Is Piriformis the Culprit of your Buttock Pain?

Is Piriformis the Culprit of your Buttock Pain?

Often when people get buttock pain, they consult Doctor Google or even traditional musculoskeletal medicine textbooks and immediately lay blame on poor piriformis. ‘Piriformis Syndrome’ has been the popular diagnosis for some decades now but is not quite as common as once thought. Piriformis can have different structures in different people and the relationship of the Sciatic nerve to Piriformis is thought to change the likelihood of symptoms. In a small percentage of people, the Sciatic nerve does pass right through the middle of Piriformis (about 10% have variations). Sciatic nerve involvement may produce pins and needles or numbness due to irritation or compression of the Sciatic nerve if it passes through the Piriformis muscle.

There are many pain producing structures through the buttocks. Some of the other muscles in that region include the Gemelli, the Obturator muscles, Quadratus Femoris, Gluteus Medius, Minimus and Maximus. Many of these muscles originate from the Sacrum and/or the Iliac crest of the pelvis. Buttock pain can also be a result of referred pain from the Thoraco-lumbar junction, Lumbar spine and Sacroiliac joint. It is not unusual for multiple anatomical sources of buttock pain.

Gluteus Medius has complex anatomy that changes function according to hip position and is a more common cause of buttock pain as well as lateral hip pain.

Management normally involves local treatment to settle symptoms and working on improving the way the muscles around the pelvis interact with their complex biomechanics. Weakness on one side will often cause symptoms on the other. A graduated return to increased load / exercise is important.

If you experience buttock pain start your Physio management as soon as you can, so you can moderate your exercise rather than needing to stop.