Pain in the Bum

Too much sitting or standing stresses the deep-seated piriformis muscle and leads to rear end aches

WRITTEN BY Lauren B. Johnson
PHOTOGRAPH BY Piyawat Nandeenopparit

As excited as many are to travel this season, getting to a far-off destination can be a vexing journey packed with luggage restrictions, heavy traffic and jet lag. For those who suffer from piriformis syndrome, though, a long-distance trip may be a literal pain in the butt.

The piriformis muscle wraps across the buttocks at the hip joint and works to stabilize the hips and rotate the thighs. When a dysfunction exists in this deep-set muscle, doctors refer to the ailment as piriformis syndrome. Regularly confused with sciatica, the condition manifests as a shooting, burning or aching sensation in the rear end or the back of the thigh. Some may experience numbness or tingling along the back of the leg, and symptoms often kick up after extended periods of walking, standing or sitting (hence, the travel troubles).

“There’s no real cause as to why that muscle might be more aggravated,” explains Roper St. Francis Healthcare affiliated physical therapist Lauren Moore. “Often, it’s just a person’s individual anatomy.” Piriformis syndrome can relate to pelvic floor dysfunction, poor body mechanics, prolonged sitting or improper stretching. While the condition isn’t selective in whom it affects, Moore frequently sees the diagnosis in men carrying thick wallets in their back pockets and in pregnant women.
To alleviate the discomfort in your derriere, she recommends performing easy sitting stretches and applying heat. “You can also massage the muscle by placing a tennis ball between your rear end and a wall, then leaning into it,” directs the physical therapist. If you experience any numbness or tingling, or if the condition becomes unmanageable or disrupts sleep, follow up with a doctor or physical therapist, who can diagnose the problem with a physical exam. In addition to pain medication, treatment will likely include physical therapy to address any underlying weaknesses or flexibility issues.

The bottom line? While you can’t change your musculature, you can help prevent buttock pain by being mindful of body mechanics and stretching daily, especially if your job requires extensive sitting or standing.

End Game

“In some people, the sciatic nerve passes under the piriformis, while in others, it runs right through the muscle,” says Moore. Given this close anatomical relationship, piriformis syndrome and sciatica symptoms often overlap, though the two conditions differ. Here’s how to sort out these confusing backside complaints:

Piriformis syndrome:
• Caused by aggravation of the piriformis muscle, trauma to the hip or buttocks or sitting/standing for extended periods
• Pain typically felt in the buttocks and hip
• Discomfort usually increases with prolonged sitting and/or during hip movements

• Caused by a medical problem, such as a herniated disc, that irritates the nerve roots in the lower spine
• Primary symptom is leg pain that may radiate down to the toes
• Pain results when lifting the affected leg while lying down