Is running becoming a pain in the butt?
 By
Michael Gordon, MD, Milwaukee Orthopaedic Group, Ltd. Orthopedic
Surgery, Sports Medicine Fellowship
Piriformis Syndrome, an uncommon cause of pain in the gluteal (i.e.,
“butt”) region, has sparked numerous discussions on the Badgerland
Striders' Web site. Located in the back of the hip, the piriformis
muscle runs between the pelvis and the posterior aspect of the thigh
bone (i.e., “femur”). This muscle functions as an external rotator of
the hip helping to turn the foot outward.
Running directly underneath the piriformis is the sciatic nerve. This
nerve serves the muscles of the back of the thigh, as well as the entire
lower leg. It's also the source of the term “sciatica,” a reference to
the pain that radiates down the back of the leg and is frequently
associated with low back problems. Oftentimes, when the piriformis
muscle gets inflamed, it can irritate the neighboring sciatic nerve and
mimic the symptoms of sciatica.
Piriformis Syndrome is classically described as a direct trauma to
the back of the hips through an injury to this muscle. It can also occur
in active individuals when a muscle imbalance across the hips leads to
inflammation of the muscle. In particular, the repetitive impact of
running can easily convert a slightly inflamed muscle into a severely
symptomatic Piriformis Syndrome.
The symptoms of Piriformis Syndrome include pain in the back of the
hip/upper thigh, as well as a sense of pain or aching that radiates down
the back of the leg. In addition, patients may note that sitting on a
hard surface can exacerbate their symptoms. Upon examination, the
classic finding of this condition is decreased hip internal rotation
with the ability to recreate the pain with this maneuver.
It's important to distinguish Piriformis Syndrome from a low back
problem or a herniated disc that can lead to sciatica. These conditions
are also characterized by low back pain with the possibility of pain
radiating down the back of a leg. Specifically, any changes in strength
or regions of numbness could be signs of a more serious lumbar spine
problem.
The treatment for Piriformis Syndrome focuses on decreasing the
inflammation, stretching out the muscle, and correcting any muscle
imbalances. A short course of anti-inflammatory medications is
recommended as a 1st step provided there are no medical
contra-indications for the particular patient. Next, a stretching
regimen, which works the muscles about the hip, and in particular the
“short external rotators”, is emphasized. Finally, a good biomechanical
and gait evaluation should be completed to locate and ultimately correct
any muscle imbalances that may exist.
If a patient has symptoms that are resistant to these treatments,
then further investigation may be needed to confirm that the diagnosis
is correct. Additional testing can include nerve conduction studies
(checking for a pinched nerve), MRIs, and a diagnostic injection of a
local anesthetic into the region around the piriformis muscle. If the
diagnosis is confirmed, then the next level of treatment includes a
cortisone injection along the piriformis muscle or possible surgery to
partially release the muscle. Since there are several other muscles that
serve a similar purpose, the piriformis can be partially cut without
much consequence.
A fairly rare condition, Piriformis Syndrome can be a difficult
diagnosis to make. Fortunately, it generally responds very well to
conservative treatment and doesn't keep runners off the road for too
long. If you're experiencing similar “pain in the butt” symptoms, have
it checked out by a sports medicine physician or with a
free injury evaluation at the Aurora Sports
Medicine Institute.
Dr. Michael Gordon, of the Milwaukee Orthopaedic Group, Ltd. is an
orthopedic surgeon with a fellowship in sports medicine. For questions,
you can reach Dr. Gordon at 414-276-6000.
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