The Piriformis Muscle
Do you have pain in your buttock? Low Back Pain? Your Piriformis muscle may be the culprit.
Your Piriformis muscle is a small, deep, buttock muscle. Many of us have a tight piriformis muscle which can cause pain issues in your gluteal/buttock region as it passes right over your sciatic nerve. When your piriformis becomes tight it can compress your sciatic nerve and start creating all kinds of issues. Many of us sit at computer desks for many hours on most days. This essentially means that you sit on your sciatic nerve, gluteal muscles and piriformis muscle every day. If your nerve is calm and not irritated, that feels ok but if it is stirred up from a tight piriformis muscle your gluteal and buttock region can become extremely painful.
Symptoms of piriformis muscle syndrome
If your piriformis is irritated you may feel pain in your buttock region, pain down your leg, numbness and tingling traveling into your leg and foot, pain on sitting, standing and squatting down.
Our therapists determine if your sciatic nerve pain is originating from your piriformis muscle or from your spine. If your piriformis muscle is the culprit, you will feel like your pain originates in your buttock regions, not your spine. Another distinction between the two origins of your pain is that with a tight piriformis muscle you usually won’t have muscle weakness in the affected lower limb side whereas you if your pain originates from your spine you may get symptoms down the affected limb side.
Some men have had a sciatic nerve irritation caused or aggravated by sitting on their wallet in their back pocket. “Note– Never sit on your wallet” Piriformis muscle pain doesn’t have to be isolated to the muscle itself. You can have SIJ (sacroiliac joint) pain and wider spread gluteal muscle pain too.
Piriformis Muscle Treatment
Your physiotherapist will first identify the cause of your pain and symptoms. This may include a biomechanical assessment of certain movements involving your lower limbs and pelvis. We will then target hands-on treatment to release your tight Piriformis muscle. We will also assess and treat any tightness or symptoms around your other gluteal muscles and lower back if they are contributing to your pain issues. Treatment techniques that may be helpful include IMS Dry needling and Shockwave Therapy.
What is it?
Hip bursitis is a fairly common condition, and involves inflammation of the bursae around the hip joint. The bursa are small fluid-filled sacs, and are present to reduce the friction between tendons and the bone and ensure that everything is able to move smoothly. However they can become inflamed and painful with overuse, trauma and incorrect muscle use or weakness. There are many, however the bursitis we most commonly see is the Trochanteric Hip Bursitis. The trochanteric bursa cushions the outside of the hip against the gluteal muscles (especially gluteal maximus) and the Iliotibial Band (ITB). It is the most commonly injured as these are muscles very commonly used and therefore give the bursa a lot of work!
What are the causes?
As mentioned earlier, there are a few key causes of bursitis:
Overuse (or muscles around the area) and repetitive stress – eg. With frequent running, jumping, squatting
Trauma – e.g. a fall directly onto the outside of the hip (where there isn’t much padding)
Incorrect muscle use and muscle patterns, causing altered biomechanics of the lower limb – this can also include weakness of the core muscles
Weakness in the deeper gluteal muscles (Gluteus Medius and Minimus), and tightness in the Iliotibial Band (a band that runs down the outside of the thigh). As a result of the weakness in the deeper gluteal muscles, the gluteus maximus (biggest gluteal muscle) is forced to work more than it should, and so places more pressure in the bursa, which over time causes irritation and inflammation, and pain.
Interestingly, there are recent studies to suggest that hip bursitis does not often occur on its own, and that there is commonly some element of Gluteal pathology – especially tendinopathy of the Gluteus Medius (the main stabilising glute muscle). This may be the causative reason for weakness in this area, however it is not known yet as to which comes first – the bursitis, or the tendinopathy.
What are the signs and symptoms?
Commonly, sufferers will have a sharp pain on the side of their hip (worst directly over the bony outer part of the hip, and often tender to touch). This pain may extend down towards the knee, or even upwards towards the lower back. In fact, as the lower back, hip and knee are so closely linked, it is not uncommon to see problems in all areas along with hip bursitis, including pain, stiffness and restricted movement of these areas.
Sometimes there will also be a visible swelling over the outside of the hip, or even just the feeling of swelling.
There is often difficulty lying down on the side (due to the direct pressure), or even on the unaffected side (due to the stretch). This may cause trouble with sleeping.
