Sock Doc: Natural Treatment & Prevention of Piriformis Syndrome, Low Back Pain, & Sciatica

 

Video Transcript

Hey, this is Doctor Gangemi, The Sock Doc. In today’s Sock Doc video is on Piriformis syndrome, lower back issues, and sciatic type pain, or what many people perceive as sciatic type pain. Lara O’Brien who is a principal dancer with Carolina Ballet is going to be helping us out today, and we’re going to go through some of these common ailments and some things that you can do, hopefully at home or with a friend to alleviate some of the pain that you might be having.

First on sciatic nerve, let’s talk about that. Your sciatic nerve comes down the back of your thigh here and comes all the way down and exits the back of your knee, which is called the popliteal region, and then forms two common nerves, your common peroneal and your tibialis nerve.

Down here in the lower leg is where most of the people experience actually true sciatic type pain. This is where you might get some numbness, some tingling, some loss of feeling in your toes, your foot area, or your calf.

A lot of people think that this area, just because the sciatic nerve comes down through here and in your glute region is actually sciatic type pain, but it’s actually usually not that. It’s called sclerotogenous type pain. What pain in this region is, this sclerotogenous pain, is a referred pain from other areas, other areas of tissue, most common muscles, ligaments, and tendons. Or it can even be a direct tightness of the hamstring muscle, or even your glute max which we’re going to talk about in a minute.

Sciatica is a symptom most often misdiagnosed, but when the sciatic nerve is even pinched up in the lower back region here, it could be from a disc issue, it could be from some arthritis, or it could be from some muscle imbalance, some instability of your bio mechanics of your pelvis that’s impairing the sciatic nerve, putting some pressure on it, resulting in pressure all the way down and causing numbness, or pain, or discomfort in the foot. However, you end up dealing with the issue way up here where the sciatic nerve originates, or starts to come together from the nerves of the lower back and the sacral region.

The most common muscle is your piriformis. The piriformis muscle comes off of the front part of your sacrum actually, tucked in on the side here, and then comes to the outside of your hip here. That piriformis muscle like this, you can turn around, does two things: It turns your foot out, and it brings your leg up and elevates it, which you can do that on both sides. You can see they’re pretty symmetrical. Someone with pretty bad piriformis syndrome, or pain in their piriformis is, first of all, they’re going to feel pain deep in their butt region, in the glute, especially right here on the side, and they’re going to have some imbalance or pain doing that motion from side to side.

The sciatic nerve, pretty much in most people, 80 percent data said, the sciatic nerve comes below your piriformis muscle. In about 20 percent of people, the sciatic nerve actually goes through that piriformis muscle. If you had an injury to your piriformis muscle resulting in imbalance, or resulting in a hip rotation issue, then that can put pressure on that sciatic nerve and cause pain in your foot.

I’m going to show you in a minute how to deal with that sciatic nerve, but the other muscle we’re going to talk about real quick for a second is the glute max. Your glute max as I talked about in the ITB syndrome, iliotibial band video, is that big hip extensor muscle that comes, actually, all the way down into your thigh here and joins with your tensor fasciae latae to make up your iliotibial band. Most people think of their glute max, or butt muscle, just as this area right here but you’ve actually got to think all the way down here. Glute issues which have to do with extension, a lot of times will cause an imbalance of the lower back, obviously cause a person to have lower back problems and result in hip pain and lower back pain, that sort of thing.

Piriformis issues are going to do more left and right problems. Piriformis, which come off the side of your pelvis, those are major sacral stabilizers. Having a piriformis imbalance will actually cause pain anywhere up your spine since it’s sort of like the base of your spine, like the pyramid, the foundation to your spine. You can get pain all the way up in your neck. People get shoulder problems. People get headaches from actually their piriformis being aggravated on the one side rather than the other. That will cause your sacrum to rotate one side to the other, or your pelvis, where glute max issues will cause your pelvis to rotate forwards and backwards rather than side to side like the sacrum. We’re going to think about those two things when we talk about the stability of the pelvis.

With the piriformis here, as the piriformis comes out to the side and attaches to the top of the thigh muscle here, the greater trochanter, typically there’s going to be a trigger point somewhere in there. Trigger points are these points we’ve talked about in other videos where you’re just going to hold that or have someone hold it for you, and any sore spot you basically hold, rub it out. If you have trouble getting in there, if your hands aren’t strong enough for your partner that you’re doing this with, some people like to use their elbow, and you can come in like this. You’re kind of scooping the glute muscle out of the way a little bit and pulling it towards you to hold that in there. That’s one thing with the piriformis.

