Piriformis syndrome is a condition that occurs when the piriformis muscle, located deep in the buttocks, compresses the sciatic nerve, leading to pain, numbness, and tingling along the back of the leg. This syndrome is characterized by symptoms of sciatica, including persistent buttock pain that may worsen with prolonged sitting or certain movements.
To alleviate piriformis syndrome, targeted stretching of the hip and pelvic muscles is crucial. Unlike deep tissue massage, which may exacerbate the condition by applying pressure to the piriformis, effective relief can come from techniques such as Thai massage that incorporate yoga-like stretches and joint mobilisation.
Buttock pain is a common problem for travelers. Sitting for long hours in a cramped airplane or intercity bus seat often leads to excessive tension and spasms in the piriformis muscle. This small, deep muscle is located in the buttocks and plays a key role in hip rotation and stabilization, as well as turning the leg and foot outward.
When the piriformis muscle becomes tight or spasmodic, it can compress or irritate the sciatic nerve. The sciatic nerve, the largest in the body, runs from the lower back and passes above, below, or even through the piriformis muscle before traveling down the back of the thigh to the feet. This condition is known as piriformis syndrome.
Symptoms of Piriformis syndrome
The primary symptom is a burning or shooting pain in the buttocks (not the lower back!) that radiates down the back of the thigh along the sciatic nerve. This pain, known as sciatica, is often accompanied by numbness or tingling in the affected leg. Additional symptoms may include leg weakness and a reduced range of motion.
It’s important to note that sciatica can also result from nerve irritation higher up in the spine, such as from a herniated disc or spinal stenosis. These are different conditions requiring different treatments.
What else can cause the piriformis to flare up
Prolonged running, swimming, climbing stairs, performing squats, and even transitioning from sitting to standing without proper stretching beforehand can also cause a tightening of the piriformis muscle and squeezing on the sciatic nerve. Short-term muscle spasms in the buttocks may also occur from sitting on hard surfaces or sitting cross-legged for extended periods, a direct blow to the hip area, or rapid leg rotation using the legs as a pivot.
People with sedentary lifestyles or jobs that require frequent twisting or turning of the waist are at risk of developing chronic piriformis syndrome. The chronic form of this condition is more common in people aged 40–50 and is seen more often in women than in men. This is partly because women have a wider angle between the thigh and shin bones, and also because pregnancy often causes the pelvis to tilt forward.
How to get rid of sciatica
Reducing pressure on the sciatic nerve is crucial for alleviating sciatica. Many online sources suggest addressing this through deep tissue massage, a specialized technique that targets the deeper layers of muscle and connective tissue. This method focuses on relieving compression or irritation of the sciatic nerve. However, it is often overlooked that this type of massage is effective only if the sciatic nerve is compressed by relatively accessible back muscles, which can be manually “moved away” from the nerve.
Direct massage cannot effectively reach the piriformis muscle, as it lies deep within the gluteal region, hidden behind the gluteus maximus—the largest and most superficial muscle in the buttocks. Applying indirect and non-specific pressure to the piriformis muscle can cause it to compress the sciatic nerve even more, exacerbating the condition.
After disembarking from a long flight with a “rock-hard backside,” resist the temptation to head straight to a massage parlor for a deep tissue massage to “break up muscle knots” in your buttocks. Instead of relieving the pain, this approach could actually make things worse.
The only effective way to heal piriformis syndrome is by targeted stretching of the muscles around the hip and pelvis – whether on your own or with the help of a physical therapist or a massage therapist.
Piriformis syndrome and Thai massage
Thai massage is ideal for addressing the “pain in the butt,” as it combines yoga-like assisted stretching with joint mobilization and targeted pressure strokes.
There is a well-established protocol in therapeutic Thai massage for treating inflammation of the piriformis muscle. If your Thai massage therapist is truly a certified professional, they should be familiar with it.
This procedure begins with broad, warming strokes across the lower back, hips, and pelvis to prepare the muscles connecting the spine to the buttocks and improve blood flow to the affected area. Once the tension in the outer gluteal muscles is reduced, the therapist moves on to focus on the underlying piriformis muscle. This involves a combination of stretching, lengthening, and strengthening techniques unique to Thai massage.
A common sequence in the supine position includes three steps targeting the piriformis muscle:
- Piriformis stretch
The therapist gently bends the client’s leg while applying pressure along the thigh to stretch the piriformis muscle.
- Twist the body
The client’s leg is crossed over, and their body is gently twisted to relieve tension in the lower back and hips.
- Leg stretch
The therapist stretches the client’s leg while stabilizing their body to target the piriformis and surrounding muscles.
Self-stretching
You can also perform self-stretching exercises to relieve tension in the piriformis muscle. There are dozens of exercises designed to alleviate pain caused by piriformis syndrome, including some that require extra caution (e.g., the pretzel stretch or seated twist stretch). The easiest and safest options include:
- Knees to Chest
Also known as the beginner-level yoga pose Apanasana, this stretch releases tension in the lower back. Lie on your back, bend both knees, and bring them toward your chest. Use your hands to gently pull your knees closer, feeling the stretch in your lower back and buttocks. Hold for 20-30 seconds and release.
- Knees to Opposite Shoulder
This stretch directly targets the piriformis muscle with a precise diagonal movement. Lie on your back and bend one knee. Gently pull it across your body toward the opposite shoulder until you feel a stretch in your buttock. Hold for 20-30 seconds, then switch sides.
- Reclining Pigeon Pose
Also known as the intermediate yoga pose Supta Kapotasana, this stretch opens the hips and targets deeper muscles. Lie on your back with both knees bent. Place one ankle over the opposite knee, forming a “figure four.” Gently pull the lower leg toward your chest, feeling a stretch in your hip and gluteal area. Hold for 20-30 seconds and switch sides.
If you’re in a situation where you can’t lie down, try the Standing Hamstring Stretch:
Place one foot on an elevated surface at hip level. Hold the edge of the surface with both hands and lean forward, stretching your buttocks. Lower the hip of your raised leg instead of lifting it to deepen the stretch.
Regular massage and stretching exercises will likely help loosen the muscle and reduce pressure on the sciatic nerve. However, if your symptoms persist, consult a doctor. Persistent hip or leg pain might not just be muscle inflammation but could indicate a more serious condition.