Pain in the Buttocks when Sitting? Use these Tips to Manage Piriformis Syndrome

If you (or your client) has ever had sensations like sharp pain, numbness, or tingling in your lower back and buttocks (glute) region that travels down the back of your leg, you’re not alone. And, a muscle called the piriformis could be to blame.

This small muscle plays a big role in keeping lower body movements smooth and balanced, particularly during extension, abduction, and external hip rotation. And, when you know how it affects movement and pain, you can help clients avoid what’s called avoiding piriformis syndrome. Simple mobility and flexibility exercises can help alleviate the symptoms and stay pain free.

What Is the Piriformis Muscle? 

Buried deep within the hip and glute area, the piriformis muscle is essential for many lower body movements. It is a pyramid-shaped muscle that attaches to the sacrum of the pelvis on one end and the greater trochanter at the top of the femur at the other end. 

Running mostly horizontally from the pelvis to the top of the thigh, the piriformis is an external rotator muscle. It contributes to abduction, the outward rotation of the leg, during walking, running, and other movements. When squatting, past a 90-degree angle, the piriformis becomes an internal rotator. 

About Piriformis Syndrome and the Sciatic Nerve

Piriformis syndrome occurs when the muscle compresses and irritates the sciatic nerve. The sciatic nerve is a long nerve that runs from the lower spine and down each leg all the way to the feet. It has to get past the piriformis muscle, which can sometimes cause a roadblock that leads to sciatica and uncomfortable symptoms. 

Symptoms of Piriformis Syndrome

If you have ever experienced sciatica from any cause, you know what piriformis syndrome feels like. The symptoms result from the pressure placed on this nerve to varying degrees: 

• Pain in the lower back and buttocks that might sometimes radiate down the leg

• Tingling and numbness

• Difficulty sitting and pain that gets worse the longer you sit

• Pain with certain activities, like walking, running, or climbing stairs

• Muscle spasms

What Causes Piriformis Syndrome? 

A lot of different things can cause inflammation, irritation, or spasms in the piriformis that, in turn, result in pressure on the sciatic nerve and piriformis syndrome. However, there are three main ways this happens: 

1. Overuse injury. Any kind of repetitive motion in this area can result in an overuse injury that inflames the piriformis. Examples include walking and running, climbing stairs

2. Acute injury. Traumatic injuries from sports, vigorous exercise, a car accident, a fall, or other causes can also injure the piriformis. 

3. Tightness in the muscle. You can worsen increase your risk of developing piriformis syndrome by sitting for long periods of time. Inactivity, especially sitting, causes the muscle to become tight. 

Another common consequence of sitting too much is tightness in the hip flexors. Here are some hip flexor stretches that can help. 

Signs You Need a Piriformis Stretch

A tight piriformis is just one of many causes of sciatic pain. If this is your issue, stretching it will help, but it’s not always obvious. Of course, if you have an obvious injury or have ongoing or severe pain, it’s best to see a doctor. 

You might feel some tightness across the sides of your hips if your piriformis is tight, but this isn’t a surefire indicator. Try doing a squat and take a look at how your knees track. If they tend to move outward, this could be a sign of tight piriformis muscles. 

If you are a personal trainer, check out this short and affordable ISSA course to help you learn how to assess piriformis syndrome in clients. 

How to Manage Piriformis Syndrome with Stretches

Hopefully, your issue is as simple as a tight piriformis muscle that you can correct with regular stretching. Start with the simpler, easier stretches, and work your way up to more challenging moves as you lengthen the muscle. The exercises are described assuming your right let is the sore one. You can repeat or switch any of these to the left leg if needed. 

Basic Seated Stretch

This is an easy one to begin with if your piriformis feels tight or you have mild sciatica symptoms. Sitting in a chair, cross the right leg over the left, placing your right ankle just over your left knee. Use your hands to keep the foot in position if necessary. Keeping your back straight, lean forward until you feel the stretch. 

You can do the same stretch sitting on the floor. Extend your left leg forward. Bend the right leg and cross it over the left so that your right ankle is over your left knee. Lean forward to get the stretch. 

Supine Stretch

Get a similar stretch by lying down on your back. This takes some pressure off your back and allows you to use the strength of your arms and legs to get a better stretch. 

While lying down extend both legs straight and upward, perpendicular to the floor. Bend the right leg at the knee, and as with the seated stretches, cross it over the left leg with your right ankle on your left knee or just above it. 

From this position, you can keep the left leg extended or let it relax. Pull your left leg toward your abdomen and chest until you feel the stretch. 

Supine Outer Hip Stretch

This one is a little more challenging and also begins in the supine position on the floor. Start with both legs straight. Bend your right leg at the knee and tuck your right foot under your left knee. Twist your right knee over the left leg as you roll your body in that direction. 

Use your left hand to push your right knee down towards the floor to get an even better stretch. In addition to the piriformis, this will stretch your outer hip and lower back. 

Pigeon Pose

This is for advanced stretchers, or anyone already experienced with yoga. Pigeon pose will give you a deep hip, glute, and piriformis stretch. 

Start in push up or downward dog position on a mat. Reach your right foot forward to your hands and rotate it outward so that the outside of your foot is pressed against the mat. Keep your left leg stretched behind you and hips squared. Don’t allow them to twist too much. 

You should feel a good stretch along your right side. You can deepen the stretch by lowering your upper body and reaching your arms forward. 

When to See a Doctor vs. Relying on a Piriformis Stretch

If your pain is severe, limits your activity and mobility, and doesn’t respond adequately to stretching, it’s time to see a doctor. Your primary doctor can give you an initial evaluation and recommend a specialist, such as an orthopedist or physical therapist. 

Knowing more about the piriformis and how it can lock up is important for prevention. Avoid sitting for long periods of time, vary your workouts, balance your body’s strength, and always make time for stretching for the best results. 

If you love learning about fitness and working out, take a look at the ISSA’s Certified Personal Trainer – Self-Guided Study Program. It’s a comprehensive course that prepares you to work as qualified fitness professional.  

Share these exercise recommendations with your clients by clicking HERE.

REFERENCES

1. Chang, C., Jeno, S. H., & Varacallo, M. (2022, October 3). Anatomy, Bony Pelvis and Lower Limb, Piriformis Muscle. National Library of Medicine. Retrieved February 15, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK519497/

2. Ask Dr. Rob about piriformis syndrome - Harvard Health. (n.d.). Retrieved August 20, 2022, from https://www.health.harvard.edu/diseases-and-conditions/ask-dr-rob-about-piriformis-syndrome

3. Carro, L. P., Hernando, M. F., Cerezal, L., Navarro, I. S., Fernandez, A. A., & Castillo, A. O. (2016). Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles, Ligaments and Tendons Journal, 6 (3), 384–396.

4. Hopayian, K., Song, F., Riera, R., & Sambandan, S. (2010). The clinical features of the piriformis syndrome: a systematic review.European Spine Journal, 19(12), 2095–2109. https://doi.org/10.1007/s00586-010-1504-9