Treating Piriformis Syndrome: Alleviating Butt Pain

The Piriformis muscle, also known as the “pear-shaped” muscle, is a small muscle located deep in the buttocks beneath the larger gluteal muscles. It belongs to a group of muscles called the “Hip Rotator Cuff” and is often the cause of pain in this area.

Piriformis Syndrome is a common and unpleasant condition where the Piriformis muscle becomes excessively tight. Activities such as bending, lifting, sitting, sports, and driving can aggravate this condition. Despite what medical professionals may say, there are no drugs or surgeries that effectively treat Piriformis Syndrome. In my 20 years of practice, I have never witnessed a successful Piriformis “Release” Surgery.

Piriformis Syndrome is more commonly found in women than men, occurring approximately 12 to 15 times more often. The reason for this is speculative, but it may be related to childbirth or the naturally wider shape of women’s pelvises. This could explain why I see it more frequently in women, even in those who have not given birth.

This syndrome is a major cause of sciatica, which manifests as leg pain, numbness, tingling, or weakness, as well as hip and buttock pain. Due to its association with sciatica, it is often misdiagnosed as a slipped or herniated disc, or a chronic low back or sacroiliac problem.

The sciatic nerve, the largest and longest nerve in the body, passes through or around the piriformis muscle. The pain associated with Piriformis Syndrome typically starts as a deep ache in the “hip” area, along an imaginary line from the top of the buttock crack to the greater trochanter of the hip bone.

Several factors contribute to the development of Piriformis Syndrome, including improper footwear, faulty spinal or lower limb mechanics, obesity, poor posture, excessive sitting or standing on concrete, lack of physical activity or excessive exercise, and being female.

Over time, mechanical stress leads to chronic tightness and contraction of the piriformis muscle, causing microscopic scarring of the surrounding fascial sheaths. The pain from Piriformis Syndrome is usually worse at rest, such as when sitting or lying down, and can be temporarily relieved by moderate activity like walking or stretching.

I have achieved successful results in treating buttock, hip, and sciatica pain by employing “TISSUE REMODELING” since 2001. Piriformis Syndrome is prevalent among women, and the medical community has yet to fully understand or effectively treat it. Drugs and surgery should not be relied upon as effective treatments for Piriformis Syndrome, and “Piriformis Release Surgery” is unlikely to resolve the issue.

Microscopic scar tissue, which disrupts the organized structure of elastic, collagen-based, connective tissues, is a common occurrence in Piriformis Syndrome, predominantly in the fascia rather than the muscle. Because fascia is highly pain-sensitive, fascial adhesions cause pain and dysfunction. Destroying fascial adhesions is key to eliminating chronic pain.

MRI scans typically cannot detect scar tissue in the fascia. In my opinion, microscopic scarring of the Piriformis Muscle is the leading cause of chronic, long-standing sacroiliac or buttock pain. It is also a common cause of sciatica originating from the buttocks.

There is a connection between the foot and the piriformis muscle. Individuals with high arches or abnormal lower body biomechanics are prone to Piriformis Syndrome. The higher the arch, the more pressure is exerted on the outside of the foot, which instantly tightens the Piriformis muscle. Custom orthotics or arch supports can help alleviate this issue. Xtreme Footwerks, a company specializing in orthotics for high arches, offers suitable options.

In summary, Piriformis Syndrome is a prevalent and painful condition that predominantly affects women. Current medical treatments often prove ineffective. Understanding the role of scar tissue in the fascia and addressing mechanical stressors can significantly improve symptoms and quality of life for individuals with this syndrome. Arch supports or custom orthotics may provide relief for those with high arches.