Helping The Muscle That Is Literally A Pain In The Butt

I have a dear patient who loves to express how much she despises the piriformis muscle.

She continually wonders aloud at what the point of having this muscle is, and laments its existence at all. She thinks it exists purely to wreak havoc on the pelvis and that its sole mission is to cause pain.

She does have a point: there seem to be an extraordinary number of situations where piriformis is causing hassles. I see this in sacroiliac problems, chronic pelvic pain, sciatica inside and outside of pregnancy, and after gynaecological surgery. Moving house, gardening and dancing can trigger it. Problems with the piriformis can be provoked by starting a new fitness regime such as running or gym classes.

When you have struggled with piriformis problems, it may seem like the piriformis is nothing but a menace to society.

But is it a case of just shooting the messenger?

For any of you who don’t know this muscle…lucky you! It probably means it hasn’t caused you many hassles (or that you haven’t found anyone who can tell you what your annoying buttock pain is!)

So what causes the piriformis to become a menace?

One simple issue is a short, tight piriformis muscle. You will probably be aware of how tight muscles can be uncomfortable – take sitting all day in a chair in the office, or holding a baby for hours a day, and imagine how your neck and shoulders feel.

If you are standing all day, you may feel active and even fit. But did you know your piriformis is quite tight in this position? There is a position many of us avoid that helps keep the length in this muscle:

Cross-legged sitting.

In cross-legged sitting (sometimes called the tailor position) the piriformis is over 20% longer than in standing, and over 11% longer than in normal sitting, according to a 2006 study.

I have seen a number of patients with problems related to shortness of the piriformis muscles and surrounding soft tissue, such as a fit elderly man with proctalgia fugax (spasms in the rectum) and a tennis coach with chronic pelvic pain who had spent 20 years in a semi-crouch position on the tennis court. Many people with tailbone pain or coccydynia tend to have problems in this muscle too.And there are very few women I see with painful sex where this muscle isn’t causing problems.

Many of us stop cross-legged sitting as adults, and I don’t think this is a good idea. If you don’t feel confident in your leg strength getting on and off the floor, try cross-legged sitting on the couch or bed.

This is not to say that stretching the piriformis is always a bad idea.

There are circumstances where this is extremely helpful. However, there are other times where it can exacerbate buttock and leg pain. Best to talk to your physiotherapist about what’s right for you.

Aside from muscle tightness, though, there is an even bigger reason that the piriformis plays up.

It is usually due to an imbalance of muscles in the pelvis.

This means that with ordinary everyday movement, you use less of the muscles that you should (such as the glutes, or buttock muscles) and this leaves all the work to the poor little measly piriformis muscle. It’s like asking your youngest child to carry all the luggage – rather unfair really.

So play fair with your piriformis, and see your physiotherapist to help reduce its load.

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