One other thing as I’m thinking about it to mention here is if the piriformis is painful on one side, you always want to check the other side because a lot of times what happens is it’s the weakness on the one side, the muscle that is not functioning well that is actually the side of the problem, where the other side is going to spasm to try and balance the sacrum from left to right. She might have a lot of pain, say standing, and doing that hip rotation, or leg rotation on side to side, she might do worse on the right, but the problem could actually be on the left hand side.

Now with the glute max, a simple test you can do on your own is to elevate each leg. Lift this leg up as high as you can, Lara. You can see she can lift about to right here on this right side, and then switch to the left. She’s about there, about the same on the other side. They’re not going to be maybe exactly symmetrical, but if this leg, say, only came up to here and then she raised this leg and it went way up, then that would be obviously something typically going wrong on that, the right side, if there was a constriction or a weakness, some muscular inhibition on that glute max. We’re going to look for trigger points in that area to see where we can alleviate some of the imbalance of that muscle. Again recognizing that that glute max comes all the way down and intertwines and forms that iliotibial band, so what someone might perceive as hamstring pain could actually be glute max pain. You can stand back up.

I would say I see a lot more glute max issues because it’s such a powerful muscle and such a powerful mobilizer with the hip rather than hamstring issues, even though someone thinks that they’re having hamstring issue problem. Another major action of the glute max muscle is squatting and climbing stairs, so many people that have knee pain or hip pain while you’re climbing stairs or squatting down, think more your glute max, even though a lot of people like to think of their thighs. That’s what we’re going to do to start to stabilize the pelvis there and look for imbalances in the piriformis and the glute max.

One other thing to mention quickly is the role of vitamin E in the pelvic stabilizer muscle, the piriformis and the glute max. That doesn’t mean go out and buy vitamin E right away. But some people, especially women, have vitamin E imbalances and they’re lacking the vitamin of the natural vitamin E found in wheat germ oil, found in nuts like hazelnuts and almonds, and that helps basically balance hormones in your body. Hormone imbalances will cause pelvic imbalance problems in women as well as guys, too.

There’s a link between the prostate and vitamin E imbalances, and prostate and hip problems. With women, uterine and ovarian problems, and hip problems. That’s why a lot of women who have PMS or hormonal issues also have hip pain. It could be a direct muscular imbalance. It could also be a vitamin E problem. Sometimes taking the natural oils of wheat germ oil, unrefined and organic, can do wonders for you as well as taking a little vitamin E. I typically don’t use too high of a dose but around 50 to 100 IU’s of natural mixed tocopherols. That’s the natural tocopherols and the tocotrienols that can help with your pelvic imbalances.

Two other things we’re going to talk about real quick to help with stabilizing the lower back, and therefore piriformis issues and the pelvic issues as well as what one might perceive as sciatic type pain are the psoas muscles which do this, bring your leg up and out and flex it, and again on the left. This would give you more pain doing that from left to right, or just bending forward as if you were touching your toes. A lot of times if someone’s feeling, even though you might feel back pain as you go and do that, it’s actually coming from the front.

Now we’re going to talk about a couple things that actually cause you to get back pain even though they’re actually front problems. So you can lie on your back again. If you ever feel pain while you’re lying on your back, supine, or especially as you sit up. If she was to experience pain in her lower back right now that’s usually going to be from the abdominal muscles, including the abdominal obliques, or the psoas muscles which help to hold her leg like that. If you can’t hold your leg up like that then you most likely have a psoas imbalance, that would be the same on either side.

The psoas muscles are your powerful hip flexors as you can see, and they actually originate mostly from the front of your lumbar spine. That’s the front. They’re very hard to get to. Then they come down and they wrap around and attach to the inside of the leg, allowing someone to flex the hip.

A couple things we’re going to do for this is to have her touch and put a little bit of deep pressure, even though she can’t get directly on top of her lumbar spine, to put pressure on one side, if she was to have lower back pain right now, to put pressure on that psoas muscle, and then she would sit up again, and lie back down. Obviously this is assuming that she could sit up because sometimes someone’s lower back pain is so bad that they can’t sit up at all. If she was able to sit up easier by doing that, we would look for corresponding trigger points in that area and then again would switch and check out the right side too, the opposite side. We’re always checking both sides.

We’re going about an inch over, and a couple inches up and down on the side of the naval on either side, so like here, here and here, and that would look like that. If that didn’t help she could go a little bit lower and then check a couple on the opposite side, and she would sit up each time. Or if she had someone like me doing that with her, or a friend, I could hold this and you would sit up, and if it felt any better to her lower back, then we would look for areas to treat in there.

