The poor piriformis muscle gets blamed for a lot of butt pain, especially in runners. Butt (see what I did there) it’s not usually the problem. Let’s dive into the anatomy of the butt and see what could be causing that glute pain and talk about some strategies like dry needling to fix it.
There are 6 muscles that rotate the hip
As you see in the picture above, the piriformis is just one muscle among many that have a similar action of rotating the hip. Like everything in our body, these muscles work together as a functional unit. So to think that only a piriformis becomes dysfunctional is a little silly and unrealistic.
The nerve anatomy of the glute region
As you can see, there’s a whole lot of nerves that are in the glute region. All of them can get irritated and cause pain. The piriformis is talked about so often because the sciatic nerve lies under it. One study found that the sciatic nerve pierces the piriformis in 17% of people. Realistically, that’s just not a big issue in most people. As you can see, the superior medial and inferior cluneal nerves, along with the superior and inferior gluteal, pudendal and posterior femoral cutaneous nerves lie in the same region.
In my clinical experience, when someone comes to me with “piriformis syndrome” it’s usually irritation of the medial and inferior cluneal nerves or the posterior femoral cutaneous nerve.
The only way to really differentiate this is to 1 be aware that these nerves even exist, that they can be irritated, then to perform a targeted hands on physical exam including Palpation of these nerves and finally to have an actual intervention that can help to calm these irritated nerves down.
You can’t mobilize or stretch all your pain away, it’s just not how pain works. Sometimes you need an actual intervention.
No amount of stretching or mobilization is going to calm down an irritated nerve. So stop looking for the perfect stretch or mobilization. These issues require an actual intervention and my favorite tool for these irritated nerves include Perineural Injections. By injecting a 5% solution of dextrose around these irritated nerves, we can instantly calm them down and reduce your pain. It’s the most effective treatment I’ve seen for “piriformis syndrome”
Stop listening to YouTube and Instagram gurus
If you want to get out of pain then go see a qualified practitioner who didn’t learn all of their tools from YouTube or Instagram. These issues require a good hands on exam and an actual intervention like perineural injections, dry needling or electro-acupuncture.
Get in touch your way
The most experienced and comprehensive Prolozone Treatment for Knee Pain can be found with Dr. Josh Hanson, DACM at Hanson Complete Wellness in Tampa, FL. Dr Hanson has performed over 30,000 procedures for the treatment of pain. Feel free to get in touch whatever way works best for you – Call or Text us at 813-534-0311, Fill out a Candidacy Form and Dr. Josh Hanson, DACM at Hanson Complete Wellness will call you to see if you’re a candidate or Book Your Visit Online Here.