A PAIN IN THE, UMM, PIRIFORMIS
Pain in the low back that goes down your leg can be serious. In some cases, it’s due to nerve pressure by a “ruptured” or “slipped” disk in your back. Luckily, though, there’s another common cause that’s easy to treat and doesn’t require surgery. It’s called “piriformis syndrome.”
The piriformis is a muscle attaching the outside of the hip to the sacrum, at the bottom of your spine. If you hold your feet together with your legs slightly bent and pull your knees apart, your piriformis muscles are being used. If you’re standing up and turn your body to the side at the hips, one of your piriformis muscles is doing the turning.
If a muscle gets strained, it’ll often cramp up. One common location for a muscle cramp is in the calf: it’s often called a “charley horse.” This is easy to treat: you grab your calf and start massaging it, and stretch it out by flexing and pulling your foot upwards. It’s only slightly harder to treat a cramp if it’s in the piriformis.
The piriformis muscle is in your buttock, underneath the big gluteal muscle. You can feel the glueal muscle work if you put your hand in the middle of your buttock as you’re sitting, and then stand up. The gluteal is a big, thick muscle, so it’s difficult to feel a cramped piriformis since it’s got several inches of gluteal meat on top of it. However, deep pressure in the upper outer part of the buttock will hurt when the piriformis is cramped.
In addition to tenderness, a piriformis cramp (or spasm) usually causes low back pain, which sometimes is felt in the leg on that side. Since the sciatic nerve is in contact with the piriformis, a hard, cramped piriformis can push on the sciatic nerve, which causes pain or numbness in the leg. It’s similar to what you’d feel with a ruptured disk, and it’s sometimes hard to tell the two problems apart.
Stretching a cramped piriformis hurts, and is one of the ways to diagnose the condition. Here’s how you test your piriformis:
While sitting, put your left ankle directly on top of your right knee. Hold your left knee with both hands, and slowly pull it up and to the right towards the outside of your right shoulder. If your left piriformis is in spasm, you’ll feel pain or a strong stretching sensation. Then, reverse legs and try it the other way to compare. With piriformis spasm, the bad side will feel a lot worse.
Stretching can be used to cure the problem, too. Here’s how to do this:
First, hold the knee on the bad side, and slowly pull it up towards the opposite shoulder until you feel a mild to moderate stretch in your buttock. Don’t pull it hard enough to hurt: just pull ‘til you feel a stretch. You can try pulling at slightly different angles to find where you feel the most stretch: this is the direction to pull. Hold the stretch for 30 or 40 seconds, and then push your knee down against your hands. Be sure to resist with your hands so your knee doesn’t go ANY lower at all!! This is very, very important.
Push down for 5 or 10 seconds with your knee (without letting it move downward AT ALL) and then relax your piriformis while continuing to pull with your hands. You’ll find that your knee will come up towards your shoulder an inch or so. This is a sign that your cramped piriforms is relaxing. Repeat this process 4 or 5 times, continuing to stretch out the piriformis. You should feel less pain.
It’s OK to stretch as often as you like: the more you stretch a cramped muscle, the faster it’ll get better. You might also try lying on your back on the floor or carpet with a tennis ball pushing on the upper outer buttock where the piriformis is. Some folks (but not all) find this helpful.
If you continue to have symptoms, be sure to have your doctor check things out. As I said earlier, it’s sometimes hard to tell a piriformis spasm from a ruptured disc. If your leg gets weak or stays numb, see your doctor without delay.
Once your piriformis is better, it’s worth strengthening it so it’s less likely to cramp again. One easy exercise is lying on your side with your hips and knees bent, and lifting the top leg repeatedly. This strengthens the piriformis. When doing strengthening exercises, always rest for a day between exercise to allow the muscle to rebuild.