Again, just rubbing slight pressure. Have got to be careful in here. There’s obviously digestive organs, there’s an abdominal aorta in there, so you have to be careful and don’t just be poking away. Usually it’s pretty tender if someone’s lower back is hurting from a psoas problem.

Obviously, the other muscles here are your abdominals, your rectus abdominis and your obliques, and sometimes you’ll have trigger points or sore spots on the side here, right where they start to attach on the top of your ilium. One thing she could do there is put her hands here on the side of the pelvis, see if there’s any tender spots, or I could do that for her, and she could sit up again and see if there’s any pain in there.

One thing you’ll notice too is if someone has pain while they’re sitting up, usually they’ll twist from one side to the other, indicating that there’s imbalance on one side. You don’t always know that that’s the side of the problem it’s on because you could be twisting away from the pain, or you could be twisting towards the pain depending on what’s going on in that area. A weakness in that psoas muscle or imbalance of the psoas muscles from left to right as well as the abdominal muscles will obviously put a lot of stress on the lower back. It’s one of the reasons why people get sway back.

You think of like a pregnant woman or a person with a belly. Then they put a lot of pressure on their lower back, causing a lot of disdegenerations, causing a lot of arthritis and lower back problems which then in turn can cause sciatic type pain and influence that sciatic nerve and cause pain all the way into the foot, numbness pain or similar issues. Even though it’s coming from way up here, an imbalance of those hip flexors, an imbalance of the abdominal muscles, or the glute max, or obviously the piriformis. Those are the four muscles that we’re going to think about for lower back issues, or any disc displacements, or what might be perceived as sciatic type pain.

In terms of exercise and therapies for these sorts of things after you’re working out the trigger point, if they continue to come back, it’s the same thing that I’ve always said. No orthotics because you’re trying to work the muscles to their fullest by being barefoot and feeling the ground and using the muscles the way they’re intended to be, not by some false supportive device. So you’re going barefoot and not wearing any orthotics or trying to wean yourself off those orthotics and wearing minimalist type shoes whenever you can.

Of course, you’re not stretching these things because whenever you stretch a muscle that’s been injured or strained, you’re further elongating those muscles and you’re not going to feel it. We don’t stretch our psoas muscles, we definitely don’t stretch our piriformis muscles like a lot of people like to do, like bring these over and trying to stretch the hip.

It’s just going to further irritate the back muscle and if you have a sciatic issue, especially if you’re one of those people your sciatic nerve goes through your piriformis, it’s just going to cause more problems over time.

By walking, running, dancing for her, or doing your normal daily activities, that will help to rehab those muscles once they’re actually functioning normal. Consider vitamin E, and especially fatty acids too, that help fight inflammation like fish oils and others, nuts, seeds, flax oil, that sort of thing in those beneficial categories.

That should do it. Thanks.

 

In this video I discuss piriformis syndrome, low back pain, and “sciatic pain”, which is often not true sciatica, but another type of pain known as sclerotenogeous pain. Many athletes suffer from hip pain and back pain. Hip flexion problems are very common in runners and those who use their bodies to jump and kick. Extension-type pains can be an issue with these athletes too, and especially with cyclists.

Your sciatic nerve is a thick nerve originating from many fibers in the lower back and sacral area. Actually it’s the sensations in the lower leg & foot – weakness, pain, numbness – that are typically true signs of “sciatica” symptoms as the sciatic nerve comes out from behind the knee and branches out into the tibial nerve and common peroneal nerve where they supply movement and sensations to much of the lower leg and foot. Pain above the knee – usually referred to as sclerotenogeous type pain – is pain originating from a muscle, tendon, or ligament. That is usually what is causing pain in the lower back and hamstring/thigh area, if not a local muscle or tendon strain.

Though there may be disc involvement as well as other nerve related problems, (other than sciatica), most lower back, thigh pain, and hip pain is from muscular imbalances as well as inflammation in the body. This is a common terminology problem even in the medical arena. That deep, gnawing unrelenting pain is from sclerotomal distribution which arises from connective tissue above the knee. The type of sensation that is associated with nerve compression or nerve root compression is typically not pain, but rather decreased transmission resulting in decreased sensation resulting in numbness or paresthesia – and that is only below the knee with respect to the sciatic nerve.

The muscles discussed in this video have significant involvement in the stability, strength, and movement of the lower back, hip, and legs.

