What a Pain the Butt - Piriformis and Piriformis Syndrome



The piriformis is a small muscle in the gluteal region - small, yes, but can be plagued with a number of issues causing pain and discomfort - it is literally a pain in the butt.

The piriformis attaches at the anterior sacrum, running diagonally to the greater trochanter, a location near the top of the femur. It is deep the gluteus maximus - or, you know, the butt muscle. Given it’s width at the sacrum, and narrowing as it runs to the femur, it can have the appearance of a pear, hence its name. In Latin, “piriformis” more or less means “pear-shaped.” 

The primary reason it can cause a number of issues is its location in relation to the sciatic nerve. The sciatic nerve is the longest nerve in the human body. It begins in the lower back, and runs down through the pelvic structure, down the back of the leg. On its way, it passes underneath the piriformis. In some people, the nerve actually passes through the muscle. 

This means when the piriformis is tight, it can compress the nerve, causing radiating pain and numbness down the back of the leg. You’ve probably heard of Sciatica. Sciatica is an impingement of the nerve in the lower back, usually by a herniated disc. When the nerve is compressed by the piriformis, it is known as Piriformis Syndrome, also sometimes called “false Sciatica.” This condition can be exacerbated by such things as sitting for long periods of time, especially with a wallet in the back pants pocket that further compresses the nerve.

Because of the muscle's attachments at the anterior portion of the sacrum, and the greater trochanter near the posterior aspect of the femur, tight piriformis muscles of varying degrees on either side of the body can pull the sacroiliac joint out of alignment, causing further pain and imbalance.

How Massage Can Help Piriformis Syndrome

Firstly, there are a few tests that can be done prior to massage work to assess and determine whether the client is experiencing a compression of the sciatic nerve in the lower back, or at the piriformis. This involves running the client through a series of stretches and positions in order to briefly recreate symptoms felt in the client’s day-to-day life. 

Once it’s determined the issue is at the piriformis (more on Sciatica and treatment for it in a later post), massage can help loosen the muscle and return it to its proper length, relieving pressure on the sciatic nerve. This process may be uncomfortable during the session itself, but bring great relief after. Massage should also be applied to the surrounding gluteal area, hamstrings and calves, to relieve any lingering nerve pain. Self-care stretches and corrective exercises done between sessions can maintain effects of massage work.