A Pain in Your Arse – Literally!

Piriformis Syndrome is not new to us, we’ve known about it for quite a while now. It was in the 1920s that we first heard of sciatic nerve pain or symptoms being linked to Piriformis muscle tightness and two short decades later, the term ‘Piriformis Syndrome’ became a way of articulating it. So why is it that we still have issues recognising it even exists? Some people you speak to will swear by it and others will tell you there’s no such thing.   As with a lot of things in life, I try not to get too stuck on the small details like “What name is best to describe this?”. Instead, I focus on the bigger picture of a patient’s presenting condition. For example “Where is the pain exactly?” “what type of pain is it?”, “What movements make it better or worse?” “Is it getting any better?” “Do you have any pain at night?” “How does the pain behave in a 24hour period” etc. These things as well as my own clinical findings after I have assessed a patient help me build an idea of if Piriformis is involved or not. If it is, then treat it. If not, treat what’s involved. Your patient wants simply to be pain-free. Simples.     


A small but very important muscle, it originates from the pelvic surface of the sacrum and inserts into the superior border of the greater trochanter (i.e right on top of the head of your thigh bone, responsible for:

  1. External rotation (turning your hip/knee outwards when your leg is bent)
  2. Abduction (taking a straight leg out to the side)
  3. Extension (taking a straight leg back)

WHY IS IT IMPORTANT?   In 15-20% of people, your sciatic nerve passes through the piriformis muscle, whilst in the majority of the population, it passes just beneath it. This means that any tightness, inflammation or similar in the muscle will cause irritation to the sciatic nerve, producing the all dreaded symptoms of sciatica, including pain shooting from your buttock all the way into your foot. Eww, no one wants this!   Nerves are very sensitive and can be sometimes difficult to treat. The sciatic nerve is a major nerve and issues with this have been known to lead to depression, isolation and other mental health issues, due to how debilitating it can be if left untreated, or not treated properly.     WHAT DO I DO IF I HAVE PIRIFORMIS SYNDROME?   Definitely, go see a physiotherapist. It’s not something you want to diagnose yourself or allow someone else to diagnose if they aren’t a qualified physio. Diagnosing any type of musculoskeletal issues certainly requires the skills and knowledge of a physiotherapist – preferably, a Chartered Physiotherapist.   In the meantime,

  1. keep your back and hips mobile by doing gentle movement exercises and stretches. I have a video of back exercises here. Make sure you avoid the flexion-type exercises until you’ve been told by your physio if you have slipped a disc or you have Piriformis Syndrom
  2. You may need some pain/inflammation management – don’t be shy of these, you will definitely need them
  3. Stay active – swim, gentle walking etc. Keep moving
  4. Avoid prolonged sitting
  5. Complete the piriformis stretch at least 3x/day in the video below

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