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Finding and treating piriformis trigger points can be a powerful way to get pain relief, both from buttock and back of thigh pain and sciatica. This article will cover:
The piriformis is a fascinating muscle. It’s one of the deep rotators of the hip. The hip joint has a long bone – the femur – which has a big round ball at the end of it. That ball sits in a cup of the hip joint. Even though the hip joint cup is quite large, it’s still a very mobile joint.
The other important point about the hip joint is that it’s a weight bearing joint. What the deep rotators of the hip do is stabilize and move the femur as you walk, stand and run.
The most important muscle of the deep rotators is the piriformis. It arises from the sacrum, or tailbone, and runs across deep inside the buttock to attach to the head of the femur.
When it contracts, it rotates the femur externally. In action, when you activate this muscle you’ll see your foot and whole leg rotating outwards.
The piriformis has another function. As you step and put weight on your leg, and it will contract and it will stop your pelvis rotating. In this capacity it works to stabilise your core as you move.
So it’s a rotator of the leg and a stabilizer of the pelvis, giving stability to your core muscles.
The piriformis muscle in an interesting position. It runs from the pelvis (or sacrum) and through what’s called a sciatic notch, which is a bony curve in the pelvis. This is important because the sciatic nerve runs through this same bony space.
For most people, the sciatic nerve runs underneath the piriformis, but for a small group of unfortunate people, the sciatic nerve may run through the muscle. Another variation is for the sciatic nerve to run above the piriformis, in between the muscle and the bony arch.
This means that when the piriformis muscle contracts or if it goes into spasm, it will literally squeeze the sciatic nerve. This causes classic radicular pain, otherwise known as sciatica. This is nerve pain which radiates down the leg in the distribution of the sciatic nerve.
The piriformis is not a very big muscle and it has a very important stabilizing function. Because of this, it often gets trigger points. When you get trigger points in this muscle, you feel pain deep in your buttock.
Piriformis trigger points cause a deep ache running in your buttock, down your leg, and into the back of your thigh. The piriformis trigger point pain zone usually ends above the knee.
With active trigger points, you may or may not have actual squeezing or irritation of the sciatic nerve. This depends on where the nerve runs in relation to the muscle. However, an extremely tight piriformis muscle is an often overlooked cause of sciatica.
Finding and treating trigger points in this muscle is made difficult because the piriformis is such a deep muscle. It lies under the gluteus maximus, which is a very large muscle.
From a practical standpoint, it can be difficult to know exactly which trigger points you’re turning off. The more important thing is to be able to get deep into the buttock muscles.
The piriformis is part of a number of deep rotators and stabilizers of the hip. Therefore you may also be turning off trigger points in some of the other muscles in this group. The other muscles are: the gemellus superior, obturator internus, gemellus inferior, quadratus femoris and the obturator externus.
Some of these hip rotators may also have active trigger points, and be part of the cause of pain. However, because they’re all doing similar actions, this isn’t a problem when you do your treatment. Simply seek for the area which is exquisitely painful, deep in the buttock.
Getting down to the piriformis can be difficult depending on how much fat or muscle the person has. The trigger point treatment involves ischemic pressure and if you’re treating yourself, it’s best to use a trigger point release tool like a theracane or back knobber.
Because this muscle is so deep, the more common treatment is dry needling or trigger point injections.
Dry needling involves putting an acupuncture needle down into the muscle, and into the active trigger point. To be effective, the needle placement needs to be accurate.
Usually you’ll use more than one needle. You may need to put a number of needles in because there may be a number of triggers in the piriformis and in the other deep hip rotators.
Depending on the person’s level of fat or muscle, you may need to use longer acupuncture needles to get to the trigger points.
Wet needling, or trigger point injections involves injecting tiny amounts of local anesthetic into the trigger points. You can also add a small amount of cortisone for an anti-inflammatory effect.
After any treatment – massage, dry needling, or injections, it’s very important to stretch the muscle out to length. A piriformis stretch is done with a mixture of flection and internal rotation of the hip. After the stretch, apply gentle heat for 5-10 minutes.
Treatment usually needs to be done on a number of occasions over a period of time because the piriformis is a deep, difficult muscle to get to. Sometimes you first need to relax and relase the overlying muscles before you can get right down to it.
Piriformis trigger points are a common cause of chronic buttock pain sometimes sciatica. If you’d like more information on successfully treating triggers, here’s where to go next.