Piriformis Muscle: The Root Cause of Your Low Back and Hip Pain
Piriformis Muscle: The Largest and Most Important of the Hip Rotators
I will explain the importance of the piriformis muscle, common places of trigger points and fascial adhesions found within the muscle, and effective ways to treat an overactive piriformis muscle, which can be related to sciatica-like pain known as piriformis syndrome.
The piriformis muscle is the largest and most important of the six short hip rotator muscles that are located between the sacrum and the greater trochanter in the middle of the buttocks. The piriformis muscle attaches just inside the rim of the sacrum and then travels across to attach to the top of the greater trochanter. With leverage gained by these attachments, the piriformis muscle is able to strongly rotate the leg outward. When the leg is stationary, the piriformis turns the body in the opposite direction. Overdoing either of these rotatory movements leads to overactivity, large trigger points, and chronic facial adhesions within the muscle.
The facial adhesions and trigger points can cause a tremendous amount of misery, ranging from muscle aches to nerve and blood vessel entraptments, which is referred to as myofascial pain. When the piriformis is to blame for your trouble, you're lucky if you ever find out.
The Story of a Typical Runner
Bob, one of my patients, is in his mid forties. An avid runner and a salesman for an insurance company, he has suffered for years from a deep ache in his right hip. His discomfort rarely rose to the level of outright pain, but it was unrelenting and oppressive. Sometimes he also had pain, numbness, and tingling in his foot and the back of his leg. He would say that "it's pretty obvious it comes from running and sitting all day, but I have to sit for work and running is my stress release from the day, I been doing some passive physical therapy and a lot of stretches, but it never gets any better."
The facial adhesion and/or trigger point in Bob's hip were what was causing his discomfort. Which, typically will not fully relax on there own without some sort of release. Although he took steps to keep the muscle flexible by moving his leg into alternate positions at work and stretch before running each day, chronic facial adhesions will require a great deal of precise tension to break-up.
Note to treat Bob's right hip pain: I performed several passes of Active Release Technique, a patented, soft tissue massage technique, on his piriformis muscle, after which he got a 30% improvement. By performing the sciatic and peroneal nerve flosses (exercise videos below) in congruence with regular piriformis stretching (demonstrated in the video below), Bob has been able to stay pain-free, and he is still running.
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An Effective Piriformis Stretch for Hip and Back of Leg Pain
Helpful Images To Help Further Understand What Can Cause Sciatica or Piriformis Syndrome
This image represents a posterior lateral disc herniation, which is causing irritation on the adjacent nerve root. It is important to manage dysfunction like this, muscle restrictions, and joint stiffness early to avoid more serious and complicating conditions.
This is a diagram is of the pelvis demonstrating sciatica. The sciatic nerve of the right (yellow) passing under the piriformis is not affected. However, the sciatic nerve on the left is inflamed (orange). This condition can result in pain, numbness, and/or tingling down the leg as discussed above. It may also lead to muscle spasms in the glute region.
This image is of a normal low back (side view). Showing the disc and separate spinal vertebrae. This image is provided for you to use as a comparison with the following image, which demonstrates sciatic like symptoms.
The image below demonstrates the discs as inflamed (pink) and the nerves as irritated (orange). Symptoms that are likely related to this condition are back pain, leg pain and/or soreness, muscle spasms, weakness in the leg or back muscles, tingling sensations, numbness, burning, aching, and shooting pains down the leg.
Excessive low back curve or hyperlordosis is demonstrated below. The result is more stress on the low back and hips. Leading to overloading of the lumbar discs and adding strain to the posterior spinal joints known as the facet joints.
Additional Home Remedies for Sciatica Type Pain
When you have piriformis syndrome or sciatica it is extremely hard to find a sleeping position that you can stomach for more than an hour or two during the night.
Making your sleep both restless and a continual dread when you have had weeks of pain.
Symptoms and Treatment
Symptoms. Pain and other symptoms in the buttocks are likely to be composite effects from more than one muscle. Nevertheless, in most instances, you can expect the piriformis muscle to be involved, especially for women. Problems caused by facial adhesions in the piriformis muscle are six times more prevalent in women as in men. (1992: 193, Pace 1976 435-439)
Referred pain from the piriformis muscle is felt in the sacrum, buttocks, and the hip. Adhesions and trigger points may occur either at the insertion or origin of the piriformis, but both may refer to the entire buttocks area. Trigger points occurring in the other short rotator muscles just below the piriformis are believed to have similar referral patterns (1992: 187-188, 192; Retzlaff 799-807)
Tension in the piriformis muscle can also lead to twisting the sacroiliac joint, adding to your pain. The resulting tilt in the sacrum cam make you appear to have a short leg. Shortening of the piriformis muscle with addition of facial adhesions will make it difficult to cross your leg inward. Spreading your legs may also be extremely painful. You may limp because of the pain, and sitting for periods longer than 15 minutes may become unbearable.
Treatment: By far the most effective form of treatment is manual therapy at the site of the adhesion. Treatment techniques like trigger point release, Active Release Technique, and Graston are all extremely effective methods of treatments. I have been certified in both Graston and Active Release Technique for over 5 years and would have to say that without a doubt finding a certified Active Release Technique practitioner would be your best bet to get the fastest improvement if you have facial adhesions in your piriformis muscle currently.
Below are videos I made to demonstrate the most effective way to perform a peroneal and sciatic nerve floss to help relax the piriformis muscle, aiding in the relaxation your external hip rotators.
Sciatic and Peroneal Nerve Flosses - Treat The Entire Portion of Leg Supplied By The Sciatic With Two Exercises
Sciatic Nerve Floss - to treat the entire nerve, helping relax hamstrings, glutes, hips, and calfs
Peroneal Nerve Floss - helping relax lateral hamstrings, outside hips, and lateral calves