I’m about to show you, step-by-step, how to fix piriformis syndrome as quickly as possible without wasting months or years in information overload… This is a very important post so make sure you also save it so you can go back and review it. Here’s what we’ll cover:
- The piriformis muscle (location, function, why it is hurting)
- Is it sciatica or piriformis syndrome? what’s the difference?
- What causes piriformis syndrome?
- How to fix piriformis syndrome quickly
- How to avoid flare-ups and setbacks
7 Years ago when I was diagnosed with piriformis syndrome, I remember spending hours online reading medical articles, watching videos, and trying everything under the sun to get some relief…
… The pain started out of nowhere and I couldn’t figure out how to fix it. I could fill out this whole page with how many treatments I’ve tried, and how many therapists, doctors, specialists, and chiropractors I visited. Nothing worked for the long-term.
Of course, I’ll get some relief for a few hours or even a day or two, but then I try to act normal or go to the gym, and then I’m hit with another flare-up. I was lost in Information overload and following ‘common wisdom’ that didn’t lead me anywhere.
Now, here’s why you should listen to me… I’ve actually been able to beat this nagging chronic pain for good. I’ve been flare-up free for more than 3 years and I’ve helped so many women and men heal from piriformis syndrome as well. I’ve also backed my experience with a lot of education and got certified as a strength coach. (I’m also studying for an advanced certification this summer!).
Now you know that I’m not just someone on the internet giving you regurgitated advice on what to do. Or, someone who’s got no clue about what you’re going through. I know how horrible this pain is and how it interferes with everything. I want this post to cover everything you need to know about this hip dysfunction. And if you find yourself unsure about something, just comment below and I’ll answer all your questions.
I’m going to keep this post as concise as possible but allow for about 3-5 minutes to fully digest the information here...
The Piriformis Muscle Functions
The piriformis muscle is a deep buttock muscle. It’s a hip external rotator that attaches to the sacrum. It has so many important functions: it accelerates and decelerates hip external rotation, abduction, and extension. It’s also a major hip stabilizer.
Piriformis Syndrome vs Sciatica
It’s extremely important to know the difference between sciatica and piriformis syndrome…
Piriformis syndrome is usually felt as deep gluteal pain mostly around the hip area. It does NOT radiate down the leg.
Sciatica is when the pain starts from the lower back and radiates all the way down through the knee and foot. Sciatica is a common symptom of a disc herniation or an underlying disc issue. Compression occurs at a disc level creating inflammation, pain, and numbness.
Either way, it is important to get a proper medical diagnosis from your doctor to rule out any serious disc issues.
Piriformis syndrome (deep buttock pain) occurs when the sciatic nerve is irritated and compressed by the piriformis muscle itself.
You may also feel some pain down your buttocks around the hamstring area. But again, it shouldn’t radiate below the knee. If that happens, you’re possibly looking at sciatica and not just piriformis syndrome.
I’ve also found a very interesting publication here that goes deep into the gluteal space anatomy… with images of the muscles.
What Causes Piriformis Syndrome
The good news is since piriformis syndrome is mainly a muscle tissue problem, it can get solved pretty quickly. If you have piriformis syndrome, you’re more likely looking at a muscle imbalance. Plain and simple. And it can be fixed.
The bad news is… there is a lot of recycled information online. Most people get stuck in information overload…looking for the next quick fix…or endless stretching that drives the hips out of balance, creating more pain. This cycle can last months or even years. In addition, only addressing the symptoms and not looking to fix the underlying problems will (always) only lead to short-lived relief.
The piriformis muscle is not hurting for no reason. The human body is an interconnected system and pain is a sign that something isn’t functioning right that needs your attention.
Here’s just a short and condensed list of the muscles associated with the lumbar spine and pelvis:
- Adductor complex
- Hip flexors
- Erector spinae
- Intrinsic core stabilizers
- Lats (Latissimus dorsi)
- TFL (tensor fascia latae)/IT band
- Gluteus medius
- Gluteus maximus
Any imbalance in how these muscle function will lead to a hip or lower back injury or dysfunction leading to pain.
It’s important to understand that piriformis syndrome is a result of muscular imbalances and, possibly also, postural deviations (posture affects muscular tension too). And in order for you to fully heal and restore proper function, you can’t ignore these imbalances and just focus on numbing the pain with pills or quick-fixes.