Walking is also aggravating, especially first thing in the morning, or after a busy day. A limp may be present. There may also be pain with sitting cross-legged, or rising out of a chair after sitting for a while.
What are the treatment options?
There are several options when it comes to improving pain and keeping the bursitis away.
Physiotherapy – this is highly successful for treating trochanteric bursitis. Initially, treatment will involve techniques to reduce the pain and swelling (eg. Ultrasound, ice, gentle massage, acupuncture, taping). Following this, your physiotherapist will aim to return full range of motion of the affected hip (and also lower back, knee if affected), correct any muscle imbalances around the hip and restore full function of the stabilising hip and core muscles, and work to eliminate any excess tightness that may be contributing to the problem. Due to the nature of trochanteric bursitis, and the danger of it recurring, a long-term program may be required.
Ice – due to the inflammatory nature of trochanteric bursitis. Ice for 15 minutes at least once per day, and also after aggravating activities
Cortisone Injections – this involves injecting a corticosteroid (anti-inflammatory) along with a local anaesthetic into the bursa in order to settle the inflammation and stimulate healing. A guided injection (usually via ultrasound) is preferred as it will assist with needle placement. Cortisone injections can be very helpful, however repeat injections have been shown affect tendon health detrimentally – it would be wise to discuss side effects with your GP.
What can I do to help?
If sleeping is a problem, it can be improved in the short term with a pillow between the legs, to level out the hips when laying on the unaffected side.
Driving can be aided by sitting slightly higher (so your hips are not as bent). This may involve lifting the seat (in newer cars), or simply sitting on a pillow. Do make sure you can still reach the pedals & drive safely however!
There are several helpful exercises that will assist in recovery and strengthening. These will ideally be performed after the initial healing phase is completed (that is, when the pain and swelling have diminished). These exercises should be performed within your comfort levels, without causing pain.
Seated gluteal stretch
Sit on edge of chair, cross one foot over the other knee, SIT UP TALL, and lean forwards
There should be a comfortable stretch in the buttocks, or even down the side/back of the leg
Hold 20 seconds, repeat 3 times each leg
Lying gluteal stretch (Single knee to chest)
Lying on your back, slowly bring one knee up towards the opposite shoulder as far as comfortable.
You should feel a gentle, comfortable stretch in your lower back, or buttocks
Hold for 10 seconds, repeat 5 times
Start on your back with knees bent (no pillow is best)
Slowly roll pelvis/hips off floor, followed by one vertebrae at a time
Aim to lower down, one vertebrae at a time
Try 10 repetitions
Prone Knee Bend
Start by lying on your tummy, feel the front of your hips on the floor.
Bend one knee to 90 degrees and then slowly lift thigh off floor (the front of your hips should stay firmly on the floor)
Once lifted, straighten your leg in the air, then slowly lower your straight leg
Repeat 10 times each leg
Start lying on your side with knees bent slightly. Make sure your shoulders, hips and feet are in a straight line.
Keep your feet together, back still and gently open your knees apart.
Repeat 10+ times on each leg, or until fatigue
* This exercise is especially helpful as it targets the Gluteus Medius
As above, make sure your body is aligned well.
This time, lift your feet up, keep your lower knee on the floor and lift your knees apart.
Repeat 10+ times on each leg, or until fatigue
If you want to steer clear of lower back pain, remember this: Arch is good, flat is bad.
Back pain is anything but rare; only headaches and colds are more common. According to the National Institute of Neurological Diseases and Stroke, Americans spend more than $50 billion each year on lower back pain, which is the No. 1 cause of job-related disability in the country and one of the leading contributors to missed time from work.
There’s acute lower back pain, sometimes intense but generally short-lived discomfort resulting from injury to the lower back incurred during sustained physical activity (playing sports, doing yard work) or by a sudden jolt (being in a vehicle collision). But it’s chronic lower back pain, the kind that lasts for more than three months, that is more debilitating and more difficult to treat.
Much of that chronic pain is caused by damage to the discs — the spongy, multi-function structures that lie between the spine’s vertebrae — in the lower part of the back right above the pelvis known as the lumbar region. And much of that damage is caused by poor body mechanics — the way people stand, walk, lift, carry, reach, bend, sit and sleep — in which the back is too often flat, not arched.
