Piriformis Pain and Modern Work Life
Written by Melissa Schenkman, MPH, MSJ
Have you ever noticed how after sitting for a while part of your backside aches when you walk around? If you have, you are likely feeling your piriformis muscle.
It’s a muscle that Elizabeth Rudd, PT, DPT, of Well EquiPT knows well, as she has treated many patients with piriformis-related pain.
“The piriformis muscle is a small muscle in the back of the hip that attaches the low back, sacrum, and pelvis to your actual hip bone. Its function is to rotate the hip out,” Rudd said. “The unique thing about the piriformis muscle is that underneath it is the sciatic nerve, and it can play a role in sciatica too.”
While you may not have noticed any soreness coming from this area of your body in your early 20s, for many of us once we started working that changed. Transitioning to a career with a desk job can have major impacts on our muscle health, even those of us who are still regular exercisers.
Rudd breaks down how desk jobs can lead to piriformis issues, how to identify piriformis problems, what preventive measures we can take, even in our transition from sitting at work to exercising, and how to treat piriformis pain, so that we can heal from (and hopefully prevent) this literal “pain in the behind.”
The desk job transition: Risk factors for piriformis issues
You might have heard the buzzword, “piriformis syndrome.” It’s when your piriformis muscle compresses your sciatic nerve resulting in inflammation. The sciatic nerve (the longest and largest nerve in the body, which runs from your lower back down each of your legs).
Research shows that up to 17% of people with chronic low back pain might have piriformis syndrome. One of the major causes of this is prolonged sitting as is the case in desk jobs.
The more hours at a time we sit, decreasing our daily standing and moving activity compared to when we were active college students or just not at a desk job, the more it can lead to muscle imbalances. It’s these imbalances that ultimately hurts the piriformis and before you know it, our brains are sending us the message about that pain in the piriformis.
“We have about 20 muscles that attach to the hip, and if some of them are or are not working optimally, that piriformis may kick in and overwork. This makes it get tight and become weak,” Rudd shared.
In addition to pain, common symptoms of piriformis syndrome are aching, burning, numbness, tingling, or shooting in the butt, hip, or upper leg. These symptoms can be exacerbated by walking, running, climbing stairs, or sitting for long periods of time.
Posture contributes to increasing the risk from piriformis issues, and what’s key here, Rudd told us, is movement.
“Our bodies aren’t really meant to sustain one position for a long period of time. So, even if you are trying to stand up all day, the same muscles are going to be working the whole time, getting overworked, and tight,” Rudd said.
Therefore, after having the same posture for hours, such as sitting in a desk chair typing on the computer all day, our piriformis is overworked, and you end up with a lot of aches and pains.
From desk to gym: The second transition
While movement is definitely one of the antidotes to piriformis pain, it must be done strategically to not further aggravate your muscle. Suddenly increasing your activity will do just that, especially if you have been sitting most of your day at work and already have been having piriformis pain.
“It’s all about strategy. Don’t go from 0-100%. You want to grade yourself back into a workout routine,” Rudd said.
Take running for example. If you go out to run after sitting for most of your day, Rudd told us that it is imperative to complete a proper warm up before the run and that it is extremely important to make sure you are supplementing your running with accessory muscle strength training, like core and glute work.
Across all sports or any type of exercise you enjoy the key to preventing piriformis pain from Rudd shared is: “Making sure to warm up, strengthening the proper muscles to help with preventing in sports-specific pain that can turn into injuries, and allowing proper time to recover. Hydration and getting adequate sleep are very important too.”
Identifying piriformis problems
Diagnosing a piriformis muscle injury can be very tricky because it’s in close proximity to the sciatic nerve. On top of that, there is no special test to determine that the piriformis is the root of the pain.
That’s why seeking professional help from someone who is both a physical therapist and a strength and conditioning specialist ideally, like Rudd is, is very important. You need someone who can distinguish between what your experiencing being muscle pain versus nerve pain.
“Knowing how the muscles work, attach to the body, and what their roles are with certain movements are key. And then, just knowing too what kind of pain it is. Is it a nerve pain? Is it a muscle pain? Is it an acute injury or a chronic injury?” Rudd explained. “When we know if it's acute or chronic, we can address it slightly differently and know what exercises activate what muscles.”
