Deep Butt Pain in Runners: Piriformis Syndrome
by Nora Gilman, MS, LAT, ATC
There is a small, deep muscle that sits below the glute max. It is called the piriformis. The main responsibility of the piriformis is to suspend the femur from the hip socket. Basically, it is the rotator cuff of the hip. Often, when runners have ‘deep butt pain’ after a run or sitting, this muscle is the culprit. The piriformis is also situated above the sciatic nerve which can sometimes cause this condition to be extra painful.
Common symptoms of piriformis syndrome is deep butt pain and/or low back pain. Since the sciatic nerve runs behind the piriformis, some athletes will experience nerve pain that radiates into the glute area and sometimes even down the leg.
My Clinical Experience:
(Note: this experience has not been clinically trialed and are theories only)
Piriformis syndrome is very common due to the mix of our lifestyle and the function of the piriformis. Our typical lifestyle habits involve a lot of sitting. Sitting in our cars, at work, at school, or at home for extended periods of time can cause injury. These sitting habits cause our glutes to ‘turn off’ which is a problematic scenario when the piriformis is always ‘on.’ The piriformis is always ‘on’ because it is coordinating proper hip function around the clock. Without proper changes to our lifestyle in combination to run training, the piriformis can become overworked and cause pain. Since the piriformis is very small in relation to the large glute muscles, it doesn’t take long for the piriformis to cause a problem with running which involves a lot of power and endurance.
What you can try:
Modify running: If you find running makes your symptoms worse, try to find an intensity or amount of running that you can sustain without making the condition worse.
Stretching and Strengthening: While you modify your running to a tolerable volume and intensity, adopt a regular regimen of hip stretching and glute strengthening. Perform this regimen as often as you can.
Cross Train: You can find other activities to engage in to keep your aerobic fitness while you turn down your running volume. Some alternatives are biking, swimming, or water jogging. These activities can strengthen other muscles that you may not be using in running. If any of these activities make your symptoms worse, try a different activity.
Use pain as your guidance: This muscle re-education process detailed above will take time and patience. The best way to know if you’re making progress is to keep track of your pain and symptoms and adjust based on progressions and regressions.
Refrain from complete rest: This pathology is largely caused by muscles not working, therefore, complete rest will not likely assist your progress and could potentially make it worse. Choose movement instead of sitting.
When to contact an athletic trainer:
If you need help and advice on properly modifying your activity, an AT can provide you with ongoing support.
If you need direction with the right stretching and strengthening protocol, an AT can get you started on effective exercise progression and regressions.
If any nerve or hip pain worsens, an AT can advise you on the right steps to take next.