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Piriformis Muscle: Low Back, Hip, Buttock, Pelvic, Thigh Pain

The piriformis is a small muscle in the hip that can cause unrelenting pain and discomfort. If you are experiencing hip, buttock pain, or sciatica symptoms, there is a high probability that the piriformis is involved.

The two most common causes of piriformis pain are the development of trigger points in the muscle and piriformis syndrome. These conditions are not mutually exclusive. It is possible to have both at the same time. Trigger point pain is most often felt at the base of the spine and in the buttock over toward the hip joint. Pain may travel down into the upper thigh.

Piriformis syndrome pain mimics sciatica symptoms. Pain can run from the lower back down into the buttock, continuing down into the back of the thigh, and down into the calf and foot.

The symptoms of piriformis trigger points and piriformis syndrome are similar, but there are differences. Trigger point pain is more of unrelenting aching pain. Piriformis syndrome pain is more intense. The pain can be aching or sharp and sometimes accompanied by tingling, burning sensations, numbness, and hypersensitivity.

Piriformis Referred Pain Pattern
Contents of Article

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    Piriformis Muscle Anatomy

    Where is the piriformis muscle?

    The piriformis muscle connects the sacrum (base of the spine) to the femur (greater trochanter).

    What Movements Does It Control?

    • Twists (external rotation) the thigh away from the body when the hip is straightened (extended)
    • Moves the thigh away (abduction) from the body when the hip is bent (flexed)
    • Helps to stabilize the hip

    For detailed muscle anatomy information visit Piriformis Muscle Anatomy Page.

    Piriformis Trigger Points Signs and Symptoms

    Piriformis trigger point pain can be relentless. It is almost impossible to find a comfortable position. When standing, you will tend to shift your weight back and forth. When you are sitting, you will tend to squirm around to find relief. Even lying down does not alleviate the discomfort.

    Other signs and symptoms:

    • Low back pain at the base of the spine
    • Buttock pain
    • Pain around the hip joint
    • Aching pain, burning, or tingling sensations down into the back of the thigh, which occasionally extends into the lower leg and sole of the foot.
    • Pelvic and groin pain
    • Walking is painful. You will tend to have a shortened stride
    • Difficulty or inability to cross your legs
    • Difficulty or inability to spread the leg(s) side to side
    • Difficulty or inability to step out widely when walking/running
    • Extended sitting increases pain.
    • Lying down may help diminish pain but will not totally alleviate it.

     Sombra Warm Therapy Gel is recommended for relaxing muscles and relieving pain. It warms without the burning heat of other gels. An excellent choice for pain caused by trigger points, muscle/joint over-use and stiffness, and arthritis. (Not sold in stores)

    Biofreeze Professional Gel is recommended for the pain and symptoms of muscle strains. It provides excellent pain relief and may help reduce inflammation caused by a strain and is recommended by medical professionals and trainers. 

    What Causes Piriformis Trigger Points To Develop?

    • Slipping on a slick surface and trying to stay on your feet
    • Sitting excessively
      • A tendency to sit with more weight on one hip
      • Sitting with your leg tucked under the hips
    • Hip Injury
      • Hip Replacement
      • Hip Fracture
      • Hip Pointer
    • Twisting while lifting
    • Golfers are prone to piriformis muscle problems because of the twist of the body when swinging.
    • Activities and sports requiring quick abrupt changes in directions
      • Tennis
      • Football
      • Soccer
      • Basketball
    • Ankle and foot injuries can affect the piriformis muscle because it affects how you walk, causing limping or shortened stride.
      • Sprained, broken, and dislocated ankle
      • Plantar Fasciitis
      • Heel spur
      • Achilles tendon injury

    How To Avoid Development of Trigger Points In The Piriformis Muscle

    • Sitting for hours a day will cause the muscle to become short and tight. To prevent this, make it a point to walk around and do some stretches. Consider a standing desk, and alternate your sitting and standing time. While sitting, make sure your weight is evenly distributed on your buttocks.
    • Twisting on your foot or at the waist when lifting. The item does not have to be heavy-it is the twisting motion with the added weight that puts stress on the muscle. Lift and secure the object before moving off to walk.
    • When walking on a slick or icy surface, wear rubber-soled shoes to prevent slipping.
    • Limit sudden, abrupt stops and quick changes in direction while playing sports or exercising. Warm-up, do not push too far past your conditioning level.

    TWD Recommends

    Cureve Hot Cold Pack can be used for warm and cold treatments. It is recommended that you use cold packs for injuries, swelling, and after a TrP treatment. Use a warm treatment when the muscle is tight and needs to relax.

    Piriformis Trigger Point Treatment

    Locations of trigger points in the piriformis muscle

    Trigger points in the piriformis muscle are easy to self-treat. The Trigger Point Therapy Workbook is an excellent book to learn how to deactivate trigger points in the piriformis muscle and muscles throughout the body. It takes time and patience to learn TrP therapy, but once you learn, you can treat trigger points throughout the body.

    If you are buying the workbook to treat the piriformis you will need a small hardball to use for treatment. The Massage Balls are the right size and work very well.

