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.
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!
Thanks for the info., Doc… I refer my patients to your videos often. …a great service.
Awesome & thanks!
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.
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.
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?
Sure that’s okay – you’re working a trigger point with the ball. To see why I’m so against stretching read Stop Stretching!.
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.
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!
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?
A TENS unit may only help relieve pain, it doesn’t address or correct a problem.
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
I really doubt you’re the rare case for an orthotic. Your situation is nothing uncommon. Check out the SD Foot Video if you haven’t already – that’s where I discuss the peroneus longus and supination. You may need to start there to help the low back and hip problem. http://sock-doc.com/2012/05/foot-injuries/
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
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
I really can’t comment on if those are effective for you or not. If you feel benefit then sure they are, but if you have to keep going back again and again then you’re not addressing the problem. I discuss this more in this article: http://sock-doc.com/2012/04/trigger-point-therapy/
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!
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!
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!
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 ~
Pelvic imbalances can put strain on the perineum; not uncommon – affects the pubic bone.
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
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.
That’s a sad, but common story. Precisely the reason I wrote this: http://sock-doc.com/2013/02/recover-prevent-injuries/
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
This video: http://sock-doc.com/2013/01/hamstring-calf-glute-injuries/
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
Find a doc or therapist who can fully evaluate and treat you; that’s your best bet.
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.
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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!
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
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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.
Thanks Sock Doc! I’m currently boarding a plane to Taiwan. I’ll try that as soon as I can lay down!
Chris
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
That’s hard to say. It would be best to have that evaluated and assessed by a health care professional you trust.
I forgot to mention that I have MILD scoliosis as well. Can that causes imbalance muscles?
Thanks,
Leigh-Anne
Yes, but more often it’s the muscle imbalances that cause the scoliosis.
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.
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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?
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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
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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.
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