Location The piriformis muscle is one of the six short hip muscles located underneath of the much larger gluteal muscles. It attaches on one side to the sacrum and then runs across the buttock to attach at the top of the greater trochanter. Greater trochanter is the large prominence on the side of your hip which most people point to when describing their hip pain.
FunctionThe piriformis is an important muscle for rotation of the leg and the trunk. When we are standing still, the piriformis helps to turn our body in the opposite direction. This is particularly important during a golf swing. Many golfers present with pain related to piriformis when increasing frequency or duration of playing. Piriformis also helps to turn our leg outward which is one of the reasons why many people present with pain related to piriformis after a long car drive. Switching constantly between the gas and the brake pedal while compressing the piriformis against the car seat, can lead to significant overuse of the muscle.Piriformis and piriformis syndrome Sciatic nerve, several other nerves and blood vessels, run directly underneath of the piriformis muscle. In some individuals the sciatic nerve can run through the piriformis muscle. When piriformis develops trigger points, it may compress the sciatic nerve and you may experience symptoms of what’s known as the Piriformis Syndrome. The symptoms associated with piriformis syndrome are very similar to the classic sciatica. Sciatica usually presents as low back pain with excruciating shooting or burning pain running down the leg. In case of piriformis syndrome, however, the radiating pain along the back of the thigh typically doesn’t pass the knee, unlike in the classic sciatic pain, where the radiating pain typically reaches all the way down to the foot. Piriformis syndrome also causes much less severe pain. It has to be pointed out, however, that an individual may experience simultaneously pain due to piriformis syndrome and sciatica. In this case, the sciatic nerve gets compressed in the spine causing the sciatic pain, as well as in the buttock by the piriformis. Many people present with these symptoms particularly after prolonged car ride as described earlier. They typically wake up the next day with sever back pain and sciatica like symptoms.
Most characteristic pain caused by trigger points in PiriformisThe pain referred from trigger points in the piriformis typically causes most pain in the sacrum which is the base of the spine, as well as in the hips and in the buttock. Occasionally the pain is felt in the back of the thigh (piriformis syndrome). It has been also reported, that women tend to have more problems with this muscle compared to men. When trigger points are particularly active, the individual may not be able to walk or even sit still and constantly looks for more comfortable sitting position. Please see gluteus maximus muscle which also tends to cause problems finding comfortable sitting position. Most people develop trigger points in piriformis when they are not well conditioned and suddenly engage in sport activities which call for rapid changes in direction, such as playing soccer, football or basketball. Prolonged work that requires constant twisting movement is also frequent a culprit.Location of trigger points & Acupressure tipsTo locate the trigger points in the piriformis, first locate the greater trochanter. You can easily locate it, if you slide your hand along the IT band over the side of the thigh, until you feel the prominent hip bone. From this point, imagine a horizontal line slanted slightly upward towards the edge of the sacrum (the base of the spine). The tender trigger points are usually found slightly off the edge of the sacrum and halfway on this imaginary line. The best way to massage these trigger points is to lean against the wall with a tennis or baseball ball between your buttock and the wall. You can also place the ball on the floor and lay down on the ball. In this case, turn your leg outward to relax the overlying gluteus maximus and maximize the access to the piriformis. A foam roller is not recommended to address these trigger points, because it cannot deliver the specific pinpoint pressure through the layers of fat tissue in the buttock muscles.
Summary
SymptomsDifficulty to cross legs or to turn leg inwardSpreading legs may be extremely painfulLimping due to the painInability to walk when trigger points are very painfulYou can’t find a comfortable sitting positionPain radiationEither trigger point may refer to the entire buttock areaAlong the path of the sciatic nerveThe upper two thirds of the thighLocation of trigger pointsBetween hip bone & the edge of the sacrumFeel for exquisite tenderness when palpating the muscle
Causes for development of trigger pointsAfter long car journeys (right leg, accelerator pedal)Quick change of direction in tennis, soccer, football, basketballWork that requires twisting while liftingToo much sitting
Trigger points self acupressurePlace the ball between the wall and your buttockFind the most tender area over the trigger pointMove the ball horizontally over the tender spotMassage the piriformis on the floor or against a wall
General recommendationsMove ball over the tender area 15-20 timesFind a new spot & repeat the processApply this massage at least 2-3 x a daySeveral short daily sessions are preferableDo not apply very strong pressurehttps://learnandfeelbetter.com/buttock-muscles-2/
