Piriformis Syndrome

Is It Really As Common As It Seems?

Okay, let's get into piriformis syndrome. What is it and why does it seem like everybody has it… or do they? This is a very common diagnosis that people come in for, basically anytime they have pain in their hip running down, and we like to run a little bit of diagnostics to first, make sure they actually have the issue. It's not as common as people might think. And second to see why that might be happening. If that is the case, there's a lot to uncover. So let's get into it.


(need to see video to understand) Starting off with a little context, this number 27 here is the piriformis. The sciatic nerve, which isn't shown here, would run out of the spinal cord right here and down through here, down into the leg. And the justification is that the piriformis might be pinching the sciatic nerve because the nerve will either run through, which is uncommon, or under that piriformis. So if it were to be tight, it may be putting extra pressure on the sciatic nerve, creating those symptoms in the hip, as well as down the leg that a lot of people are familiar with.


Whether it's self-diagnosis from “Dr. Google” or a medical professional actually told you that you have piriformis syndrome, usually one of three things tend to be true with these people. Number one, is they point to the spot and say, yep, this is where my pain is, right where my piriformis is. The second one is, well, my hips are tight. So it makes sense because doing that pigeon pose stretch really helps loosen my hips up temporarily, or for a while. And the third thing they'll say is it's really tender to the touch in that same area. In fact, when I put a tennis ball or lacrosse ball on it, it helps alleviate the symptoms while the ball is there.


What I want to do now is explore these three reasons a little bit more in depth and kind of reverse engineer why I think that those are shaky at best reasons to diagnose somebody with piriformis syndrome and then go into a couple things that could actually mean that the piriformis needs to be addressed or what we need to do if we're not finding anything with the piriformis,

Just because you have pain in an area, does not necessarily mean that that's where the pain is coming from. And you can do this just like I can, you can go to triggerpoints.net, and if I have pain in that piriformis region on the backside, I'm going to looked that up. And this shows a referral chart of all of the muscles that refer pain into that spot. There's quite a few of them and not all of them are the piriformis. So something to think about.

So you may or may not be aware that I've already shot a video discussing what happens when we stretch a nerve. And usually when somebody has something a little bit more sinister than piriformis syndrome going on, that pigeon post stretch is absolutely stretching out the sciatic nerve. So we want to take a look at what all is going on with that - why that may be exacerbating the problem. Instead of repeating myself, I'm just going to link to that video below because it's much better to watch the whole thing and understand what's going on.




The reason some people might perceive extra tenderness in that spot on the hip is because the sciatic nerve is more exposed in that area. Not too dissimilar from how we have a nerve exposed right here (points to elbow). So assuming that that's the only reason that it must be piriformis syndrome is like assuming that I have “funny bone syndrome,” because every time I tap this part of my elbow, I get a shooting signal or I get pain that runs down my arm. Hitting a nerve is going to create those symptoms, and if it's an irritated nerve, it's going to create them a little bit more easily.


So if we do in fact, find tension in the hips, we still have to uncover why that tension is there, because there are a couple different reasons that could be. For instance, if pain originates at the spinal level, your hips could be engaging a little bit more often as a protective mechanism for the spine so that the hips end up being tighter. Another reason that it could be tight is there's nerve tension and the body is trying to stop the nerve for being stretched. Then finally, when there's pain, we know that the glutes can be inhibited, which is going to put more pressure on the piriformis and other hip external rotators to work, which can lead to tension.


This video would quickly turn into an hour long if I were to try to uncover every single reason that somebody might have pain right here in the buttocks or something that runs down the leg. But suffices to say that a lot of people end up with gluteal inhibition. So I'm going to follow that thread a little bit and explain how I might uncover what's going on. We're going to use something called clamshells that a lot of us have heard of, but may not have been using appropriately. So we're going to dive into that next.


(need to see video for context) Clamshells are done from the sidelying position where the feet stay together and the knees are spread apart. All of the motion is happening at my hip here, no motion at the spine. And I am also avoiding, rolling back, like, so I've also got my hand across my hip feeling those lateral muscles for engagement. That's very important that I understand what it feels like to have my glutes engage.


Now, a lot of people who have been diagnosed with piriformis syndrome have tried clamshells and probably perceive them as a failure. They're doing three sets of 10 or 12, even maybe with a band around their knees and are given the impression that you can strengthen those glute muscles and all of a sudden that strength will just overpower the pain, but that is not how we are using them in this context. We are using them as a means to see if activating the glutes helps loosen up my hips or give me more mobility in those hips. What I mean is that first I'll test my hip mobility to see if I have tension in them. If I find tension and I think it might be glute inhibition, what I'll do is I'll do like six to eight clams shells to engage those glutes. And then we'll immediately return to those positions and retest my hip mobility to see if any changes have been made. If my mobility improves, then I have some indication that yes, in fact, my glutes were inhibited and that was creating some of the tension so that engaging the glutes and using them more often through functional movements is going to help improve the tension in my hip.


When I'm making these videos I am trying to divert from the videos that we've all seen before, which are “the top five ways to get rid of back pain” or “top five ways to get rid of piriformis syndrome.” And simply because I don't believe that those exist. And I think if you asked any physical therapist, chiropractor, doctor, they'd all agree that all symptoms can be snowflakes. Everything is just a little bit different and there is no one single way to drive at this. So I also recognize that nobody's going to want to watch these videos if I don't give you some kind of understanding of how I reason through these issues, but if you've been dealing with this for a long time and you're ready for it to go away, my best advice is not to try any single thing that I showed you in this video or any single thing that you're finding on Google or YouTube.


The biggest thing that we need to do is get to the bottom, find the root cause of your symptoms so that we can reverse engineer out the problem and make sure that you can actually have a sustainable solution where we actually snuff out that root cause.


If you're interested in something like that, that's what I do. That's the thing that I love to do the most, especially with back and hip pain, and I'd love for you to give us a call. All you have to do is sign up by clicking the button below. I will reach out personally, and we'll be able to talk about what's going on with you, whether or not we even think that I can help you and what the next steps are in terms of getting you that sustainable solution that you're looking for so that you can continue your active lifestyle without that constant nagging irritation. I hope this has been helpful! Until next time, take care.


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