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Piriformis Syndrome: A Real Pain in the Butt!

Piriformis Syndrome - Physiotherapy and Chiropractic TorontoDo you have a dull ache or pain in your buttock when you sit down for a long time or when you are walking up stairs or an incline?

Does your hip feel stiff, with limited mobility?

Does your pain occasionally go down the back of your thigh or your leg?

If you answered yes to these questions, it’s possible that you may have piriformis syndrome.

What is Piriformis Syndrome?

The piriformis muscle is a deep muscle in your buttock region that connects your thigh bone at the hip to the tailbone and lower back. This muscle runs diagonally upwards from the hip and is located beneath the gluteals.

When this small muscle tightens up and/or spasms, this can cause a pain in the buttock. This is called Piriformis Syndrome. In addition to pain in the buttock, the sciatic nerve can become irritated and symptoms of sciatica such as pain down the back of the thigh, leg and foot can appear.

The sciatic nerve runs vertically from your low back down the back of your thigh and can either pass behind the piriformis muscle or right through this muscle. The close relationship of the sciatic nerve and piriformis muscle is the reason why many individuals with Piriformis syndrome are misdiagnosed. The sciatic nerve can get compressed and/or irritated in many different places: 1) The low back, 2) The Piriformis Muscle, 3) Anywhere along the back of the leg.

It is important that a qualified health care professional, such as a chiropractor, physiotherapist or sports medicine physician assess you to determine where your sciatica is originating from so that treatment can be specific to the site of dysfunction.

What Causes Piriformis Syndrome?

Below are some reasons why your piriformis muscle may be in spasm and leading to your buttock pain:

Fat wallet

Piriformis SyndromeThe problem is you might actually have a fat wallet. Many men often put thick wallets in the back pockets of their pants. Being creatures of habit you usually put your wallet in the same back pocket every day. When you sit on your thick wallet it puts extra pressure on the piriformis muscle and shifts your pelvis. If you sit for long periods of time like a truck driver or office worker you may be aggravating your piriformis muscle and giving yourself piriformis syndrome. The easy solution is to take the wallet out.

Fall on your Buttock

If you have recently fallen on your buttock, you may have either bruised your piriformis muscle or caused damage to the structure of the muscle which may have healed inappropriately and with scar tissue. This can cause spasm in the piriformis muscle. Additionally, a fall to the buttock can shift the bones in your pelvis (including your tail bone) which the piriformis connects to. If the bones are shifted, they could be putting additional strain on the piriformis muscle because the muscle is forced out of its optimal length in order to accommodate a new resting length position. The piriformis will react to this by going into spasm or developing trigger points.

Hip Dysfunction or SIJ Dysfunction

If you are experiencing issues with your hip or sacroiliac joint, your piriformis muscle may need to overcompensate or work harder in order to help you manage with this pain or injury. Limping can also put more strain on your piriformis muscle. Ultimately, correcting your hip problem or SIJ dysfunction and improving the muscle control and balance in this region can take some of the strain off the Piriformis muscle and allow it to work the way it was made to.

Improper Sitting

For some of you, sitting long periods will tighten the piriformis muscle. Many of you put more pressure on one buttock or sit bone in comparison to the other side . Crossing your legs or shifting your body to one side repeatedly can cause this. This will put increased pressure on your piriformis muscle as well as your sciatic nerve. And you will end up with piriformis syndrome.

Treatment for Piriformis Syndrome: How can a Physiotherapist or Chiropractor help with Piriformis Syndrome?

Piriformis Syndrome 2If you suspect you have piriformis syndrome you may need help from an experienced and skilled health care practitioner like a physiotherapist, chiropractor or sports medicine doctor. They will determine what the root of the problem is and if it is in fact Piriformis syndrome that you are suffering from. Once you have been correctly diagnosed, your chiropractor or physiotherapist will be able to apply treatment strategies that include manual therapy and acupuncture as well as muscle strengthening to correct the issue.

