How can I banish that pain in my butt?

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Jack asks: I am experiencing a deep pain in my buttock. Sometimes it seems to be going down the back of my left leg. I've taken some time off from running and it doesn't seem to be any better. A runner friend suggested it might be piriformis syndrome. What can you tell me about that?

When experiencing pain that does not go away with rest, it’s best to consult a doctor or physio for a definitive diagnosis and treatment plan. Based on the description, your friend may be right. It does sound like piriformis syndrome, but get evaluated by a professional for an accurate diagnosis and to rule out other possible causes, too. 

The piriformis is a small, but powerful, muscle that sits deep behind the gluteals and is responsible for the external rotation of the hip joint. The most common symptoms reported with this syndrome are a dull, deep ache in the buttock, pain down the leg or up the spine and/or pain when sitting.

The sciatic nerve passes right by the piriformis muscle, and when the piriformis contracts or spasms, it can sometimes compress the nerve, resulting in pain. Repetitive activities, like running, can fatigue the muscle and irritate the nerve. Likewise, prolonged sitting can also irritate this nerve, so runners with desk jobs may be even more susceptible.

Piriformis syndrome typically responds best with time off from running along with specific stretching and strengthening exercises. Maintaining appropriate balance of opposing muscle groups and flexibility is very important, especially for hip and pelvis stability. Hip flexors and quadricep muscles contract every time you pick up your leg, so hip flexors and quads can become overly tight and shortened because of running.

Sitting most of the day at work behind a desk adds to this shortened, contracted state. When hip flexors and quads are contracted, they pull on the anterior aspect of the pelvis. If there is a strength imbalance between the muscles on the anterior and posterior sides of the pelvis, the posterior muscles may not be able to counter balance the anterior pull, and this may lead to piriformis syndrome developing. 

Other suggestions to discuss with your health care professional include having your running form evaluated, checking for leg length discrepancies, assessing muscle strength imbalances and measuring flexibility. Also, orthotics may be in order because there are some indications that this condition can be brought on by excessive overpronation, or the inward movement of the foot when you land.

When you are able to resume running, keep these tips in mind:

  • Always warm up thoroughly
  • Decrease mileage and rebuild in small increments
  • Reduce the intensity of your runs, keeping them easy
  • Avoid cambered (slanted) roads
  • Avoid hill work