A Real Pain In The Butt!!

Any pain, niggle or discomfort is at best annoying, at worst - really hurts! Injuries that affect your ‘play time’, preventing you enjoying your sport of choice can be incredibly frustrating. None more so irritating than symptoms in your bum! As a well read bunch you’ve all, I’m sure, heard of “Piriformis Syndrome” - it seems to be a dominant feature in many running magazines and blogs yet is Piriformis Syndrome as prevalent as it seems? Or is it used as umbrella term for a collection of symptoms that arise around the derriere?

In this blog I will attempt to unravel the mysteries of the diagnosis, give clear cut information based on fact, expert clinical opinion and up to date research to give you greater insight and management advice on the pains that kick our performance.

Anatomy: Piriformis acts as a stabiliser of the pelvis in walking and running especially in the stance phase of the gait cycle. It has two actions depending on leg position - laterally rotating the leg (turning the leg outwards) in hip extension and abducting the thigh (moving it away from midline) in hip flexion. Piriformis is located in the buttock area originating from the anterior (front) part of the sacrum - inserting on the greater trochanter of the femur. The muscle in parts is fused to the other lateral rotators and Gluteus medius and is closely located to the Sciatic Nerve, making it difficult to isolate the muscle alone as the sole source of symptoms (Windisch et al 2007, Netter's Clinical Anatomy, 2010).


• Pain in and around the buttock,
• Localised tender spots within the buttock,
• Lateral thigh / leg pain,
• Pain at rest especially in sitting,
• Aggravation of symptoms when stretched (hip flexed to 90 degrees and adducted).
(Boyajian 2008)

Differential Diagnosis: The literature supports the theory of the existence of Piriformis pain (Hopayian 2010) yet its prevalence as a sole diagnosis is limited (Thomas-Byrd 2005). In only 5% of low back and leg pain patients, Piriformis was the primary source (Popadopoulus 2004). 3.4-38% of long distance runners report upper leg injuries with a variety of sources, with the most common injures being of the knee (Lopes et al 2012, Van Gent et al 2007). Other conditions resulting in similar symptoms include: Lumbar spine pathology (facet joint, disc), sciatic nerve radiculopathy, muscular instability of the pelvis, active trigger points, Sacro-Iliac Joint dysfunction and Trochanteric Bursitis (Shah 2015).
Piriformis Syndrome or Umbrella Term?: So does pain arise from the Piriformis muscle – YES! I have seen many patients over the past 15 years who present with symptoms that could be diagnosed with the label of Piriformis Syndrome however does Piriformis Syndrome exist in isolation? – I would beg to differ! Many conditions are not in isolation and Piriformis Syndrome, if diagnosed, is unlikely to be the ONLY area that needs attention. It is essential that the whole lower quadrant is assessed. Treating the muscle alone, without looking at the other contributing factors will only result in prolonged injury – that ‘play time’ I talked about – ruined!

What to do?: A thorough musculoskeletal assessment is essential to obtain a true diagnosis and establish a personal management programme. The following should be assessed and addressed: Lumbar spine mobility, neural mobility, restoration of muscular length, myofascial mobilisation, optimisation of pelvic stability, correction of muscular imbalances, assesssment of lower limb biomechanics – including gait analysis and foot position, ergonomic assessment – occupational stresses and driving position.
When it comes to your sport – observation of technique and movement analysis is key, often a bike fit is required and can go a long way to ‘ease’ symptoms and reduce stress on the musculoskeletal system.

Management: Treatment may include – manual therapy, specific strength training and conditioning exercises (clams, single leg stance, single leg dips, crab walks with exercise band, core stability work), specific stretches and soft tissue mobilisation (myofacial release, foam rollering, trigger point work) neural mobilisation, dry needling/acupuncture, ergonomic changes to your work station and postural correction.

So, Piriformis problematic? Don’t suffer in slience and don’t allow the internet to ‘diagnose’ your symptoms. Do get yourself assessed by someone with the expertise to alleviate your pain and prevent reoccurance. A pain in the butt? Gone!


To make an appointment or discuss things further please do not hesitate to contact Claire at

or call 07870 649 575.

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PhysioSynergy at RaceHub
Melton Road, Six Hills, 
Melton Mowbray,
Leicestershire, LE14 3PR