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"This tiny muscle is a common cause of lower back pain (and you’re probably not even aware of it)

Posted by Naomi May . 27 SEP 2024

Struggling with a sharp lower back pain? Welcome to your piriformis. Most of us have never heard of the tiny muscle, but piriformis syndrome is super common and can cause all kinds of havoc. Here, writer Naomi May explores how – under the guidance of an osteopath – she managed to reverse her own piriformis trouble. 

Imagine a muscle the size of a pear having the power to totally debilitate you. It seems bizarre that something so small can have such a whole-body impact, but that’s exactly what piriformis syndrome can do. You may have never even heard of it, and if you don’t suffer from back issues, you’ve probably never felt it. But once that tiny muscle starts acting up, you can be in for a world of pain. 

During the first lockdown in 2020, I started to experience sharp stabbing pains in the base of my back. When these struck, I was barely able to move; I couldn’t just get up from my desk, I had to slowly rotate to ease out of my seat like a corkscrew. Three years on, I’m still dealing with the issue: the base of my back still throbs, aches and spasms almost every time I move. 

It was only after moaning about the situation recently to a family friend and former physio that I hit upon the cause. They told me that I was suffering from an acute case of piriformis syndrome. “My piri-what now?” I cried.

“The piriformis muscle is a small, deep muscle located in your bottom,” Anisha Joshi, principal osteopath at Osteo Allies, tells Strong Women. “And for some people, the sciatic nerve runs beneath or through the piriformis.”

Bingo. The pain was being caused by this hitherto unknown muscle pinging my sciatic nerve. We’re way more familiar with sciatica; it’s estimated that around 40% of Brits will suffer a bout at some point. Might some of that sciatic soreness actually be caused by the piriformis? That’s certainly been true in my case, so I’ve been spending the past few weeks trying to work out how I can fix my creaking lower back and get rid of chronic pain once and for all.

WHAT IS PIRIFORMIS SYNDROME?   
“Piriformis syndrome is a condition characterised by the irritation or inflammation of the sciatic nerve by the piriformis muscle,” Joshi explains. “If the piriformis muscle tightens or spasms, it can impinge on the sciatic nerve, leading to symptoms like one-sided back pain with referral down the leg.” After an examination of my back and general form, Joshi tells me that my piriformis is indeed weak and causing significant strain on the left-hand side of my lower back.

Rik Melling, a celebrity personal trainer and pilates instructor at Heartcore in Hampstead, explains that a weak piriformis is linked to weak glutes. The pain comes from the muscle hitting my sciatic nerve, and there’s no quick fix for stopping that from happening.

Now, you might be thinking that three years is a ridiculously long time to sit on a painful issue, but according to Joshi, many people are only just coming forward for help with lower back and hip pain. “[Post-pandemic], people realised that they hadn’t been looking after themselves as well as they could’ve been,” she says.

A glance online confirms this. #PiriformisSyndrome has been viewed more than 185 million times on TikTok and, according to Google Trends, searches for ‘piriformis massage’ have spiked by 100% in the past year alone.

The good news, the experts tell me, is that piriformis syndrome is curable. While there’s no way of immediately relieving the pain, Melling and Joshi explain that a cocktail of glute and core-strengthening workouts, sleep, nourishing food and time can make a significant difference.

WHAT DOES PIRIFORMIS SYNDROME FEEL LIKE?   
If you’re wondering if your back pain might be a piriformis issue, your best bet is to get checked out by a chiropractor, osteopath or your GP. In my case, the syndrome manifests as a sharp stabbing pain in the base of my lower back; it feels like I need to click something back into place. But, Joshi says, the issue can feel different for everyone – with pain severity spanning from a dull ache to a sharp, shooting sensation.

“Piriformis syndrome most commonly presents with pain, tingling or numbness in the lower back, bottom area that may radiate down the back of the leg. Patients often describe discomfort while sitting for extended periods, walking or climbing stairs,” she continues. 

HOW TO MANAGE PIRIFORMIS SYNDROME
On my first visit to her clinic, Joshi asks me if I exercise. I tell her that, although I love walking, I don’t really do much gym work and that structured workouts aren’t really a part of my life. That’s got to change, she insists.

“Core and hip strengthening exercises are going to be key to recovery,” she says, explaining that staying active in a way that strengthens and rebalances the body is crucial. The piriformis is supposed to be part of an ecosystem of muscles that support the movement of your glutes. When you’ve developed piriformis syndrome, however, the piriformis acts in isolation.

So it’s back to Heartcore’s St John’s Wood studio for my first session with Melling. We begin by foam rolling my lower back. 

“A foam roller is a really cost-effective and easy thing to buy,” he says, while noting that this session is designed to mobilise, strengthen and stretch my body. “Foam rolling is worth doing because it loosens tight muscles – including the piriformis.”
We then move onto a few single-leg and hip exercises, which burn like nothing else. “Your left side [where the piriformis syndrome is located] isn’t as strong as the right-hand side, which explains why the piriformis is flaring,” Melling explains. “It might be under an immense amount of stress as the glute on that side isn’t doing its job properly.” 

At the end of our session, Melling, who trained the actors on the set of Barbie, advises me to keep doing a few left-leg exercises every day to work on that lazy glute. On the days when I can’t make it to a pilates class or gym session, I’ve been doing leg rotations and lifts from the comfort of the sofa and balancing on my left leg while I brush my teeth (a move proven to improve longevity – a double win).

As well as committing to a regular strengthening regime (the more you strengthen a weak muscle, the more the supporting muscles are able to work effectively), I’m focusing on resting and eating well. 
I’ve learned that the long-term solution to my piriformis syndrome isn’t having Joshi click my back every day (the dream) or enjoying a PT session every week (who can afford it?). My overall lifestyle is in equal parts sedentary and chaotic, and that makes finding time to prioritise movement and deep rest difficult. You think you’re resting during the nine hours sat in front of a laptop, but true rest comes from a decent sleep regime and calming practices like yin yoga (great for stretching out hard-to-reach muscles).

After a few weeks of really focusing on improving my strength and balance, however, I’m already noticing a positive difference. It’ll take time but given that up until now I’d never really tried to forge a proper fitness regime or work out a solid bedtime, the progress made so far is encouraging. Armed with a few basic skills and a hefty dose of motivation, I’m now committed to prioritising my piriformis.

3 MOVES FOR BUILDING A STRONGER PIRIFORMIS
Give these simple exercises a go for better balance and strength.

SINGLE LEG DEADLIFT
Stand with your feet shoulder-width apart and hold a dumbbell in your right hand. Place your left hand on your hip or extend it out to your left.
Keeping your back straight, send your hips back, as though you are trying to get them to touch a wall behind you. Allow your arm to lower down towards your feet.

Make sure your hips stay in alignment by pushing your left hip forwards and engaging your core.
Press through your heels to come back to the starting position. 

SINGLE LEG GLUTE BRIDGE
Beginning in the same position as before, tuck your left knee in towards your chest and hold onto it with your right hand. Place your left hand behind your head.

Keeping your tailbone tucked, press through your right heel to lift into a bridge position. Remember to squeeze your glutes at the top.
Slowly lower back down. 

THREE-LEGGED DOG HIP CIRCLES
Standing with feet hip-width apart, bend from the hips and start to walk your hands forward.
With your bum in the air, hand flat on the floor, bend your right knee and raise into the air. 
Working from the hip, start to circle that knee in one direction and then reverse.
Bring that foot back onto the ground and repeat on the left hand side.  "