Piriformis – this muscle  extends from under the front side of the sacrum and attaches to the greater trochanter in the upper leg. The major action is to laterally rotate the hip as well as turn the foot out. The sciatic nerve actually comes out right under the piriformis, but in 15-20% of people, it goes through it. “Piriformis syndrome” irritates the sciatic nerve. An imbalance in the muscle often causes pain and  can cause the foot to turn outwards. Since the pirformis muscles stabilize the sacrum and therefore the base of the entire spine a person can have pain all the way up to their neck or down to their foot from a piriformis issue.

Gluteus maximus – this powerful muscle extends the hip and rotates the thigh laterally a bit too,  just like piriformis. Many people think they’re having hamstring pain or hip pain from a bad disc, when really it’s because they have a glut max that isn’t functioning properly. Also, a lot of knee pain is because of a strained glut max. This muscle also makes up a significant amount of the ITB – another common injury I discuss here.

On the front side of the body are the  psoas and abdominals muscles and they are often involved in low back pain, hip pain, sciatica, and disc problems. Leg flexion, hip rotation, and the ability to reach down and touch your toes is made possible by the action of these two muscles. So pain performing these movements means that they are not working correctly. Can’t sit up because of pain or weakness from laying on your back? Pain putting on your shoes or flexing forward to pick something off the ground? Pain running, jumping, or kicking? Psoas and abdominal involvement.

No stretching! No orthotics!

Enjoy the video and check out the other Sock Doc videos as well!

Comments

  1. Josh Stevens says:

    Thanks for the info., Doc… I refer my patients to your videos often. …a great service.

  2. I am a “recreational” runner (barefoot/minimalist). I have some forefoot numbness (sometimes pain) and also some tightness/pain in my calf muscle (left leg/foot only). I also rarely get some pain in my left hip (only if I do certain activities that aggravate it). In the video, you seemed to say that this could be due to a sciatic nerve problem. Is that correct? If so, can you recommend a treatment for this?

    • Hi Joe, yes that could be a sciatic symptom, or a local issue. If it’s sciatic, follow the advice I show in this video. If it’s more local, check out the other videos – such as plantar fasciitis and Achilles tendonitis, they should help you out.

  3. 2coldhere says:

    I have been diagnosed with piriformis synrome and also two herniated discs pt tells me the pain is from the muscle not the discs he tested me. I do have pain in my hip and in my calf and my ankle and foot not really numb, aches mostley in my calf pain so bad in my hip I can hardly stand for my shower in the morning.

    • A lot of times you’re not going to feel the actual pain in the herniated discs. It’s the muscles that control the biomechanics. Muscle imbalances = arthritis, herniated discs, muscle spasms, pain. You can either come see the Sock Doc or send me an email and I can see if I know anyone close to you.

  4. Chin Gan says:

    Dear Dr. Gangemi

    I am confused. My physiotherapist and most other sources of information advocate stretching however you appear to be very much against it. Can you explain the opposite views? I use a tennis ball to pressurise the painful point. Is that ok?

  5. Shane Magnan says:

    Hi Sock Doc,

    I am a 33 year old, otherwise healthy and fit male that has been suffering from pain in my lower back (minimal and occasional), my glute area (painful and constant) and hamstring area for about 4 years.  I just watched your video on pain in this area and heard a lot of things that I have never heard before from many doctors and heard contradictions from what they have been telling me.  I have had no pain relief from about 3 months of physical therapy (who told me to do the stretch of the piriformis as you demonstrated not to), 4 steroid injections (2 in my piriformis muscle, 1 in my SI joint, and 1 in my lower back) of which none of them provided any significant relief.  I have been to 2 different types of chiropractor, and had acupuncture multiple times.

    The pain severity differs from day to day, but is always present.  I am a recreational runner (I wear only minamalist shoes) and am severely hampered by the constant pain.  It is too uncomfortable to run for any distance unless I take Tylenol beforehand now.  I recently have also had pain in my right outer knee which I have attempted to self diagnose as ITBS and feel it is likely related to everything else that is going on throughout my right side.

    While watching your video, I can tell you that I got squeemish even watching the young lady sit up straight from a lying position.  I can not even come close to touching my toes, and it is painful enough just to lie on my back, much less lift my right leg up in the air.  While sitting in a chair, I can not straighten my right leg even a little bit!  Until watching this, even after 4 years of visiting doctors, physical therapists, etc., I had never even heard of the psoas muscle, nor has anyone ever said it could be coming from my abdominal area.