Manual Therapy

Your physiotherapist or chiropractor may work on releasing your piriformis muscle or mobilizing the joints that are contributing to the tight piriformis muscle such as your hip, your SIJ or your low back joints.

Acupuncture or Dry Needling (Gunn IMS)

Medical acupuncture can be used to stimulate the piriformis muscle and restore normal nerve conduction to the muscle. Acupuncture will also help to stimulate the sciatic nerve and increase blood flow to the nerve, bringing it back to health. Dry needling or Gunn IMS can decrease the tension in the piriformis and other tight hip muscles releasing tension on the nerve.


Your health provider will determine what muscles are too tight and which are not strong enough and might be placing additional load on the piriformis muscle. It is important to note that everyone is unique and your muscle imbalances will be assessed individually. This means that the prescriptive exercises that you are given will be unique to you and will help only you!

What are the Best Exercises to Help with Piriformis Syndrome?

The “Figure 4” Stretch

This stretch that is also known as thread the needle in yoga is performed by lying on your back with your knees bent and feet flat. Take the leg to be stretched turn the heel inwards and place it across your thigh of the other leg, you should look like your legs are making the number “4”. Then grab behind the knee of the leg with the foot flat and pull it up towards your chest. You should feel a deep buttock stretch in the leg that is crossed. Hold 30 seconds, repeat 3x, 3x/day.

Sciatic Nerve Flossing

Lying on your back, holding the thigh of the sore leg with your hands clasped around. Start with your knee bent and your foot flexed, then slowly and smoothly transition to your knee being straighter and your foot pointing. You do NOT want to pull your leg into a range with pain or heavy tension but you should feel a gentle stretch along the back of the thigh. Your movement might start off limited and then increase as you rhythmically go slowly in and out of the movements 15x.

Bird Dog Exercise

Perform 10 reps 3sets a day.


Perform 10-15 reps, slow and controlled 3xday.

What Should be Avoided with Piriformis Syndrome?

  • Crossing your legs or ankles when sitting
  • Not stretching
  • Prolonged periods of sitting, without movement breaks
  • Take your wallet out of your back pocket
  • Avoiding treatment while the symptoms are getting worse

How Can You Treat Piriformis Syndrome at Home?

You will want to first try making some lifestyle modification by avoiding the above-mentioned habits and trying to adapt a daily exercise routine. If your self-diagnosis is correct and you are on top of these exercises you should see improvement in symptoms in the first week. However, do not stop the exercises, keep performing them daily until the pain has subsided and then try to maintain them on an ongoing basis 3-4xwk.

If you are not seeing results with these strategies in 2 weeks of implementing them, it is best you book a consult with your trusted chiropractor and/or physiotherapist. The injury may be misdiagnosed or more complicated and require the expert care of a treating professional.

How Long Does it Take to Recover from Piriformis Syndrome?

Estimated recovery from this condition is 6-8 weeks. With the proper treatment and directed rehabilitation exercises recovery can occur sooner.

It will be important to strengthen the core and glut muscles while stretching in the deep hip rotators. This process will show some immediate gains but then take about 6 weeks of committed exercises for the desired outcome.

For more information or to book an initial consultation with Dr. Ken or our other health care practitioners please contact us or request an appointment online. Our team of qualified and highly skilled chiropractors, physiotherapists and sports massage therapists are here to help you recover from your injury. Our team has a lot of experience dealing with Piriformis Syndrome as well as a wide variety of other conditions and you can be rest assured that we are 100% committed and dedicated to our work and to helping you feel your best! Book today.

Dr. Ken Nakamura, Chiropractor

Dr. Ken Nakamura is a chiropractor practicing at Rebalance Sports Medicine in downtown Toronto.

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Yonge & AdelaideRebalance Clinic Yonge Adelaide
110 Yonge Street Suite 905
Toronto, ON M5C 1T4
T: (416) 777-9999
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155 University Avenue Suite 303
Toronto, ON M5H 3B7
T: (416) 306-1111
E: [email protected]

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