You may not have heard of it, but piriformis syndrome can be literally a pain in the backside and is fairly common among regular runners. Your piriformis muscle is a flat band-like muscle that runs from the top part of your hip underneath your glutes (bottom). It works in almost every single leg movement. Piriformis syndrome is when the muscle pushes on the sciatic nerve, causing pain deep in the hip and bum, around the hip area and sometimes referring down your leg.
The two most common reasons are sitting for long periods of time and running. Sometimes climbing stairs can trigger it as well. Lack of flexibility or weakness could also contribute.
Treatment of piriformis syndrome
Follow the rehab exercises below to strengthen your muscles and improve your flexibility. You can continue steady paced running on soft surfaces such as grass. You should also check your posture, as that might be the cause of the tightness in your piriformis. The way you sit at work or when driving could be a factor, so check your desk set-up at work. You might also need to adjust your car seat. Avoid sitting for long periods of time.
Rest and use ice and heat: if there is swelling or acute pain, use an icepack for 20mins, three times per day. If it’s a dull ache, use a heat pack to increase blood circulation and stimulate healing. Chiropractor or osteopath treatment can help if there is a problem with hip alignment.
How long should I take off?
Avoid hilly running and sprinting. Stretch your piriformis muscle and strengthen your glutes and core. If pain continues, take four to six weeks off and contact your healthcare practitioner.
Sets and reps: Perform three sets of 10-15 repetitions. Hold the stretches twice for 20 to 30 seconds.
Single-leg half-squat on a step
Front thigh (quadriceps)
• Stand with one leg on a step
• Bend your knee slightly, to a maximum of 30 degrees
• Straighten your leg again
• Complete one set before changing over to the other side
Hold onto something if you struggle to keep your balance or if your knee is sore.
Resistance band bridge – open knees
Back thigh, bottom (hamstring, glutes)
• Lie on the floor with your knees bent and your feet flat on the floor
• Tie a resistance band around your thighs
• Lift your hips off the floor and hold the position
• Open your knees pulling against the resistance on the band
• Close your legs and lower your bottom back to the floor but don’t rest
Pull your tummy muscles tight when lifting your hips up.
Hip flexors (piriformis, psoas muscles)
• Kneel on all fours
• Bring your left leg forwards
• Bend your knee and place your leg on the floor
• Slide the other leg backwards
• Reach forwards with your hands
Ensure that your hips stay square. If your hip flexors are very tight, you might not be able to go as low as demonstrated in the picture. Keep stretching and you’ll get there.
Foam roll ITB release
A thick strip of connective tissue that runs on the outside of your leg (Iliotibial band, or ITB)
• Lie on your side with your hip on a foam roller
• Roll the foam roller down towards your knee
• Keep rolling up and down
• Where you feel tight knots, hold the foam roller for a few seconds before continuing
Never roll over a joint.
Back thigh (hamstring)
• Lie on your back on the floor
• Keep both legs straight
• Extend one leg up to the ceiling
• Grab hold of your thigh and pull your leg towards you
• Hold the position
• If the stretch eases off, pull a bit more, but don’t bounce your stretch
Ensure that you don’t bend your knee as you want to stretch the tendons behind your knees.