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Pain in the Butt - What Is Piriformis Syndrome

Posted 5/13/2016 by UHBlog

It's not always easy to diagnose the source of your lower back pain – and treating it can be a pain in the butt. We can help.

Pain in the Butt: What is Piriformis Syndrome and How Can I Prevent it?

Many Americans can expect some form of lower back pain as they age. In fact, 80 percent of us are likely to experience back pain at some point in our lifetime. While the causes and sources of the pain vary, one type – piriformis syndrome – can make sitting, squatting and climbing painful, says sports medicine specialist Sean Cupp, MD.

Piriformis syndrome affects the piriformis muscle, which is one of the muscles that forms the buttocks and is used when you rotate your hip. Even though it’s a small muscle, it can exact a big wallop of pain.

“The piriformis muscle can become irritated from prolonged, direct compression over a long period of time,” Dr. Cupp says. “People who come in often think their pain is sciatica. That's because the piriformis muscle runs next to the sciatica nerve. The sciatica can run in front of, behind or – in about 20 percent of people – through the piriformis muscle.”

This can make diagnosing and treating piriformis syndrome difficult.

“This is a chicken-or-egg type of problem," Dr. Cupp says. "Does the nerve create the problem or the muscle cause the pain?”

Regardless, he says, a good sports medicine doctor can help you know what you have by excluding other types of back problems.

Treating piriformis syndrome requires rest and changing those activities that can aggravate piriformis syndrome, such as:

  • Downhill running
  • Bicycling
  • Seated-types of sports, like rowing
  • Excessive sitting, for instance in an office chair, which can cause your pelvis muscles to tighten and shorten

Sometimes, relief comes from removing your wallet.

“One of the names for this condition is 'wallet neuritis' due to the big, thick wallet men stuff in their back pockets,” he says. "When the man stops sitting on his wallet, the problem lessens."

If you still have pain after a few days of rest and icing the area, you should see a sports medicine doctor.

“We'll be able to help get you started on a plan to relieve the pain,” he says. For instance, initial treatment might include anti-inflammatory medicines, physical therapy and other modality treatments, such as moist heat and/or ultrasound.

“A longer-term treatment would include lumbar strengthening and core stabilization exercises,” Dr. Cupp says. “With weak core muscles, your pelvic can shift, which can contribute to piriformis syndrome.”

Sean Cupp, MD is a sports medicine specialist and sports medicine co-director at University Hospitals Cleveland Medical Center, lead medical team physician for the Cleveland Browns, and associate director, Sports Medicine Institute at University Hospitals. You can request an appointment with Dr. Cupp or any other University Hospitals doctor online.

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