Lower back top of buttock pain relief

Discomfort from too much sitting? Inactive glutes? Buttock and leg pain? Though small in size, the piriformis could have a big impact on keeping the human movement system moving smoothly. Addressing an overactive piriformis may be part of the solution.

Within this article, you will find some valuable stretches to relieve piriformis syndrome.

For further validation on the effectiveness of stretching from a corrective exercise perspective, enroll in the Stretching and Flexibility Coach course by NASM.

What is the Piriformis? 

The piriformis is a tiny muscle that originates on the anterior surface of the sacrum, travels through the greater sciatic foramen, and attaches to the greater trochanter of the femur (1,2). It accelerates hip external rotation, abduction, and extension.

What is Piriformis Syndrome?

Piriformis syndrome has traditionally been described as a referred neural pain in the posterior hip and leg caused by hypertrophy or spasm of the piriformis. The pain is caused by pressure applied to the sciatic nerve by the piriformis due to the passage of the nerve through or under the muscle (2).

Pain associated with this problem often mimics the signs and symptoms of lumbar nerve root compression or sciatica in the buttock and posterior leg. The client will often report sciatica-type symptoms and experience tenderness in the piriformis fossa. Pain when sitting is common, as is pain with hip flexion, adduction, and internal rotation.

Signs and Symptoms of Piriformis Syndrome

The signs and symptoms of piriformis syndrome are: 

• Pain in the buttock
• Pain down the back of the hamstring, or posterior thigh
• Pain when sitting
• Pain when walking up stairs or inclines
• decreased range of motion of the hip joint

While the signs and symptoms of the syndrome may be similar to other lumbo-pelvic pathology, the cause of piriformis syndrome remains relatively undefined as to reasons for development of spasm or hypertrophy of the muscle.

See "Is The Piriformis Tight? Really?" for an additional perspective on symptoms, causes, and solutions of Piriformis Syndrome.

It is interesting to note that a description of the syndrome is found in most medical texts, yet the criteria for diagnosing piriformis syndrome and pathophysiology still remains a controversial issue (3,4).

However, the reason why the piriformis is hypertrophied or in spasm is often described as "undefined and confusing." If the practitioner considers the principles of the kinetic chain and dysfunction of its linked components, it is not difficult to hypothesize why the piriformis may become involved in an impingement of the sciatic nerve. If the client has chronic tightness of the hip flexor, the gluteus maximus will become reciprocally inhibited (1).

This is significant because of the functional responsibility of the glute to decelerate medial femoral rotation during heel strike or functional movements. Since the piriformis is a primary external rotator of the femur, it becomes synergistically dominant in controlling the femur.

This type of dominant function has the potential for causing the spasm, hypertrophy, or tightness described in most texts. The external hip rotators have also been noted as being the least stretched muscles of the lower body (5).

Piriformis Syndrome Treatment and Therapy 

If a client complains of pain in their buttocks, hip rotators, or the lumbo-pelvic complex in general, the health and fitness professional should first instruct the client to visit their medical professional. If a client has been released from therapy or their doctor and the pain persists, an effective corrective exercise strategy for correcting this type of dysfunction would be to first release the hip flexor through appropriate integrated flexibility techniques, then implement reeducation of the gluteus maximus through isolated strength training.

Finally, recondition the lumbo-pelvic hip complex through integrated functional movements in the appropriate range of motion, plane of motion, and speed, specific to the needs of the client.

Piriformis Stretches To Try

• Foam Roll Piriformis
• Foam Roll Quads
• Foam Roll IT Band
• Static Stretch Piriformis
• Static Stretch Biceps Femoris
• Static Stretch Hip Flexors
• Leg Slides
• Floor Bridge
• Lateral Tube Walking
• Ball Squats

SMR Piriformis

SMR Quads

SMR IT BAND

Static Stretch: Piriformis

Lie on your back with one foot placed on top of a stability ball and the other foot crossed over your knee. Pull the ball toward your body with your heel. Press the crossed knee away from you until a stretch is felt in the back of your hip. Hold for 30 seconds.

Static Stretch: Biceps Femoris

Static Stretch: Hip Flexors

Leg Slides

Begin by lying on your back with your knees bent and your feet flat on the floor. Breathe normally as you gently draw-in your navel towards your spine. Hold the contraction and relax as you slowly extend one leg until it is completely flat against the ground. Remember to keep your navel pulled in and be careful not to move your spine. Slowly return your leg to the starting position and repeat with the opposite leg.

Floor Bridge

See the exercise library page on floor bridges for more. 

Lateral Tube Walking 

Ball Squats

Conclusion

In many cases, tightness in the piriformis can be alleviated with the proper steps (as noted above). However, we must always remember that we are not licensed medical professionals, we should always consult a licensed practitioner to help understand our client's problems and refer our clients out whenever necessary.

If you are interested in learning more about how to best utilize corrective exercise to alleviate inactive piriformis muscles and streamline your client’s movement, look to become a Corrective Exercise Specialist. 

For a 4-phase breakdown of the entire corrective exercise process, our Corrective Exercise Continuum is a great reference point.

And our blog post on whether or not you should foam roll the lower back will help guide your SMR programming. 

How do you relieve lower back pain and buttocks pain?

What causes pain in the lower back top of the buttocks?

How do you release a sciatic nerve?