Dealing With Piriformis Syndrome Bicycling

By Richard Ellin

Question:  I’ve been dealing with this condition for quite some time. The piriformis is a small muscle in the butt that primarily controls the orientation of the leg during biking, running, etc.  It affects runners more than bikers.  I have been trying to stay aerobic by using biking since running is not possible with this malady. However, I am finding that hard pedaling brings on the same symptoms as running. Since hard leg movement in a bent-over position accentuates the problem I am wondering if some bicyclists might have to deal with piriformis syndrome.  In addition to the discomfort (pain, really), leg strength is also compromised. — Fred H.

Dr. Richard Ellin Responds: 

Piriformis Syndrome is a diagnosis often given to people with either low back pain, or pain down the back of the leg reminiscent of sciatica.

It is due to tightness or spasm of the piriformis muscle, located in the pelvic/buttock area. However, it can be an elusive diagnosis because of the difficulty clinicians have in proving its existence in a particular patient.

It is a diagnosis not accepted by some back specialists because it is often impossible to confirm clinically. It is sometimes given to patients who complain of pain in the buttock and/or tenderness over the sciatic nerve where it penetrates the buttock muscles.

It is often made worse by prolonged sitting (in chairs; I’m not aware of any studies that correlate it to prolonged sitting in the saddle, though logically it would seem this could cause it).

Physical exam findings include pain in the buttock when the piriformis muscle is stretched. Such movements include when the hip is passively flexed (thigh pulled forward on the trunk), adducted (thigh pulled toward the opposite thigh), or internally rotated (flexed thigh rotated toward opposite thigh). This is similar to the repetitive motion made when cycling.

Most tests are not able to either confirm or rule out the diagnosis; thus, the confusion. Occasionally electrophysiologic studies (e.g. nerve conduction study) may confirm the diagnosis.

Treatment is similar to treatment of other conditions with similar symptoms: physical therapy and home exercises, as well as avoidance of sitting. When that doesn’t help, evaluation is appropriate to exclude other diagnoses, such as compression of a lumbar nerve root due to a herniated disk or bone spur.

Richard Ellin, MD, FACP, is a board-certified specialist in Internal Medicine who practices in Alpharetta, Georgia. He received his medical degree and completed residency at Emory University, and has been in practice with Kaiser Permanente for 26 years. He is also an avid cyclist.