More than 3 million people visit the doctor each year with sciatica pain; that is, pain, tingling, and numbness in the lower back that radiate into the buttocks and down the leg. Sometimes the underlying culprit is a herniated disc, other times a bone spur. But when medical professionals rule out those options, there is one left—piriformis syndrome. A fairly uncommon condition, piriformis syndrome is compression of the sciatic nerve by the piriformis muscle deep within the hip. Once you understand what causes the piriformis to aggravate the sciatic nerve, the treatment is fairly simple: reduce inflammation, improve alignment, and strengthen the muscles surrounding the hips.
Piriformis syndrome is caused when the piriformis muscle (deep in the buttocks) compresses the sciatic nerve, causing pain, tingling, and numbness from the lower back down the leg. This condition is considered uncommon, but it occurs more frequently among dancers than other demographics due to their tendency to assume a consistent externally rotated position. This condition is not easily diagnosed, and is often misdiagnosed on first examination, because its symptoms are similar to other conditions, such as herniated discs. Medical professionals often arrive at a piriformis syndrome diagnosis after eliminating all other conditions that affect the sciatic nerve, by using MRI and CT scan.
The primary symptom is sciatica. It begins as pain, tingling, or numbness in the buttock, and subsequently, if left untreated, the pain can radiate down the leg. Some people even experience pain in the lower back, though if it starts here, the sciatica is likely caused by a herniated disc as opposed to piriformis syndrome.
The piriformis is one of the six deep outward rotators of the hips. The muscle runs from the lower back (anterior portion of the sacrum) to the outer hip (greater trochanter) deep within the hip. The sciatic nerve, a long, thick nerve that extends from the lower spine (lumbar spine) down the leg, is located right next to the piriformis muscle. In fact, in about 17 percent of the population, the sciatic nerve actually passes directly through the piriformis muscle. When the piriformis becomes swollen, inflamed, or injured, it can compress the sciatic nerve. This compression causes a symptom called sciatica—pain that radiates from the lower back through the buttocks and down the leg.
A few different things can cause the piriformis muscle to compress the sciatic nerve. The first is a muscle spasm. If the hip muscles are overused, muscle spasms may occur. This is especially true if the piriformis is weak to begin with, and suddenly needs to exert a lot of force. For example, if someone decides to run a half marathon one day, but has not trained for it, the muscles in the hips are not going to be strong enough to deal with such exertion. They will quickly become fatigued. As the person pushes through the fatigue, the muscles will begin to spasm. Spasms can last long past the event that causes them.
Sciatica can also be caused by a misalignment of bones in the hip joint. If the bones are not aligned properly, there is not adequate space for the piriformis muscle and the sciatic nerve to function optimally, and the muscles in the hip cannot strengthen in the proper proportion. This may result in undue pressure being placed on the piriformis muscle, which can lead to inflammation and swelling. This type of misalignment can be hereditary, or it could come from a habitual imbalanced gait or posture. Additionally, an acute injury to the hip (broken hip, pulled gluteals, etc.) can cause swelling and even bleeding in the piriformis, again causing (you guessed it!) piriformis syndrome.
- Equalize your weight. Notice your sit bones, those protruding bones in the middle of your buttocks, and how you distribute weight on them while seated. Sit in your office, kitchen, or living room chair, and ask yourself, “Is there more weight on my right sit bone as compared to the left, or more weight on my left sit bone as compared to my right?” If the answer to either question is yes, take time to fidget until the weight is evenly distributed. Memorize that feeling of equalizing your weight on your sit bones and remind yourself to find that equalization each time you sit. Equalizing your weight while seated reduces misalignment in the hips. Proper alignment ensures all of the bones, muscles, and nerves have adequate space and can proportionately stretch and strengthen without strain.
- Avoid inflammatory foods. Piriformis syndrome is often caused by excessive inflammation of the piriformis muscle. Because of this, a diet consisting of highly processed, inflammation-inducing foods may exacerbate symptoms of piriformis syndrome. Make whole foods 95 percent of your daily diet, leaving processed and junk foods for special occasions. To minimize pressure on the sciatic nerve, the best thing you can do is reduce inflammation in the piriformis muscle. This can be accomplished in great part by focusing your diet on anti-inflammatory foods, which will expedite your healing.
