By Gabe Mirkin, M.D.
If it hurts to touch a point that’s in the middle of one side of your buttocks, you probably have piriformis syndrome. This chronic condition is very difficult to diagnose, because other injuries may produce exactly the same symptoms. Similar pain may be the result of an injury to bones, muscles, tendons, bursae (pads between the tendons and bones), the hip joint, or the sciatic nerve, but there are ways to determine from which condition you might be suffering.
If you feel most pain when you land after hopping on one leg, you might have an injured hip joint or a stress fracture in your pelvis or upper leg bones. An x-ray will usually reveal a joint injury, but only a bone scan will reveal a stress fracture.
If you feel pain in your buttocks, particularly when you touch your toes while keeping your knees straight, you might have a tear in the large muscles or tendons that run down the back of your hips.
If you feel pain when you touch a spot that’s either on the lowest point of your pelvis (the part that touches a chair when you sit) or at the top of your femur (thigh), you might have injured your bursae (bursitis) or torn the tendons that are attached to bones at these sites.
If your back hurts, particularly when you bend backwards, and the pain goes down the back of your leg to below your knees, your sciatic nerve is probably being pinched in your back.
Cause: The sciatic nerve is the longest nerve in your body. It starts on the lower part of your spine, [passes through a hole between the piriformis muscle above it and several other muscles beneath it, and goes down the back of your leg to below the knee. When you run, the piriformis muscle contracts and squeezes the sciatic nerve underneath it. Repeatedly squeezing and relaxing the piriformis muscle can damage the sciatic nerve and cause pain. This injury is thought to be caused by an innate tightness of the piriformis muscle or a structural abnormality in the path of the sciatic nerve. It can’t be attributed to a specific error in training.
Treatment: Priformis syndrome won’t ease until you stop running. Don’t run again until you can run without feeling pain in your buttocks. If it hurts to touch, it hasn’t healed.
In most cases, pedaling a bicycle will also be painful. You probably shouldn’t do any exercise that causes you to bend at the hip while keeping your knees straight, because this will stretch the sciatic nerve. You might be able to swim, if it isn’t painful. Medication doesn’t usually alleviate the pain, and even if it does, the pain will return as soon as you stop taking it. A visit to a chiropractor may help.
Sometimes, the pain will disappear after a rest of a few days to several months; frequently it does not. In this case your doctor will be able to make an accurate diagnosis by injecting a mixture of xylocaine and corticosteroid drugs directly into the piriformis muscle where it passes over the sciatic nerve. If the pain disappears, you may resume running only after a few weeks, but remember that this injury tends to recur. If you feel pain in that area, stop running immediately, and don’t attempt to run again until you can do so without pain.
Nick North says
Piriformis Syndrome is in fact a pain. I experience that pain and sciatica IF I don’t stretch properly. I could describe stretches that work for both problems, but that would take to long. Look online and you can find stretches that will alleviate the piriformis syndrome pain. You don’t need to stop running or biking. You do need to properly stretch before and after your event.
Sciatica is a very different problem that may emanate from the exit point in your hip bone before the nerve passes under the piriformis muscle. See a sports physician (such as Gabe Mirkin, M.D) for that issue.
Certified Personal Trainer
North American Fitness and Health
US Navy SEAL (retired)
Jim b says
I’m just seeing this but spot on! I went to a physical therapist (stay away from chiropractors) and he gave me stretching exercises 15 years ago that still work today. When I stretch I don’t have pain. When I don’t I do have pain. Even if I have pain though doing the stretches alleviates it!! Thank you!!!
Eight months ago I started to feel pain in my glutes after a ride. About a month priorI had dropped my bars down about 1-1/2 inches (too much at one time, I now realize). This continued to occur so after about a week of this pain I quite riding thinking that a break in riding would cure the problem. It did not. After a month or so I rode my trainer and experienced the same pain. So I stopped riding completely and during the winter I implemented stretches meant for Piriformis Syndrome. I have occasionally tried to ride my trainer and an easy ride can be fine, but after a vigorous ride I experience the same pain. Also, stair steppers, up hill hiking, even mowing the lawn can bring on the pain. I have not continued these tasks but only used them to see if the issue had gone away. The pain is: lower back pain, glute pain, some pain down the back of the legs. I tried all of the tests that you describe above to pinpoint the cause, but none of the tests cause the pain.
The pain may be due to weakness of the piriformis So try doing exercises to strengthen the muscle. I’ve found clamshell and straight leg side lifts to be helpful along with variety of bridges. Continue with stretching of hamstring and calves. Good luck as I know the pain can become intolerable. I learned the hard way that my pain is attributed to weakness and not tightness. This seems to be overlooked by many.
George Straznitskas says
The actual rolling and stretching starts about 2:20 in.
Works well for me. Good luck.
William Baucom says
piriformis syndrome is typically associated with gluteal weakness. Gluteal strengthening is a key element to treatment of piriformis syndrome.
Steve Landau says
i am confused by the advice to avoid bending at the waist with legs straight because that stretches the sciatic nerve. but we are supposed to stretch and loosen our hamstrings, which requires that kind of movement, doesn’t it?
So i have had the pain for about a month. it is as described. Top part of my leg to just where my buttocks meets. I then also feel it in my Achilles area as well. Not thought the area around my knee or calf. I have been seeing my chiropractor weekly for about 6 weeks. Do all the stretches a few times a day. If I am on my feet most of the day ( I bought a lift desk so I am not sitting most of the day) and go on walks the pain goes away. I can work out in the yard and the more activity I do the less and less I have pain. I can still go on rides (50+ miles) and it only hurts the first few pedal strokes or when I have to stop at a red light, etc for a 30 + seconds to a minute or two. An hour or so into a right as I am pretty loose the pain is minimal to none at all. My issue is after sitting, or in the car for a bit it starts to hurt and then initially when I get up and start to walk it hurts sometime really bad. I walk it off within a few to 10 or so steps. using a heat pad at night to keep it warm. Any ideas or suggestions?
Teri Brewer says
I found shortening my Piriformis and strengthening helped my pain. These two exercises helped me. They start around 6 minutes into video. https://www.physicaltherapyjohnson.com/piriformis-syndrome-treatment-stop-stretching-start-strengthening/
my buttocks on the R side really hurt bad for two months now. It hasn’t gotten any better. Can’t run; if i try to touch my toes that is not possible sitting really hurts. i’ve been to a chiropractor and a sport’s specialist for a month now. It is no better.Looks like it isn’t going to ever go away. Not sure what i did to cause this but my life has changed 100 per cent. X-ray didn’t show any problem in my hip. wish i knew what this is so i would know what to try to do to help it. Jim