When someone comes in complaining of posterior hip pain, she always rules out if anything is going on locally in the lumbar spine—the vertebrae in your low back—because the sciatic nerve runs from L4 (the fourth lumbar vertebrae) down to S1 (the first vertebrae of the sacral spine).
It is ideal, she told us, to get professional help for your piriformis pain no more than 2-3 weeks after it started. She recommends absolutely not waiting any longer than 2-3 months to get checked out.
Prevention and management strategies
Prevention of piriformis pain and management of it focus on being strategies that involve balancing different forms of movement with your daily activities.
During work hours
Move regularly. It is very important for preventing piriformis pain and syndrome because it the mobility allows you to change position. You should aim to stand up from your desk every 20 minutes.
Engage in simple exercises and stretches at the office. Two easy, but effective stretches, are the:
Seated ankle over knee stretch – hold for 30 seconds on each side three times, twice a day
Standing small range squat- 10 times per set with three sets once or twice daily
Consider having an ergonomic desk setup. This includes a desk chair that supports your spine, making sure that your legs and feet have enough room under the desk, that the desk’s height allows your wrists to be straight, and that your computer monitor is arm’s length away.
There are good ways or ergonomically sound setups to help you reduce aches pains, reduce potential piriformis pain, and that is going to play a key role.
When starting a workout routine
Progress in your exercise intensity gradually
Focus on proper form and technique
Make sure to incorporate more than one specific piriformis stretch and exercises into your routine (*A great one is the pigeon pose used in yoga).
Elizabeth Rudd, PT, DPT, is the founder of Well EquiPT, an Atlanta-based practice that specializes in orthopeadic care through a unique blend of strength and conditioning, education, movement analysis, pain management and personalized physical therapy programming.
Dr. Rudd earned her degrees at and completed her training in physical therapy at Columbia University. She is a board-certified Orthopaedic Clinical Specialist who specializes in keeping active adults who feel compromised by pain, playing the sports and hobbies they love. Dr. Rudd aims to provide each of her patients with the knowledge and confidence they need to regain function and improve overall fitness.
Treatment approaches for existing issues
Having professional guidance in your recovery from a piriformis muscle problem is key for treatment to be effective and long lasting.
“A lot of people like to just crank on really tight muscles and stretch them to their capacity, but if you have an irritated muscle and you stretch into pain that typically is going to be counterproductive. As a PT and strength coach, I know to stretch the piriformis muscle gently because we want to gain some mobility, but we don’t want to aggravate it,” Rudd said.
In doing so, she applies physical therapy techniques, like muscle release methods and strengthening surrounding muscles to restabilize them to support the piriformis. This helps reduce pain.
Rudd also can tell her patients what specific exercises to do to achieve that strengthening and teaches them what proper form looks like during those exercises.
Long-term strategies for piriformis health
Whether or not you currently are injured, it’s crucial to think about piriformis health long term. As much as the muscles surrounding the piriformis need to be balanced, so too, do you need to balance desk work with regular physical activity.
When it comes to desk work remember that your movement habits are key to maintaining not only good but also proper posture.
“I would say the number one thing in my mind is just stand up. For 20 minutes stand up, and it will prevent anything that you are having,” Rudd said. “You want to get into the routine of sitting at your desk for 20 minutes and then standing up, doing a few squats, and then sitting back down throughout the day.”
Also, it’s important that you regularly do exercises targeting the piriformis muscle and hip health. Part of that is affected by doing regular physical activity outside the office and how you perform that.
Rudd recommends that you do a proper warm up and add proper strength training and cross training to you routine. Recovery is also key for the mitigating piriformis muscle pain. So, making sure you are getting sleep, nutrition, and hydration.
Achieving balance in modern work-life
In our world of computers, desk jobs are always going to be a mainstay of employment, but piriformis pain from sitting too much absolutely does not need to be.
“There are good ways or ergonomically sound setups to help you reduce aches pains, and reduce potential piriformis pain in your desk job, and that is going to play a role,” Rudd emphasized.
Remember these keys to managing piriformis muscle health and keeping you pain-free:
Get movement in throughout your workday
Make sure you have an ergonomic set up at work, especially with your desk chair
Engage in simple stretches at the office that are designed to target the piriformis muscle
Strengthen the muscles surrounding the piriformis as part of your workout routine
Make your transition to an active lifestyle at the gym after working a desk job all day safe and effective by doing a proper warm up beginning your exercise routine.
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