- Stretch it out. Tightness in the hips can lead to hip misalignment, muscle strain, and pain in the lower back. Implement a regular stretching practice focused on the muscles in the hips and legs to facilitate better alignment in the hips, reduce symptoms of piriformis syndrome, and prevent its reoccurrence.
1. Ground the Feet. The feet act as the foundation for proper alignment throughout the rest of the body. Grounding the feet facilitates better alignment in the hips, thus reducing compression of the sciatic nerve. To Ground the Feet, first create equal pressure on the left and right foot. Then, imagine points at the base of your big toes, pinky toes, outer heels, and inner heels. Pull the toe stems long and push all four points of the soles into the ground. In everyday life, you can Ground the Feet when you stand in line at the grocery store, brush your teeth, or sit at your desk at work. No matter if you’re seated or standing, connect to the ground beneath you by simply pressurizing through the four points of the soles (with equal weight on both feet), and reach long through the toes.
2. Anchor the Hips. The piriformis muscle is located deep within the hip. When the glutes (butt muscles) are overactive, the piriformis is forced to work extra hard and the space between the piriformis and the sciatic nerve is compromised. Release excess tension in the glutes and bring the hips into proper alignment through the technique Anchor the Hips to reduce the risk of developing piriformis syndrome. To Anchor the Hips, make “L” Mudra with your hands. Place your thumbs on your ribs and your index fingers on your hips. The space between the thumbs and the index finger is called the side body. This area shortens when you slump or slouch. Increase the space between the index fingers and thumbs to lengthen the side body. Now, draw the lower belly—the space between the belly button and the pubic bone—back toward the spine and up toward the ribcage to engage the deepest layer of abdominal muscle (transverse abdominis). Finally, release the glutes. To learn to release your glutes, it may help to understand what it feels like to do the opposite—grip the glutes (tighten the butt muscles) by squeezing them together. Now release. In everyday life, you can Anchor the Hips when standing up from a chair. Before rising, lengthen the side body. On an exhale, Ground the Feet, and simultaneously pull the belly in toward the back and up toward the ribcage and release the glutes to stand.
3. Mobilize the Ribs. Inflammation is a response set into motion by the “fight or flight” nervous system (sympathetic nervous system). If the sympathetic nervous system is overactive, the body will continue to send inflammation to an injured area long after the body no longer needs it. Excessive inflammation causes pain and triggers the development of tough, inflexible scar tissue. Mobilizing the ribs involves taking fuller, deeper, and slower breaths, which signals the sympathetic nervous system to turn off. To Mobilize the Ribs, expand the ribs in all directions on your inhale—toward the back, sides, and front. On an exhale, contract the ribs toward center. Start by noticing your natural breath and breathing tendencies. Then, actively expand and contract the ribs as you breathe. You can use a mirror to see where you more easily inhale or exhale, or better yet, place your hands on your ribs and feel the movement. If you typically breathe in the front of your ribs, try to inflate the back of your ribs. It may be harder than you imagine. Since you are constantly breathing, you can Mobilize the Ribs any time of day! Practice while waiting on your morning coffee or tea, walking down the street, or warming up before you exercise. Notice the ribs expand wide as you inhale. Now, actively contract the ribs as you exhale. Challenge yourself to keep the side body—space between ribs and hips—long as you contract.
RICE. RICE stands for Rest, Ice, Compress, and Elevate. These are the four steps to reducing inflammation in an injured area. If your doctor has diagnosed you with piriformis syndrome, the first step is to rest. If you notice the pain specifically during certain activities, take a break. Apply ice for 10 to 15 minutes 4 to 6 times a day. Compression shorts or leggings can add support and further reduce inflammation. If possible, elevate the affected area above the heart, which uses gravity to help draw blood back to the heart, reducing swelling even further.