There are other things that can also make this condition worse and slow down recovery…things like stress or experiencing emotional trauma. I’ll link to other posts where I discuss this further at the very end…
Now that we understand what is piriformis syndrome and what can cause it, let’s explore a little more how to pinpoint the root cause of the pain and identify these imbalances so you can fix them quickly.
How To Heal From Piriformis Syndrome As Quickly As Possible
The Root Cause Of Piriformis Pain
To pinpoint the root cause of the glute/piriformis pain, you need to look at the following things:
- Identify and fix muscular imbalances
- Identify and fix postural deviations
- Correct Flawed movement patterns (daily pain triggers)
The reason we also want to identify and fix flawed movement patterns is that these are the things that are triggering pain on a daily basis. Once you fix your posture and correct how you’re moving on a daily basis, you’ll notice a huge improvement and you’ll be able to avoid flare-ups. This will help you get relief while working on fixing the underlying muscular imbalances that have caused the pain.
Fix Muscular imbalances
Assessing every single muscle imbalance is beyond the scope of this post. You can join my coaching program here and I can help you identify and fix these imbalances (that’s actually what I do for a living!). But let me get you started here with an exercise to test for piriformis tightness and overactivity:
The overhead squat test
Film yourself during this test. You can also complete face a mirror but you’ll be focusing on too many things and it can alter your results. So it’s best to film yourself so you can watch multiple times and keep it for reference whenever you go back to re-assess.
You want to stand nice and tall, feet shoulder-width apart, lift your arms up and complete 5 repetitions of the overhead squat. You don’t need to go very low, we just want to observe how your hips, knees, and feet behave.
If you’re knees and feet are staying straight…knees right above feet and no shifting or rotation…Great. That’s what we want to see. Otherwise, there are two common scenarios…
Scenario 1 – If your feet flattened and your knees started caving in:
You’re looking at a few muscular imbalances here. The TFL, Adductors (inner thighs) and possibly the hip flexors are extremely tight, driving the knees inward. The piriformis muscle is actually elongated and pretty weak here. Even if it feels tight and sore. This is where you should NOT be stretching the piriformis.
You need to be releasing the TFL, Adductors and working on hip and core strengthening exercises. Here’s a great piriformis and glute strengthening exercise plan to start with. Don’t ignore your feet here too. You’ll want to also release the Peroneals and strengthen the posterior tibialis.
Click here to download a free piriformis syndrome exercise PDF with video tutorials.
Situation 2: if the feet and the knees rotated out.
This is the scenario where the piriformis muscle is extremely overactive driving the hips out (remember that it’s an external rotator).
This is the only time where you should release the piriformis. You should still not overdo it. You can also release the piriformis with a massage or tennis ball against the wall. You need to always control the pressure that’s why I prefer this technique to sitting on a foam roller.
My knees caved in but It still feels tight!
Just because the piriformis or glutes feel tight, it doesn’t mean they need to be stretched. In scenario 1, the piriformis is long and weak already. If it was actually tight, it would pull the hip out. The fact that it’s failing to rotate the hip out means it’s elongated and weak. I hope this makes sense.
When it comes to extensibility, muscles behave like a rubber band…it only gets tighter as you pull.
Fix Postural Deviations
In addition to muscular imbalances, we also want to identify any postural deviations that may be affecting muscle tension.
Correcting posture isn’t easy if you don’t know what to fix.
To test for any hip postural dysfunction, stand nice and tall and you want to film or take a photo of your whole body from the side.
You want to see if you have an exaggerated anterior or posterior pelvic tilt. In simpler terms, notice if you have an exaggerated lumbar curve or if it’s the opposite…there is barely any curve, your back is rounded and the glutes are flattening down.
This will also help you determine a few additional muscular imbalances…for example, if you noticed you have an exaggerated curve and you’re rotated anteriorly, that’s a huge indication of tight hip flexors, and weak posterior chain (hamstring, glutes). So take note of every detail you observe.
If the opposite happens and you notice rounding of the back with your head possibly traveling forward (rounded shoulders), you need to be strengthening the back muscles here. I have a video post on how to correct the rounded back and shoulder posture.
Fix Flawed Movement Patterns.
The way you move everyday can either help you heal faster or feed the imbalances.