    PLEASE help me figure out who I can go see or what I should do to treat this!  I am so sick of attempting to be active and taking care of my body when I am in so much pain!  I live in northern Vermont and I can’t seem to find or get referred to anyone that doesn’t want me to stretch, stick needles in me (with or without drugs) or cut me open!

    Thank you so much for your site and the help you are giving people.  Any help would be appreciated.

    Sincerely,

    Shane Magnan

    • Hi Shane – well your story is typical unfortunately. Even 4 weeks would be a long time to have pain like this let alone 4 years. You mention you watched the video but it doesn’t sound like you’ve tried anything I suggest. Correct, or not? You might want to try a deep tissue massage therapist or a rolfer who really understands these muscles. But it could be coming from other areas of your body too. Sorry I don’t know anyone in VT to refer you to, I just saw a VT woman with another problem who couldn’t find a good doc either.

      • Shane Magnan says:

        Actually, based on your video, I did some research on the psoas muscle. What I found is basically just what you said, which is to go to a deep tissue massage therapist and I already made an appointment for Wednesday. I’ll let you know how it goes. Thanks!

      • Shane Magnan says:

        Sorry, one last question, do you recommend using a TENS unit on my back/glut/hamstring/knee? Would it help or hurt my knee if it’s indeed ITBS?

  6. Hi Soc Doc,love your site and great videos!

    i would like to know your experience with unilateral supination causng hip rotation/back pain?i ask because i have recently seen a podiatrist and physiotherapist and both have recommended orthotics which obviusly i would rather avoid.i do daily smr and have been working on strengthening my ankle to improve stability but I’m wandering if I’m one of the rare cases that actually would benefit from an orhotic.I’m a keen runner and weight lifter but have to constantly stop due to picking up overuse injury’s to my knee and low back/hip after a few weeks and particularly get a lot of trigger points/tightness in my right glute medius/tfl/itb area .Ive stopped training now for about 2 months but I’m still active daily and do a lot of walking and stability type exercises. I’m also working on strengthening my glutes but I’m struggling to get my supinated foot side to fire properly and get a lot of hamstring cramping.is there anything else i could do?
    thanks David

  7. Dr. Gangemi,

    Man, you’ve done it again! I’ve had nagging pain in my left lateral forefoot for a LONG time and pain in my first toe on my right foot (with numbness). Lots of $$$ spent on docs and MRI’s trying to figure it out—to no avail. Plus, some nagging hamstring pain—but no hamstring fascia issues… Hmm…

    Turns out that my butt is full of trigger points (piriformis and glutes). After an agonizing meeting with a lacrosse ball (a home-made myorope of torture), my foot pain is 90% gone and my hamstring pain is vanished.

    Thanks so much for your service here. Really helps a lot.

    Mike

  8. Brandon says:

    Hi Sock Doc,

    Great reading! I wanted to know your thoughts on an issue I’ve been dealing with for over a year now.
    My left hip is tilted higher than my right which is causing pain in my lower back, hips, on buttox area, and sometimes my left calf aches at night. Because of this my right leg is shorter than my left which causes me to walk “limpy.” I have seen sports therapist, chiropractors, and accupuncturists and they all tell me it’s my left lower back that’s weak and my muscles are pulling my pelvis out of place.
    I’ve been told to stretch my hamstrings but left hip area starts to get painful when attempting. After reading your article on reasons not to stretch it makes sense. Recently, I started doing hip abductor excersises to help pull my hip/pelvis back into place.

    What would you advise? I’ve taken an x ray and was told my spine and other bones look fine.
    I’m 33 workout about 2-3 times a week which consist of stationary bike riding, light machine workouts, and swimming. My sports therapist seem to have best results. He stretches/massages muscles around both legs, back, ribs, shoulders, etc. He then advises me to lay on a long round foam directly on my spine, knees bent and shift my legs from left to right until the side of my knees flex enough to touch the ground. He also told me to hang from from pull up bars and sit on half circle arch and shift my hips from left to right.

    Please advise me if the treatments I’m getting are affective enough to continue and what treatment you suggest. I live in Los Angeles.

