• A long stride
• Running down hill fast or doing too many hills too often.

Stretches & Exercises:
Piriformis stretch: Lying on your back with both knees bent, rest your ankle of the leg that hurts over the knee of your unaffected leg. Grasp the thigh of your unaffected leg and pull that knee toward your chest. You will feel a stretch along your buttocks and possibly along the outside of your hip on the affected side. Hold this stretch for 20 to 30 seconds. Repeat 2 times.

Quadruped Extensions: This exercise is best performed with a friend watching you to make double check your form. Activate your lower abdominals by pulling your belly button up towards your back. Extend your right leg towards the wall behind you. Lift your leg up until it is parallel with the floor. Be careful not to twist your spine or buttock. Extend the opposite arm as shown. Hold 3-5 seconds. Lower and then repeat with opposite leg and arm. Do 5-7 sets.

These few tidbits should be of some benefit. Avoiding hills and canted roads should help alleviate some of the pain that you might be experiencing. Shortening your stride and reducing the amount of speedwork performed will also help. Also stretching appropriately and doing strengthening exercises will help keep you healthy and ready for the season to come.