    Many massage therapists, physical therapists, and chiropractors have training in trigger point therapy if you decide not to go the self-treatment route. A trained therapist can show you how to find specific trigger points and self-treat at home.

    Trigger points respond best to several short treatments of 1-2 minutes throughout the day. Consistency is important for successful treatment.

    How Long Before I Feel A Reduction In Pain?

    Piriformis trigger points can be stubborn and take a few weeks to resolve. However, after a few days of consistent treatment, most begin feeling pain relief. You must continue self-treatment until the trigger point(s) can no longer be felt or produces pain when pressed for successful treatment.

    Interesting facts:

    • If the muscle is shortened by trigger points, swollen due to injury, or you have piriformis syndrome, you may experience feelings of swelling in the buttocks, leg, calf, even the foot.
    • A chronically tight and shortened piriformis muscle can compress gluteal blood vessels and nerves which may cause the buttocks to waste away.
    • Women are six times more prone to problems with piriformis muscle pain.

    Piriformis muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

    • Sacral nerve compression
    • Sacroiliac joint displacement
    • Sciatica
    • Hip pointer
    • Hip dislocation
    • Trochanteric bursitis
    • L4 or L5 radiculopathy
    • Intervertebral stenosis
    • Ankylosing Spondylitis
    • Deep vein thrombosis
    • Pelvic floor syndrome
    • Cauda equina syndrome
    • Injury of the ankle
    • Injury of the hip
    • Injury of the Achilles tendon
    • Plantar Fasciitis
    • Bone Spur in the heel
    • Tensor Fasciae Syndrome

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    Other muscles that should be considered and examined:

    Satellite trigger points associated with the piriformis muscle:

    Trigger points in the piriformis muscle will produce other trigger points in these muscles:

    • Gluteus minimus
    • Obturator internus
    • Gemellus superior
    • Gemellus inferior

    What is Piriformis Syndrome?

    Piriformis syndrome develops when the sciatic nerve is irritated or compressed by the piriformis muscle. The pain is very similar to sciatic pain, which causes pain in the low back, hip, and back of the thigh that can descend into the back of the lower leg and foot.

    Piriformis Syndrome

    Symptoms of piriformis syndrome are:

    • The pain may be a relentless ache but can be sharp with a feeling of electric shocks shooting through the hip, buttock, and down into the thigh. Sensations of tingling and numbness may be experienced.
    • Limited range of motion (stiffness) in the hip and thigh.
    • Pain and symptoms increase on the affected side when weight (sitting) or pressure is applied to the hips and buttocks.
    • Muscles spasms in the hip and buttocks.
    • Pain often increases when walking.
    • Pain in the hip and buttocks when going up or downstairs.
    • Moving the legs apart vertically and horizontally causes symptoms to intensify.

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    What Causes Piriformis Syndrome?

    Piriformis syndrome is usually caused by injury or an external cause. These include:

    • Injury to the hip or buttock area
    • Hip replacement surgery always affects the piriformis muscle
    • Prolonged sitting
    • Sitting on a wallet or other items in your back pocket
    • Sitting with the majority of your weight on one hip

    Anatomical Causes of Piriformis Syndrome

    The sciatic nerve normally lies under the piriformis muscle (label A in image); However, in approximately 15% of the population, there are variations in the sciatic nerve and piriformis placement as diagrammed in labels B - E. These deviations are rare. They do not always cause piriformis symptoms and pain.

    Anatomical Cause of Piriformis Syndrome

    Image source: [mfn]File:PiriformisAnatomy.png, https://www.physio-pedia.com/index.php?title=File:PiriformisAnatomy.png&oldid=86126 [/mfn]

    Examples of piriformis and sciatic nerve placements. (A) is normal, the sciatic nerve lies under the piriformis muscle. (B) The tibial branch of the sciatic nerve passes through the lower part of the piriformis. (C) The tibial branch passing through the upper part of the piriformis. (D) The entire sciatic nerve passing through the piriformis. (E) The sciatic nerve exiting the greater sciatic foramen along the superior surface of the piriformis muscle. The nerve may also divide proximally, where the nerve or a division of the nerve may pass through the belly of the muscle. Other anatomical causes include abnormal spine alignment and a difference in leg length.

    Piriformis Syndrome Treatments

    The first and most important step is to stop stressing the muscle; this includes running, cycling, jumping, lunging, and any other exercises and activities that increase pain in the hip, buttocks, and leg. You will also need to limit sitting time, which puts direct pressure on the piriformis. Alternate sitting and standing to keep your body weight off of the muscle.

    If your symptoms are due to an injury such as falling, use cold packs exclusively for the first 72 hours because cold will help reduce swelling of the muscle. After 72 hours, begin alternating hot and cold treatments.

    Alternating hot and cold packs throughout the day can bring relief. Use a cold pack for 20 minutes, wait at least an hour, and apply a warm pack for 20 minutes. You can do this as often as you like during the day.

    Medical professionals recommend TENS units to reduce pain and symptoms. Follow insert directions for settings and node placement.

    Additional muscles that may contribute to these symptoms:

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    Muscles with similar pain patterns

    Gluteus Minimus
    Gluteus Maximus
    Longissimus Thoracis