Piriformis Muscle Pain: Trigger Points and Piriformis Syndrome

The piriformis muscle is a small muscle in the hip that can cause unrelenting pain and discomfort. If you are experiencing hip, buttock pain and/or symptoms of sciatica, 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 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 the back of the thigh and into the calf and foot.

The symptoms of piriformis trigger points and piriformis syndrome are similar, however, 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 is often accompanied by tingling, burning sensations, numbness, and hypersensitivity.

Piriformis Muscle Pain Referral Pattern

Contents Of Article:

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


Looking for detailed muscle anatomy? The Piriformis Muscle Anatomy Page has origin, insertion, innervation, and blood supply information. It also lists agonists and antagonists for each muscle action.

The piriformis muscle connects the sacrum to the greater trochanter of the femur (thigh bone).
Image: ©Depositphotos medicalstocks

 

Piriformis Trigger Points Signs and Symptoms

Trigger point pain in the piriformis 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 looking for relief. Even lying down does not totally 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/or 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
  • Sitting for long periods of time increases pain
  • Lying down may help diminish pain but will not totally alleviate it
Relevant Information

Trigger  Points

Trigger points are small knots found in the muscle that when pressed increase pain in the area or send referred pain to another area of the body. To learn more about trigger points read Muscle Trigger Points and How They Contribute To Muscle and Joint Pain.

Muscle Strains

Muscles strains occur when fibers in a muscle or tendon tear. Muscle Strains: Causes and Treatment explains how strains happen, how to know if you have strained a muscle, and recommended treatment.

What Causes Trigger Points To Develop In The Piriformis Muscle?

  • 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 ie. limping or shortened stride.
    • Sprained, broken, and dislocated ankle
    • Plantar Fasciitis
    • Heel spur
    • Achilles tendon injury
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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 get up walk around and do some stretches. If you work at a desk 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 a 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 slick or icy surfaces wear rubber-soled shoes to prevent slipping.
  • Limit sudden abrupt stops and quick changes in direction while playing sports or exercising. Warm-up and do not push too far past your conditioning level.

TWD Recommends:
If you sit at a desk all day consider investing in a standing desk. Alternating sitting and standing during the day will help eliminate muscle pain.

Cureve Hot Cold Pack can be used for warm and cold treatments. It is a good choice for piriformis treatment. It is large enough to lay either horizontally across the back and hips or vertically to cover the low back, hip, and top of the thigh.

Piriformis Trigger Point Treatment

Trigger points in the piriformis muscle are easy to self treat. The Trigger Point Therapy Workbook is an excellent book to learn how to treat not only the piriformis muscle but muscles throughout the body. It takes time and some patience to learn TrP therapy, but once you learn, you can treat trigger points throughout the body.

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

If you decide not to go the self-treatment route, many massage therapists, physical therapists, and chiropractors are trained in trigger point therapy.  A trained therapist can show you how to find specific trigger points and how to 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.

TWD Recommends:

The best resource to learn how to treat small painful knots is The Trigger Point Therapy Workbook. The authors explain trigger points and their effects in everyday language, not medical speak. I recommend this book to anyone interested in learning to treat their own muscle pain.

If you are buying the Trigger Point Workbook to self-treat the piriformis you will need a hardball for treatment. The Kieba Massage Lacrosse Balls are a good choice to use on the thighs and other areas throughout the body.

How Long Before I Feel A Reduction In Pain?

Piriformis trigger points can be stubborn and can take a few weeks to completely resolve. However, most begin feeling pain relief after a few days of consistent treatment. It is important that you continue self-treatment until the trigger point(s) are completely gone for successful treatment.

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)

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 6 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:

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

Relax While Easing Your Pain and Stiffness

Heated Massage Pad to relieve back pain.
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The Snailax Vibrating Massage Mat With Heat is made for those times. The mat features a full-body vibrating massage and has multiple settings for massage and heat. The remote allows you to adjust settings with a push of a button. A wonderful way to ease aches and pains in the back, hips, and legs at the end of the day! 69 inches (5' 9") long.

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 which can extend down the back of the lower leg and foot.

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 affected area. Sensations of tingling and numbness are also 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 hip 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.

The piriformis compressing the sciatic nerve against the bone.   Image: ©Depositphotos medicalstocks

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 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 and do not always cause piriformis symptoms and pain.

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 step and the 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 as that 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.

TENS units are highly recommended by medical professionals for reducing pain and symptoms.  Follow insert directions for settings and node placement.

TWD Recommends:

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

Fit Simplify Resistance Loop Exercise Bands are 5 bands of various resistance to help you stretch and strengthen the piriformis muscle. The bands include: instruction guide, an e-book, and access to online videos.

Piriformis Stretches and Muscle Strengthening

When you are suffering from piriformis pain it is important to stop activities that cause symptoms to flair. Equally important is stretching and strengthening the muscle to relieve pressure on the surrounding tissues.

Doctor Jo is a physical therapist who has an excellent Youtube video of stretching and strengthening for the piriformis muscle. She demonstrates each exercise and explains the correct positioning during each exercise and stretch to ensure that you are targeting the muscle.

NSAIDS such as Aleve and Advil will help reduce pain and inflammation. Take as directed to help reduce pain.

TWD Recommends:

Doctors and physical therapists often recommend TENS to relax the piriformis muscle and ease pain. The Belifu TENS Unit Muscle Stimulator is highly recommended and a great choice for treating piriformis syndrome and other muscle pain.

If you liked the recommended video and have or are buying a TENS unit, Doctor Jos' book Maximum Pain Relief with Your TENS Unit will help you use your TENS unit to achieve maximum results.

Other muscles with similar pain patterns:

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