    Thanks!
    Brandon

  9. Dear Sock doc,
    Thanks for the great video.
    I am a runner, suffering from piriformis (or so I am told) and nerve pain in my left upper leg and butt. I have been treated by a fysiotherapist and an osteopath with no significant result. I saw your video and according to the test you do there, it is my gluteus maximus rather than the piriformis that is affected. I have no problems with the side-way move, but I do have pain and difficulties lifting my left leg when laying on my stomach. On the other hand, I do feel nerve pain. Could both muscles be affected? On the video you do not really show where the trigger points for the glute are or what one can do against this injury. Can you give me any tips?
    Nb. I am a woman of 46 and also heard your remark about hormonal imbalances and vitamin E. I will try give those a try too.
    Thanks, Lieve

    • Trigger points for the glut max are down the back of the thigh – I show them where it says “your butt is bigger than what you think”. It is also in the ITB Video. And yes, you can always have more than one problem or muscle affected!

  10. Hello – I was watching your youtube video regarding the piriformis muscle! Great information, it’s basically describing all my issues! I’ve been having issues with my back and left leg for 7+ months and have gone to several docs, physical therapist, mri scan, and epidurals! Long story short, I came to find out it is my piriformis muscle and everything else you described on your video! I need to make progress and recover – 7 months of pain and it has been tough! One question – how can I strengthen my muscles to become more in sync and start to feel relief? Physical therapy continue to have me stretch, but I feel I’m irritating the muscle! I’m in desperate help!
    Thanks!

    • Well if you’re making no progress and the stretching makes you worse then why do you continue with that therapy?
      How do you strengthen the muscles and get relief? – you try the stuff I show in the video!

  11. Hi,

    I have found your website very helpful and referred it to my chiropractor to have a look….he seems to disagree with your theories on orthodics and stretching. None the less since May I have been slowly trying to ween myself off off my orthopedic shoes and inserts and going barefoot as much as possible. I have purchased a pair of transition saucony runners as well as a pair of Altra Delilah zero drop minimalist shoes and I alternate between the two using the more supportive ones for longer runs and the minimalist ones for walks and short runs.

    Last Tuesday I started to get some low back pain after a night in the hospital with my four year old and a morning power nursing my 16 month old in a chair in the living room. By late afternoon I noticed that my low back was a little tight and by the evening it was very sore, causing real discomfort sitting and standing, picking up the baby, going up stairs, etc.

    I went to my chiropractor Thursday, and Friday but am still in quite a bit of pain and seems to getting worse. I have noticed that there is a spot by my pelvic cradle on the right side that is extremely tender…sharp burning feeling when I sit up or pic up the baby, as well as a spot on my left hip. My gluts are feeling sore and fatigued as well. I have been trying to keep moving going for daily walks but today every step seems to hurt. I am a homeschooling mom of seven and we are getting ready to start our school year and I am very concerned that my energy levels are being drained from all the pain. I do not take any pain meds and am not open to doing so. I need some advice on what to do. I have tried the pressure point suggestions from your video daily and and though it seems to help while I am doing it once I stop and move the pain comes back.

    I hope you can stear me in the right direction.

    Dominique

    • The direction I’d steer you in here is to find a new chiropractor. Why would you want to go to one who thinks orthotics and stretching is the way to go and he is not helping you anyway. – It’s getting worse after back-to-back treatments there so you need another perspective.

      BTW – these aren’t my “theories.” He might want to check some of the research regarding orthotics and stretching. Chiropractors who tout themselves as “holistic” and “treating the cause and not the symptom” yet use orthotics are misguided, misinformed, and typically very ineffective.

      • Thanks for the advice. I will be seeing a different chiropractor tomorrow, God willing she is available and can take me. I finally filled a hot water bottle and stuck in my skirt up against my back in desperation and that seemed to loosen things a bit. So went for a walk and by the end of it my back was very painful again. I am very frustrated. What kinds of things should I expect from a chiropractor as far as treatment goes for this kind of pain? I am particularly concerned about the pain down around my pelvis.

        • All chiropractors will have a different approach. Basically you’re looking for someone who will listen to you, understand your problems, and help get you better. Good luck!

  12. Any ideas as to why I have the pain in the perineum in addition to the periformis syndrome.
    Sitting feel like I am sitting on my pelvic bone ~

  13. Hello doctor
    I’ve been struggling for 3 months for what I thought was piriformis syndrome . I had gone to to a chiropractor yet it was not until I watched your video that I was able to confirm that I had piriformis syndrome .Everything that you pointed out was exactly what I had . I stopped going to the chiropractor because he never told me exactly what I had after 5 sessions. Yet still wanted me to jump into a 2,000.00 dollar plan for more sessions so I refused . The pain is greater now when I sit or stand and now I’m starting to get discomfort in one knee. I don’t have insurance and with a million chiropractors here in Chicago I really can’t afford trial and error with all these chiropractors .Do you know anybody in the Chicago area with your type of approach you can recommend. if not do you recommend I just go get a deep tissue massage and try to strengthen the weak areas by myself ? Thank you again and God bless you?
    P.s I haven’t been wearing socks at work giving it a shot

