A Pain in the Piriformis
The Piriformis muscle is a small muscle at your hip that rotates your leg outward. While this muscle is small, it is quite popular since many individuals have pain and tenderness. The muscle is located posteriorly deep to the Gluteus Maximus muscle and can typically be felt in the area of your back pants pocket.
The Piriformis is one of the few muscles that attaches directly to your sacrum, which is essentially part of your spine. The sacrum makes contact with the ilium bone (the wing of your pelvis) and the surfaces of those two bones make up the Sacroiliac joint (SI joint). What this means is the Piriformis muscle can influence, or be influenced by, the SI joint. The Piriformis is also located along the path of the even more famous Sciatic nerve, and in many individuals the Sciatic nerve travels through the Piriformis muscle. The Sciatic nerve is made up of nerve roots that exit at most levels of your low back. So you can see that this all becomes complicated very fast when trying to determine the answer to the question: “Why do I have such a pain in the piriformis?”
The best way to correctly identify the root cause of your pain is to see your physical therapist who can complete a thorough biomechanical assessment to determine the customized treatment you will need. In the meantime, here are some ways to try to reduce/alleviate that pain.
Stretching and Rolling
While this may not correct the underlying issue, these tricks may at least help relieve some pain you are experiencing.
Seated Figure 4 Stretch: Cross your ankle over your opposite knee. Keeping your back straight, bend forward until you feel a moderate pull to the back of your hip.
If you do not have the range of motion for the seated stretch, try to lie on your back instead with your knees bent. Now cross your ankle over your opposite knee. You can grab the back of your opposite leg with your hands or with a towel or strap and pull your knee towards your body.
Use a tennis ball or foam roll to roll out the tender area at the back of your hip. You may have tightness/weakness elsewhere surrounding the hip that is placing undue strain on the piriformis. Perhaps you have tightness of the Tensor Fascia Lata muscle, or “TFL.” If this muscle is tight, and your Gluteal muscles are weak, the Piriformis may be working to keep the balance.
If this is the case, you can try stretching or rolling out your TFL with a foam roll, and then work on Glute max strengthening exercises such as bridging, dead lifting, squatting, etc.
Keep in mind your pain may also be related to Sciatica and possibly originating from dysfunction of your lower back or SI joint. If you continue to experience Piriformis pain, set up an appointment with your local physical therapy clinic.