A Pain in the Butt: Piriformis Syndrome

By Judy Kirkwood

I experienced my first prolonged pain in the butt after moving to Delray Beach, Florida, and immersing myself in an intense barre exercise class – guaranteed to firm the butt and slim the waist. Healing a broken heart after my 35-year marriage blew up, the idea was to challenge myself with such a strenuous workout that for an hour I couldn’t think of anything but pushing my body to its limits.

Since I wasn’t in shape, and was perhaps the oldest person in these classes, my expectations, as well as the teacher’s, were probably unrealistic. A tight round butt was not likely after living six decades with a flat bottom that never filled out my jeans.

The butt exercises backfired. I began to feel a dull toothache like pain in my left glute. Then it got more intense and traveled down my thigh a little. I dragged my left leg and winced when I walked. Soon I felt the ache in my whole body because the pain, although localized, was so draining it was exhausting my brain. It even interfered with sleep at night.

I went to a chiropractor for a series of appointments, with no lasting positive results. I went to several massage therapists. Finally one correctly identified my pain as Piriformis Syndrome – entrapment and inflammation of the sciatic nerve by the Piriformis muscle, a relatively small structure located deep below the surface of the buttock. The right kind of massage with a skilled therapist did help; but not enough. I even tried a six-week course of acupuncture, with no relief.

The piriformis muscle starts at the lower spine and connects to the upper surface of each femur, functioning to assist in rotating the hip and turning the leg and foot outward. This made perfect sense considering the barre exercises I had been doing, and other activities. Overuse of the piriformis muscle includes certain exercise moves, sitting for long stretches at a desk (or in my case cross-legged on my bed with my laptop) and then vigorously exercising, and sitting for long periods in a car (I would put a rolled up towel under my left thigh to try to mediate the pain).

I was thrilled that alternative medicine practitioners all seemed to know what I was talking about, even if they didn’t “cure” it. But when I told a doctor about it, he looked disgusted and said there’s no such thing as Piriformis Syndrome and refused to list it as one of my complaints. I never mentioned it to a doctor again, even though the pain affected my physical stamina and general well being off and on for months at a time over years. Until I found a gifted Pilates teacher and trainer who worked with me on strengthening my legs and core and stretching my hamstrings, the only thing that helped was taking 8 to 12 Ibuprofen a day – but don’t do that.

“Piriformis Syndrome is more pervasive than many physicians realize,” Dr. Aaron G. Filler, of the Institute of Nerve Medicine in Santa Monica, has noted. In the early 1990s, Dr. Filler on the West Coast, and Dr. Loren Fishman in New York, were pioneers in identifying, understanding, and successfully treating Piriformis Syndrome. Both have done much to spread the word that Piriformis Syndrome is a real and treatable disorder. But many mainstream physicians still lump it in with sciatica due to spinal causes therefore treating it unsuccessfully, often with unnecessary back surgery. Both Filler and Fishman have seen countless patients who are debilitated by their pain who have been to many physicians without being correctly diagnosed. “People come into our offices on gurneys who can’t sit, stand, or drive,” says Jodean Petersen, clinical services officer for Dr. Filler for 21 years. I was lucky my pain was not that bad.

For these severe cases, once the correct diagnosis is made, based on nerve imaging, Dr. Filler may suggest steroid and anesthetic injections or minimal access surgery, guided by MR Neurography. Dr. Fishman performs injections, but only recommends surgery as a last resort. He is a big proponent of physical therapy emphasizing stretching, and of yoga. His book, “Pain in the Butt” Piriformis Syndrome: Diagnosis Treatment, and Yoga (2014), is available on Kindle for $5.99.

In my case, only ongoing equipment Pilates with Amalia Brassfield at Infinite Conscious Conditioning in Delray Beach has relieved my Piriformis Syndrome. After working with her for 6 years, I know my Piriformis Syndrome can be eased, and even absent for periods of time. Staples of care are particular cross body hamstring and thigh stretches and deep tissue myofascial release on a hard foam roller, which I can do at home. The drawback is it is so painful when my Piriformis Syndrome is active that it’s hard to approach enthusiastically. Yet if I did it regularly it would prevent relapses into pain.

Having moved from Delray Beach, I’ve had to rely on myself rather than Pilates classes and individual sessions with Amalia. Predictably, things have gone downhill as I immediately pushed myself too far in Pilates classes with a new instructor not as familiar with Piriformis Syndrome. I’ve had to resurrect the dreaded foam roller myofascial release self-massage; or suffer the consequences, limping and groaning.

If you have a consistent pain in the butt you think may be Piriformis Syndrome, do not give up. Keep soliciting care until the diagnosis is confirmed by a health practitioner you trust. It is not in your head, it is real. Then find a good massage therapist and a trainer who can teach you strengthening and therapeutic movements. If your pain is so severe it affects your ability to function, make sure the doctor you see is familiar with the latest diagnostic and treatment procedures. It is possible to walk, sit, and stand without pain.

Judy Kirkwood writes articles for print and web publications – national, regional, and local; is a contributing writer to Simply the Best and Boca Raton Observer magazines in South Florida; and plays on the beach and in the pool year-round. Visit her on Facebook @JudysFlorida and please visit www.JudysFlorida.com.