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Piriformis – Pain & Trigger Points

The piriformis is a muscle of your hip. Through various activities and postures, it can develop small hard spots and trigger points that may cause pain in your buttocks and hips.

Usually it’s possible to relieve this pain, and often even eliminate it completely, by freeing the muscle of tensions with a self-massage.

On this page, I will explain how to perform the self-massage and show you which pain the muscle can cause, where it is located and why the pain developed in the first place.

1. Pain Patterns & Symptoms

Small tensions and “hard spots” in the piriformis can trigger local sensitivity of pressure and pain in the buttocks, lower back and superior lateral side of the thigh.

Trigger points in the piriformis, on the other hand, can transmit pain to the back of your thighs.

In addition to pain, this muscle can “pinch” the sciatic nerve, which can refer the pain to the posterior thigh, lower leg and foot.

1.1 Further ailments

“Problems” in this muscle are often referred to as piriformis syndrome. Its symptoms are often so unusual that it seems there can be no relation between these. In addition to the pain described above, the following symptoms may occur.

  • Groin pain
  • Sensory sensation disorders in the lower back
  • Pain in the perineum – the area between the anus and the external sex organ –
  • Pain in the posterior lower leg and foot
  • Pain in the rectum during bowel movement
  • Sexual dysfunction due to compression of the nervus pudendus
  • Dyspareunia: Painful sexual intercourse – e.g. spreading the legs is painful –
  • Impotence in men

These symptoms can get worse due to sitting, hip adduction with flexion and internal rotation at the hip, and due to physical activity.

You don’t understand what that means? I’ll explain it to you: With an adduction, the thigh is moved towards the midline of the body, with a flexion it is lifted upwards and with an internal rotation it is turned inwards.

During all these movements the piriformis gets stretched and is slightly extended. If it has a hypertonus – too much tension – this change in length can lead to increased symptoms and pain.

2. Attachment Points

Simply put, the muscle extends from your sacrum/os sacrum to the greater trochanter, a small elevation at the top of your femur.

3. Function

The main function of the piriformis is the external rotation at the hip.

But it also contributes to the stabilization of the hip by counteracting fast internal rotations (e.g. early stance phase during running or racing) and holding the femoral head in the acetabulum.

It also performs an abduction when your hip is bent 90°.

4. Piriformis – Trigger Point Activation

Tensions and trigger points usually arise in this muscle because of unusual and sudden movements.

Especially situations in which one’s own body weight has to be “absorbed” and the hip has to be stabilized are often responsible for the activation of trigger points or just tensions.

A classic example would be slipping on snow, ice or a wet floor.

Beside these suddenly occurring situations, movements in which the muscle is shortened and contracted maximally can also activate trigger points that had been existing since time before, but had been calm so far.

There is a case study in which a man has placed a heavy object on the ground between his legs and this way has overloaded his piriformis.

5. Palpation

The palpation of the piriformis is difficult, even for experienced therapists and almost impossible from the outside, which is why it usually gets palpated vaginally or rectally.

Thus, you will understand that it will not be possible or at least very difficult for you as a layman to feel the muscle.

The reason for the difficult palpation is that the muscle lies deep in the hip and pelvis and is covered by the gluteus maximus, medius and minimus.

Still, a self-massage is possible (to a certain degree) and is described in the next section.

6. Self-massage of the Piriformis

As described above, the muscle lies deep to your gluteal muscles. This of course means that the massage is performed across/through them.

A hard massage ball is suitable for this. In addition, the success of the massage also depends on how voluminous your bottom is and, overall, on how much fatty tissue there is.

For very obese people, it will be hardly possible to massage it with a small ball.

The massage:

Lie down on a hard floor and place the ball in the upper half of your buttocks. Now shift some weight onto the ball and slowly roll over it. This allows you to examine the area for painful points.

Every point you find is massaged with a few small rolling movements. Make sure that you only roll from just before to just after the point.

Of course, you can’t exactly tell whether you are really on your piriformis or just on your gluteal muscles. However, there are similar factors that lead to problems with these muscles.

This means that painful muscles in this area should be massaged anyway.

Note: It is possible to massage the sciatic nerve here. This can happen easily, especially in untrained persons with poorly developed gluteal muscles.

While a little pressure does not harm the nerve, you should avoid massaging it too long and too heavy.

Just keep your massage short at the beginning and don’t exert too much pressure. Pay attention to how your body reacts and gradually adjust the duration and pressure of the massage.

After a few sessions, you will develop a feeling for how much pressure you can tolerate.

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons‘ Myofascial Pain and Dysfunction: The Trigger Point Manual. The Lower Extremities. Baltimore, MD: Williams & Wilkins, 1993. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print