“The key to avoiding lower back pain is keeping pressure off your lower lumbar discs,” said Tadhg O’Gara, M.D., an orthopaedic surgeon at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “That means keeping an arch to your lower back.”
The intervertebral discs, essentially the spine’s shock absorbers, are under constant pressure, especially in the lower back, which supports the weight of the upper body. The five vertebrae in the lumbar region are naturally arched toward the front of the body, so bending forward compresses the front of these disks, which over time can force them out of position to press on one or more of the nerves emanating from the spinal cord. This condition — known as a bulging, herniated or ruptured disc — can cause pain in the lower back and elsewhere, especially the buttocks, thighs and even below the knee (sciatica). And that pain can be severe.
“People who haven’t had lower back pain don’t re alize how painful it is,” O’Gara said. “And many health care providers don’t realize how painful it is.”
So how is chronic lower back pain treated?
“The first thing to figure out is what exactly is causing the pain, because that determines what approach to take with treatment,” said Kristopher Karvelas, M.D., assistant professor of physical medicine and rehabilitation at Wake Forest Baptist. “That’s not always easy. Pain is usually related to the discs, but other causes of low back pain have overlapping symptoms and pain patterns.”
Basic diagnostic methods include physical examination, review of the patient’s medical history and patient descriptions of the onset, location, severity and duration of the pain and of any limitations in movement. Imaging techniques such as X-rays, MRI and CT scans also can be employed to pinpoint the source of pain.
Once the reason behind the pain is determined, the most frequently prescribed treatment is physical therapy, not surgery.
“I typically reserve surgery for patients who have a medical need other than pain,” Karvelas said. “There’s a large toolbox that we can go to for patients, and surgery is the last tool.”
Depending on the individual patient’s condition, physical therapy programs usually include exercises designed to strengthen back and abdominal muscles and to promote proper posture and balance. These can include stretching, swimming, walking and even yoga. But education also is a key element.
“Patients need to recognize that posture and activity are crucial in relieving and preventing back pain,” Karvelas said. “They need to learn what exercises to do on their own and how to do them properly to prevent future flare-ups.
“We can help resolve acute back pain episodes, but when we are talking about chronic back pain, the pain may never resolve completely. However, we do use a team approach to treat patients and teach people how to cope with their pain effectively.
Living and working in this century will have seen us spending more and more time sitting at the computer, whether it is part of our work, studying or even leisure time. An unfortunate consequence of spending long periods of time doing this is that it can cause pain in a number of areas including the neck, shoulders, arms and lower back.
Sitting at a desk for long periods means it is often difficult to maintain good posture for long periods of time. Many people will have a tendency to lean forward or slouch their shoulders which will put unnecessary stress on the spine leading to pain and fatigue. Repetitive movements such as typing /filing can also contribute to pain by placing your body in awkward positions and increasing the risk of muscle strain.
Simple tips how we can avoid this situation developing and causing pain.
Get up every 20 minutes, stretch and walk around
Specific stretches to the neck, chest, shoulders and mid and lower back.
Strengthening exercises to improve the strength of the deep neck muscles, shoulder blade muscles and the deep abdominals that stabilise the lower back.
Ergonomic assessment. The set up of your desk will have a big influence on the stresses and strains on your muscles and joints. A few adjustments could make a huge difference to your pain and also prevent future problems developing, for example adjusting your computer screen height. Many workplaces offer these assessments. Your physiotherapist will be able to advice you on simple adjustments or even visit your workplace to perform an assessment.
Already have pain from sitting at your desk?
If you are in the unfortunate situation of already having pain it is recommended that you address all the above steps immediately. It is also advised that you take some painkillers and/or anti-inflammatory medication. Consider using heat packs to soothe tightness and soreness in muscles. Most importantly, physiotherapy or your preferred form of musculoskeletal treatment should be sought. Everyone is different, so a physiotherapist will be able to specifically assess your painful area and look at the causes of your pain. Following this he /she will be able to advise what you can do yourself. This may include specific stretches and strengthening exercises, adjustments to your desk and correction of your posture.
The physiotherapist will also provide you with some hands on treatment which may include soft tissue massage, joint mobilisation and dry needling to help settle the pain. Early intervention is the key to ensuring your pain is managed effectively and will normally mean less physiotherapy treatment is required.