Every time you bend forward, twist, stand on one leg to put your pants on, or go up and down the stairs…you’re transferring force from one joint to another and one leg to another…
When you have pain, you start to move differently to avoid pain. Sometimes, one leg does more than the other, feeding the imbalance or creating new ones.
If you need personalized help, you can check out one of my coaching programs below where I can teach you exactly how to move without triggering piriformis and hip pain:
The only way to achieve long-term relief is to fix the underlying root cause of the pain. That’s how I’ve been able to get pain-free and stay pain-free. It doesn’t take long and you’ll be building an amazing foundation and a balanced healthy body. Below, I want to share with you top mistakes to avoid if you want to avoid flare-ups and setbacks…
I’ve also created a new video to explore this further but please scroll below the video to get the summary if you don’t have time to listen…
Also, in Part 2 of this post, I explore 3 little-known therapies to heal piriformis syndrome. The link will open in a new tab so you can finish this post first.
How To Avoid Piriformis Syndrome Flare-ups
I’ve made so many mistakes throughout my healing journey. Thankfully I can now share them with you so you can avoid them and fast-track your recovery.
Some of these mistakes may surprise you because a lot of them were tips or advice I found online. I’m not saying you have to follow everything I did. I’m simply sharing my experience here:
- Not listening to my body
I remember pushing through the pain at the gym when my body was screaming STOP. I ignored little signals here and there because I wasn’t mindful enough. I insulted my body and the consequences were not pleasant.
Now, I’ve completely eliminated the “no pain no gain” mentality. I always listen to my body and follow its guidance. The only way to remain pain-free is to listen to the signals and act accordingly. Pain should never be ignored.
- Overstretching. I call this ‘Stretchnitis’.
I stretched all the damn time. And the more I stretched… the worse I felt. Of course, it was only after I got the right education that I understood how stretching works and that the short-lived relief I was getting was just induced by the stretch reflex and it wasn’t gonna fix anything.
Click here to read more about why stretching too much doesn’t work to fix the pain.
In fact, stretching too much can create more hip imbalances when not balanced with a proper strengthening routine.
- Foam rolling my glutes.
As I said earlier, you always want to control the pressure you put on the piriformis muscle, especially if it’s hurting and spasming. Foam rolling is a great way to release trigger points but I personally only use it for the larger muscle groups. I always release the piriformis with a massage ball.
- Practicing high impact/plyometric exercises
I remember so many times coming home in so much pain after doing plyometrics or high impact exercises at the gym. My workouts right now are very challenging but they’re super low-impact. Ironically, I’ve been in the best shape of my life for the past few years because I’m consistent. You can find my low impact routines inside the Back Pain Bootcamp.
- Numbing the pain with toxic drugs.
When I was first diagnosed in 2011 I was only 21 years old and just starting university. The pain started a year before that… For years, I thought strong pain-killers were gonna fix the pain. I remember taking so many pills I was falling asleep in class.
Of course, we don’t want to suffer, but you need to realize that numbing the pain doesn’t make it go away. You just can’t feel it. What happens in most cases is…you’ll be acting normally, pushing through, and when the effect fades away, the pain will come back way worse. Taking more drugs isn’t a long-term solution.
I sincerely hope this post was helpful. I know it a ton of information to digest and if you feel overwhelmed or need my help, I highly suggest you look into joining one of my programs and I’ll personally help you fix piriformis syndrome as fast as possible. If I can do it (and a ton of my clients did it), I wholeheartedly believe you can do it too. Don’t give up!
Also, if you have any questions, let me know by leaving me a comment.
What To Do When Piriformis Syndrome Won’t Go Away
Following the above steps should get you relief fast. By working on the root cause of the pain, you’ll be working your way to fixing the pain once and for all. I’ve also written a step-by-step post on how to heal piriformis syndrome when you’ve tried everything else and still can’t find relief.
You’ll be introduced to 3 alternative therapies that’ll help you get relief fast and also support you in your recovery. These therapies are out of the box so please keep an open mind and definitely give them a try.
- Clark, M., Lucett, S., & Sutton, B. (2012). NASM essentials of corrective exercise training. Burlington, MA: Jones & Bartlett Learning.
- Koes, B.W., van Tulder, M.W., & Peul, W.C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313-1317.