  14. Audrey Dunton says:

    I just watched your video and it was as if you’d made the video just for me. 6 years ago I slipped and fell on my buttocks down 4 wet stairs. since then I have been to two Chiropractors, had accupuncture, and bone manipulation.nothing worked. I then went to a n Orthopedic Surgeon who told me it was my Piriformis, he prescribed an MRI after that I had 4 Branch Blocks, 1 Nerve burning procedure, 3 months of Physical Therapy for my Piriformis. the Nerve Burning took the pain away and lasted for 1 year then came back. 1More MRI,He then did 1 more branch block, and a Radio Frequency Ablation. The RFA didn’t work. He then gave me a Cortisone Shot, followed by an Epidural. the Epidural worked for a few days, and the pain came back. I am at my wits end. Then I saw your Video on UTube. and knew that for some reason YOU hit the nail on the head. I will stop doing the Piriformis stretches and take the orthodics out of my shoes. I am away from home right now, and when I get back my Dr said he will do another Epidural. Now I’m not sure if I should have it done. what else can I do. i am tired of all the pain. which goes from my lower back ( or the right side) down my leg into the top of my foot. it is worse when I lie down in bed and when I first stand up, and seems to go away when I walk, so I do a lot of walking these days, during the night too, just to ease the pain.

  15. Doc,
    I heard much about trigger points, I have been using a tennis ball and foam roller, but don’t recall hearing about any exercises. Can you recommend specific exercises for the siutations you discuss? Thanks

  16. paul hepburn says:

    hi dock , i need your help .im a footballer that has had a few injurys over the years. when iam playing my hamstring starts to tighten on my left , also if i run very intense for the 90 minutes i end up with stomach cramps both sides of my stomach , also when i lie on my stomach on a masssage table and the massure pushes on my back i can feel pain at the from of my stomach deep on both sides like its my psoas .if i lay on my stomach for a long time ,i find it very hard to get up as my back seizes up .i also feel that my groins are tight when i try to stretch them . also when i warm up and stretch my groin by standing raisng my knee and swing . i feel a click feeling at the top of my spine. aslo when i run or walk my left hamstring gets instantly tighter . i did have a side impact collision 2 years ago and really hurted my shoulder and i also had a bad groing strain back then and this is when it seemed to have all started from ,i have had mri,xrays ,ct scans and all come back clear ,and spent thousands on physios .chiros, deep muscle massages ,seems as if something is tight and not letting go .please help

  17. Dear Doctor, I love your website. I have had right hip pain as a result of repetitive strains. The orthopaedist and physio keep asking me to stretch those muscles. That always makes my problem much worse, and it has gotten to the point where my body has developed a left leaning list. Since the muscles in my hip area are tender, and contracted, it is very easy for me to further strain those fragile tissues. I cannot walk much and the repetitive strains are making me weaker and prolonging recovery. This is quite depressing. I was wondering if you had any tips for me as to how I should proceed and how I can avoid further injury and start healing. I can walk a little but my employers and doctors etc always ask me to do more than I can and I find the strain gets much worse. Please advise.

  18. Thank you! Thank you! Thank you! Last sunday I was struck by L upper leg pain going from my buttocks to my inner arch.. I hadn’t done anything to cause such a sudden onset of pain. I couldn’t sit or lay down. The pain was 9 out of 10! I have given birth to 3 kids with no pain meds and I can say this was worse. As a nurse practitioner and yogi I had to self diagnose….I went my physician and talked to colleagues who all insisted I have a herniated disk or lumbar nerve impingement! I was sent to xray and MRI. But how could I have disc issues if I had NO back pain, could touch my toes! It made no sense. Having practiced yoga I was aware of the psoas and piriformus and knew that when overstretched you could cause pain…so I googled piriformus and psoas pain–and Voila! your video! I watched and had my husband help with the trigger points followed by ice. I woke up this morning with NO pain…I am amazed. I now realize I had imbalance on my R side that effected by Left. Thank you for this great information. I intend to educate any patients that I have about trigger points and will refer them to your website!

