Some quick notes on piriformis syndrome

Posted on September 9, 2013

(Last Updated On: April 6, 2016)

One day I’ll write something thorough on piriformis syndrome and sciatica. Til then, here’s some brief info from en email exchange. Edited for relevancy:

Hi Brian,

I recently took a trip driving to Arkansas from NJ with my family.  After getting home (actually I knew while in Arkansas) my hips are out of sync, my right hip is higher than the left.  I started going to the chiropractor.  In the midst of getting treated, a few days later I got a excruciating  pain from my right buttocks, behind the right knee and some numbing of my right big toe/foot.  When I went back to the chiropractor that day the pain started, he checked me out and told me I have Piriformis Syndrome (then of course he said I have literally a ‘pain in my butt’ (well he didn’t say butt, but you get it.).  I have been icing it continuously which helps.  I have used anti-inflammatories  Flexeril and Lidoderm patches (both limitedly as I truly do not like taking any medications but this pain was worse than having my twins).  He has been treating me with ultrasound and electric stimulation (I don’t know what that thing is really called).  Today I will be going to an acupuncturist (for the very first time, although I always wanted to go to one).  I am hoping she can help too.  The pain is not as bad as the first few days and I am only icing the buttocks area where the pain is.  I do stretches – lifting my right knee to my chest and holding it, crossing my right leg over my left (where my foot is at my left knee), and some others.  Is there anything else I can do to help this go away so I can start doing ‘normal’ things again (and get my butt back into some exercising)?  Thanks for reading my rant. 

Pain radiating down the leg like that is often (but not always) actually coming from the lower back. The sciatic nerve starts at the lower back, then travels all the way down the butt, knee, and into the foot. So, if that nerve is getting pinched / compressed at the lower back, it can send shooting pain way down the leg.

Sciatic nerve close up at lower back Screen Shot 2013-09-09 at 10.17.27 AM

Next, a common issue at the lower back is the lower back is twisting too much. If you’ve noticed one hip is higher than the other, this is likely a problem you’re having.

This is an example:

You’ll notice when he bends to the right side in particular -right shoulder comes closer to the right hip- his hips are getting pushed forward but his shoulders backward. That is, his shoulders are behind his hips. Basically, when he side bends his lower back is arching and twisting all over the place. (Potentially pinching that sciatic nerve.)

So, you then need to figure out, why is my right hip higher than my left? (When are you side bending?)

Common examples include: Sleeping, driving, leaning on a desk.

Here is a thorough example going over sleep positioning and the hips. This woman actually has the right hip higher than the left too:

Diane side lying with lines top and bottom


You can see the side bending present during how most people drive as well. Left hand on wheel; leaning on console:

Lower back pain driving

At a desk, people often side bend / tilt / twist when reaching for something such as a phone, which they may always have set to one side.

Video here:

Standing on one leg can cause asymmetry in hip height too.

Standing on one leg lateral pelvic tilt

Standing on one leg lateral pelvic tilt with line

In terms of exercise, a backward rocking / child’s pose stretch can often give some nice relief:

That will even things a bit as well as stretch the back of the hip out. (Where the piriformis / sciatic nerve is located.)

Overall, you’d want to throw in something like the backward rocking stretch, then also look for instances where your lower back is twisting, or your side bending / tilting, and then get rid of those instances. Often, it’s during way more things than the person realizes.

Another way of thinking about this is, “I want to make sure my hips and shoulders always face the same direction.”

For example, when someone reaches while seated you can see their shoulders turn to the right, but their hips stay in place. The shoulders, relative to the hips, are turned to the right.

Screen Shot 2013-09-09 at 10.30.09 AM

The hips, relative to the shoulders, are turned to the left. What the person should instead do is turn the hips and shoulders at the same time. This is where a swivel chair is better than a stationary one.

Top video view:

This could be at a desk, reaching for the radio dial in the car, or maybe for you having two monitors where you tend to twist to face one monitor more than the other.

I tend to be verbose, so if you want a more thorough discussion of this stuff I’ve written these. Some are a bit more technical than others: -> More examples of the lower back twisting too much. -> This is an example of a postural assessment of a guy who also has one hip higher than the other.

I haven’t gotten around to writing a specific post on piriformis syndrome / issues with the sciatic nerve, but many parts of those posts above are related.

Hope that all helps. Let me know if you have other questions.


Here are some other common movements people fall into, and how to get rid of them.

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