The Athletic Hip Series: Piriformis Syndrome

Post by Maggie Gebhardt, PT, DPT, OCS

To a runner, the word “Piriformis” is a dreaded, scary, and frustrating word. However, the diagnosis for Piriformis Syndrome is commonly overused and misdiagnosed. I would venture to say that in the years I have been working, I have never actually seen a true case of Pirifomis Syndrome. Many people assume that  hip tightness must be their ‘Piriformis.’ Well I am here to spread the word…that is just not true!

Actual Piriformis Syndrome is when the piriformis muscle becomes so tight that it causes numbness, tingling and/or pain down into the respective leg. The piriformis muscle spans the backside of your hip, sits amongst your gluteal muscles, and runs from your tailbone to the outside of your hip. All of those symptoms mentioned above can occur with or without the piriformis ever being involved. That’s what makes this a hard syndrome to accurately diagnose. Numbness, tingling, and/or pain down into the leg can have numerous causes including, but not limited to: herniated disc, facet syndrome, foraminal stenosis, glute trigger points, and neural tension of the peripheral nerves to name a few. All of the aforementioned can cause the same symptoms as Piriformis Syndrome, with the piriformis muscle not being involved at all. Those with piriformis syndrome will have the above symptoms, but clinically there are objective tests your therapist can take you through that definitively say whether or not the piriformis muscle is the culprit.

If indeed you are one of those rare people who actually have an affected piriformis, usually the cause is some combination of poor leg mechanics. The poor mechanics are usually attributed to weakness of the stabilizing hip musculature. Yes, I know you are all shocked to hear this from me, but here it is again…Dead Butt Syndrome! With some proper strengthening, stretching and other modalities for pain and to improve the neural integrity of the nerve that was being pressed on, Piriformis Syndrome will very quickly be a thing of the past as you continue running down that road towards optimal health.

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