Piriformis Muscle: The Root Cause of Your Low Back and Hip Pain

Updated on September 26, 2018
drmattshepard profile image

I am a board certified Chiropractic Physician with full-body certification in Active Release Technique (ART).

Piriformis Muscle: The Largest and Most Important of the Hip Rotators

I will explain the importance of the piriformis muscle, common places of trigger points and fascial adhesions found within the muscle, and effective ways to treat an overactive piriformis muscle, which can be related to sciatica-like pain known as piriformis syndrome.

The piriformis muscle is the largest and most important of the six short hip rotator muscles that are located between the sacrum and the greater trochanter in the middle of the buttocks. The piriformis muscle attaches just inside the rim of the sacrum and then travels across to attach to the top of the greater trochanter. With leverage gained by these attachments, the piriformis muscle is able to strongly rotate the leg outward. When the leg is stationary, the piriformis turns the body in the opposite direction. Overdoing either of these rotatory movements leads to overactivity, large trigger points, and chronic facial adhesions within the muscle.

The facial adhesions and trigger points can cause a tremendous amount of misery, ranging from muscle aches to nerve and blood vessel entraptments, which is referred to as myofascial pain. When the piriformis is to blame for your trouble, you're lucky if you ever find out.

The Story of a Typical Runner

Bob, one of my patients, is in his mid forties. An avid runner and a salesman for an insurance company, he has suffered for years from a deep ache in his right hip. His discomfort rarely rose to the level of outright pain, but it was unrelenting and oppressive. Sometimes he also had pain, numbness, and tingling in his foot and the back of his leg. He would say that "it's pretty obvious it comes from running and sitting all day, but I have to sit for work and running is my stress release from the day, I been doing some passive physical therapy and a lot of stretches, but it never gets any better."

The facial adhesion and/or trigger point in Bob's hip were what was causing his discomfort. Which, typically will not fully relax on there own without some sort of release. Although he took steps to keep the muscle flexible by moving his leg into alternate positions at work and stretch before running each day, chronic facial adhesions will require a great deal of precise tension to break-up.

Note to treat Bob's right hip pain: I performed several passes of Active Release Technique, a patented, soft tissue massage technique, on his piriformis muscle, after which he got a 30% improvement. By performing the sciatic and peroneal nerve flosses (exercise videos below) in congruence with regular piriformis stretching (demonstrated in the video below), Bob has been able to stay pain-free, and he is still running.

Use Penetrex For Fast Pain Relief For Sports Related And Other Musculoskeletal Pain

I personally tried Penetrex to see if it truly offered any pain relief. I wanted a product that I could recommend to my more active patient base. This was by far the best pain relief product that I tried.

I have shoulder pain related to treating patients. I used it on my left shoulder and was joyfully surprised to feel an improvement in about two days. Now, I use Penetrex as a way to keep the pain from interfering with my work.

I just want other people with pain like mine to find relief too! I have recommended it to several of my sciatic patients and it has helped them to improve their activities of daily living between my treatments.

If you have sciatic nerve pain, this product is worth trying.

An Effective Piriformis Stretch for Hip and Back of Leg Pain

Helpful Images To Help Further Understand What Can Cause Sciatica or Piriformis Syndrome

This image represents a posterior lateral disc herniation, which is causing irritation on the adjacent nerve root. It is important to manage dysfunction like this, muscle restrictions, and joint stiffness early to avoid more serious and complicating conditions.

This is a diagram is of the pelvis demonstrating sciatica. The sciatic nerve of the right (yellow) passing under the piriformis is not affected. However, the sciatic nerve on the left is inflamed (orange). This condition can result in pain, numbness, and/or tingling down the leg as discussed above. It may also lead to muscle spasms in the glute region.

This image is of a normal low back (side view). Showing the disc and separate spinal vertebrae. This image is provided for you to use as a comparison with the following image, which demonstrates sciatic like symptoms.

The image below demonstrates the discs as inflamed (pink) and the nerves as irritated (orange). Symptoms that are likely related to this condition are back pain, leg pain and/or soreness, muscle spasms, weakness in the leg or back muscles, tingling sensations, numbness, burning, aching, and shooting pains down the leg.

Excessive low back curve or hyperlordosis is demonstrated below. The result is more stress on the low back and hips. Leading to overloading of the lumbar discs and adding strain to the posterior spinal joints known as the facet joints.

Additional Home Remedies for Sciatica Type Pain

When you have piriformis syndrome or sciatica it is extremely hard to find a sleeping position that you can stomach for more than an hour or two during the night.

Making your sleep both restless and a continual dread when you have had weeks of pain.

This spray has saved had great results for several of my patients. The pain relief is fast and allows one to sleep for several hours.

Symptoms and Treatment

Symptoms. Pain and other symptoms in the buttocks are likely to be composite effects from more than one muscle. Nevertheless, in most instances, you can expect the piriformis muscle to be involved, especially for women. Problems caused by facial adhesions in the piriformis muscle are six times more prevalent in women as in men. (1992: 193, Pace 1976 435-439)

Referred pain from the piriformis muscle is felt in the sacrum, buttocks, and the hip. Adhesions and trigger points may occur either at the insertion or origin of the piriformis, but both may refer to the entire buttocks area. Trigger points occurring in the other short rotator muscles just below the piriformis are believed to have similar referral patterns (1992: 187-188, 192; Retzlaff 799-807)

Tension in the piriformis muscle can also lead to twisting the sacroiliac joint, adding to your pain. The resulting tilt in the sacrum cam make you appear to have a short leg. Shortening of the piriformis muscle with addition of facial adhesions will make it difficult to cross your leg inward. Spreading your legs may also be extremely painful. You may limp because of the pain, and sitting for periods longer than 15 minutes may become unbearable.