  19. Vijay Singh says:

    Hello Doc:
    I have been sitting at desk all day in office for last few years. Had back pain last year which went away with help of medications in few weeks.
    it again came back this winter. And during the pain and medications I had to lift my right leg up to climb a wall. It has been 3 months now and i get intense pain during standing and walking. Visit to physiotherapist results in aggravated pain. Waiting for an MRI.
    Just wanted to know what is it and should i avoid streching and walking? When I lie down on floor, my right foot remains more upright than left. Is it unbalance issue?
    Thanks
    Vijay

  20. Sock Doc,

    Thanks for the great video! At 8:30 you do a test where you flex the leg and turn it outwards. What if this test causes pain at the front of the hip and into the abdomen (what most would call a hip flexor). I’ve been getting pain here cycling bending over or simply flexing the hip. External hip rotation seems to worsen the issue.

    Thanks,

    Chris

    • Most likely that is a problem with your psoas muscles. The side where you’re feeling pain could be from the other side being weak and the painful side over-working. So check for trigger points in each psoas like I show in the video. If you’re on the right spot then you should be able to hold the muscle point and see reduction in your pain.

  21. Thanks Sock Doc! I’m currently boarding a plane to Taiwan. I’ll try that as soon as I can lay down!

    Chris

  22. Whoever says:

    Hi,

    I’m 46 year old and I have a mixed athetoid cerebral palsy. I used to sleep on my stomach for very long time with NO back and hip pain. I sit in my wheelchair about 8 to 12 hours a day. Now, when I sleep on my stomach for very long time, I get tingling pain from my lower right back, upper hip and down to my thigh (outer side).

    I turn over on my stomach after I lay on my left side for awhile. Three years ago, I found out that I developed an osteopenia in my spine and osteoporosis in my left hip.

    Can sitting all day long on a Jay Curshion (http://bit.ly/18Gq6LO) cause this pain at night when I’m on my stomach?

    Please advise.

    Thank you,
    Leigh-Anne

  23. Hello Sock Doc

    I’ve had a recent Piriformis injury on my rt side. It was pinching the sciatic nerve and once I got a deep tissue massage, it quickly felt better, however, I still have pain in my calf muscle and cannot plantar flex on it at all. Is this normal? Should I not do any activity at all until it heals? Extremely frusterating. Thanks.

  24. Phyllis Jansen says:

    I am having severe pain from my right butt down to my ankle for the past 6 months. Physio was mostly stretching and that didn’t help so now I am going for cold laser and deep massage twice a week. After 5 treatments there is no change. The pain in my ankle is almost unbearable at times. It is like a bad tooth ache, less at times and more severe at other times. Pain in my right butt and on the outside of my thigh down the outside of my leg.

    I enjoyed your video, I will stop the stretching as it is not helping my pain.

    I am being told not to get discouraged but I am. What do you suggest?

  25. Hello Sock Doc,

    I’ve been having pain in my hips, lower back and low in the but area, even the front off my hips hurt. I’ve had a number of MRI’s and the see no pinched nerves. They are extremely sore on the side down in my butt area, Both sides. Now my skin hurts to the touch on my right lower back….like a sunburn that isn’t there. its also moved to my front, to the right of my belly button. Is there anything you could tell me to help….Please

  26. I’ve had severe pain in my right groin for months, along with hip problems. I had a hip replacement in Jan but the groin pain continues. It’s really bad when I bend, when I’ve been sitting and then stand, it takes several steps before the pain eases but doesn’t leave. I can’t lay down without being awakened with severe pain in my same hip and buttocks. Please help, I get no more than three to four broken hours of sleep a night.

  27. Doc,

    I intend to go through your site at length tonight but was hoping you could help. Going on 9 years of pain in left sciatic region, middle of lh leg goes numb if standing(2 major accidents 5-7 years prior to start of pain). Left neck always tight. Spine was really skewed for the first 7 of 9 yrs and through stretching and yoga have it close to normal and pain is better. NO DOC has an answer and I have seen them all.

    Biggest symptom now is, if sitting or standing and I bend and twist to the left I hear/feel multiple pops in that left sciatic region. For the last two years I thought it was two tight and really pushed it in yoga making it pop all the time with no real improvement. My symmetry is better but that problem area remains(neck too). Last week I got an injection in the sciatic joint and the pain is 90% gone but the instability remains. So is it too loose or too tight? I’m guessing tight but I have rolled a lacrosse ball across every tight muscle to no avail. Actually, that helped a lot but did not solve issue. I would welcome your feedback.

  28. Desiree says:

    I’m confused with the last sentence of this article. Is it telling us to not stretch? and to not use orthotics? I thought we are supposed to stretch out these muscles…

  29. I have all the same symptoms ect and same stories as most people

    just to clarify Yoga is stretching and and I should avoid stretching.