Treatment: By far the most effective form of treatment is manual therapy at the site of the adhesion. Treatment techniques like trigger point release, Active Release Technique, and Graston are all extremely effective methods of treatments. I have been certified in both Graston and Active Release Technique for over 5 years and would have to say that without a doubt finding a certified Active Release Technique practitioner would be your best bet to get the fastest improvement if you have facial adhesions in your piriformis muscle currently.

Below are videos I made to demonstrate the most effective way to perform a peroneal and sciatic nerve floss to help relax the piriformis muscle, aiding in the relaxation your external hip rotators.

Sciatic and Peroneal Nerve Flosses - Treat The Entire Portion of Leg Supplied By The Sciatic With Two Exercises

Sciatic Nerve Floss - to treat the entire nerve, helping relax hamstrings, glutes, hips, and calfs

Peroneal Nerve Floss - helping relax lateral hamstrings, outside hips, and lateral calves

Leave a comment! Others might benefit from it...

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Do you have piriformis pain in this area?

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    • profile image

      Chat Rodgers 

      3 months ago

      Where would I find a practitioner trained in ART and Graston near Memphis TN? Zip is 38117. Thanks!

    • profile image


      6 months ago

      Yes its painfull

    • profile image

      Elaine Winter 

      7 months ago

      do you ever answer our comments?

    • profile image

      Elaine Winter 

      8 months ago

      Why are facial adhesions more common in women? How do you know if you have a facial adhesion?

    • profile image


      10 months ago

      awesome n works

    • profile image


      11 months ago

      I got injured at work and have finally diagnosed myself as piriformis muscle being injured. Sometimes I leterally scream just bending down or getting into bed. Just want the pain to end. I live between 4- 10. Finding a position even at night is challenging just to reduce to a 4. Help.

    • profile image


      14 months ago

      I was involved in an accident where my piriformis muscle was cut. This was 9 years ago. I was not given any physical therapy at the time of the accident they just said it would heal. Two years ago I started physical therapy due to Twisted hips and sacrum. Also neck issue. I have only recently, come acrossed the piriformis syndrome. What can i do. Im in constant pain. I go to the gym everyday. I stretch and do yoga in order to walk at all. But it getting more painful. Dry needling was the only thing thst stopped the pain. But the pain came back more ferious. Or maybe i just had relief and it was wonderful then had to adjust to the pain again.

      Thanks for your time.

    • profile image


      2 years ago

      Can I do the exercises bending the leg on the table with a hip replacement?

    • profile image


      2 years ago

      Useful videos

    • profile image


      3 years ago

      Spell check - "fascial" adhesions, not "facial" - I kept wondering what any of this had to do with the face.

    • drmattshepard profile imageAUTHOR


      6 years ago

      @SugarB: I do not do acupuncture personally, but I will work with patients that are under acupuncture treatment at the same time. Been looking into dry needling as well. thanks for the compliment.

    • profile image


      6 years ago

      Fascinating article!

    • profile image


      6 years ago

      Several years ago I was diagnosed with two ruptured discs in my low back and, of course, the neurosurgeon immediately recommended surgery. Eventually I went for acupuncture (it doesn't hurt!) and about ten treatments later, I had minimal pain. Do you ever combine acupuncture as part of the treatment?

      Great lens with lots of good information,

    • profile image


      6 years ago

      Several years ago I was diagnosed with two ruptured discs in my low back and, of course, the neurosurgeon immediately recommended surgery. Eventually I went for acupuncture (it doesn't hurt!) and about ten treatments later, I had minimal pain. Do you ever combine acupuncture as part of the treatment?

      Great lens with lots of good information,

    • VigilantChef LM profile image

      VigilantChef LM 

      6 years ago

      I love that stretch and my lacrosse ball to roll out the tension.

    • drmattshepard profile imageAUTHOR


      6 years ago

      @anonymous: I would highly recommend finding someone that is certified in Active Release Technique, near where you live. He/she will be able to break the entrapted nerve free from irritation and reduce further muscle irritation. Also, you should try the two nerve floss exercises demonstrated above in the videos. They will help to reduce irritation to the nerve if done correctly.

    • profile image


      6 years ago

      I suffer from hip, lower lumbar pain with numbness on the outside of the thigh up to a very painful point on outside of my hips. I have had mri's to show only the left side disc herniated pushing on the nerve but nothing on the right side to explain the same symptoms. I get a weekly massage that helps somewhat, enough that my last mri showed the disc not portruding out as far now. I am coming off on 10 years of pain pills and am almost off of them. Now my feet are burning, tingling and my nerves cause involuntary movements of both my legs. what advice can you give? I am impressed with your info and I think there is a BIG connection.

    • WriterJanis2 profile image


      6 years ago

      I don't, but this was quite an interesting read. I like the way you explained everything as it is easy to understand.


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