Piriformis Syndrome – Pain in the butt

Piriformis Syndrome

Pain in the butt is a commonly used idiom, but it actually can be a real pain to many as piriformis syndrome. It is commonly seen in people who spend long hours sitting, such as desk bound jobs, long distance driving or riding a motor bike. Many long distance runners, cyclists, and skiers are at a high risk of getting Piriformis Syndrome as well. Symptoms are usually unilateral and are present as pain in the buttock or hamstring area. Affected side may experience neurogenic (nerve related) symptoms such as pins and needles, loss of sensation and weakness down the limb. Symptoms generally get worse with sitting or activities involving running. Many patients also report a feeling of a pebble under the affected buttock while sitting.piriformis-syndrome

Piriformis muscle is found deep under the big gluteal muscles. It runs across the pelvis area outwards and attaches to the femur (thigh bone). It serves as a rotator of the hip joint. It is an external rotator when the hip is extended and an internal rotator when the hip is flexed. Piriformis is very closely related to the sciatic nerve which runs down the leg from the lower back area. Piriformis muscle sits across and over sciatic nerve. In certain people, the sciatic nerve actually passes through the piriformis muscle itself. Any injury, irritation or tightness to the muscle may irritate the sciatic nerve and lead to neurogenic symptoms down the limb.



  • Injury to the muscle – from a fall
  • Limb length discrepancy
  • Jobs involving prolonged sitting
  • Poor sporting technique
  • Muscle imbalance around Lumbopelvic area (lower back and pelvis)
  • Piriformis compensating for weak gluteal muscles
  • Tight hip flexors and adductors
  • Overpronation(flattening) of foot  – causing internal rotation at hip
  • Altered gait biomechanics
  • Any pyogenic infection

Treatment options – Next Page

ITB Tightness – A runner’s nightmare

ITB tightness – A runner’s nightmare

ITB (Illiotibial Band) related conditions are commonly seen in endurance sports. Running, cycling, hiking are some such sports where an individual is highly prone to ITB related injuries. ITB tightness cannot be ignored, as it can lead to many injuries which can affect one’s performance. Quite often it’s not the tightness itself but increased loading or strain on the ITB because of other biomechanical factors.  These injuries are usually overuse type and if they develop, they can keep an athlete off sports for weeks or more. So, it is very important to keep a check on its tightness in order to prevent injuries.

Illiotibial band is a thick band of fascia found on the outer side of the thigh. It runs from the pelvic bone, crosses hip and knee joints and gets attached to the tibia (lower leg bone). At the hip joint, gluteus maximus and TFL (tensor fascia lata) muscle merge into ITB. It also attaches to the fascia of vastus lateralis muscle (outer thigh muscle), which is a part of your quadriceps muscle. Illiotiabial band is an essential structure as it helps in stabilizing the knee joint.

A tight illiotibial band or increased loading/strain on it due to biomechanical factors, can lead to anterior knee pain, external hip snapping and ITB Friction Syndrome. In external hip snapping, an audible click occurs from ITB moving over greater trochanter (bony protuberance) of thigh bone. Pain might also be present along with an audible click when an individual flexes and extends the hip.ITB-fs

While in ITB Friction Syndrome, pain is present on the outer side of the knee. This pain usually sets in during activity and increases gradually, which can further force an athlete to discontinue. You might notice tenderness on palpation and swelling may as well be present. This condition develops due to increase in friction and compression between the ITB and lateral femoral condyle (outer bony protuberance of thigh bone near knee joint).

Next page – Factors leading to excessive loading on Illiotibial Band

Can you do a full squat?

Can you do a full squat ?

Article by Adele Ang


Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries

As a physiotherapist I teach people to assume a squat position for many reasons. Being Asian and raised in a culture where squatting toilets were the norm, most people had no problem assuming a full squat.

With the rise of sitting toilets, less and less people are able to squat fully, this is particularly true for relatively younger people. Surprising isn’t it? So sometimes you get to see a sprightly older lady make her way to the squatting cubicles while the younger ladies wait in line for the sitting ones. And guess who is going to have more problems with the hip, knee and ankle joints in future. Well, I can proudly say I am one of those ladies, though not older, who cuts to the front to use those empty squatting cubicles.

Benefits of a Full Squat

A full squat has its benefits, both in keeping the joints of your legs sufficiently flexible and the muscles moving those joints both stronger and longer, as they support the joints through their full range of movement. Lost of joint range of movement or joint mobility is a common reason for ongoing hip, knee and ankle pain in many adults, commonly but wrongly attributed to be a result of aging.

Assuming a full squat has also been touted as a valid solution for complete emptying of one’s bowels. A full squat requires you to have your thighs brought up to your chest which tightens your abdominal muscles, the position places a slack on your pelvic floor muscles which in turn relaxes the anal sphincter.

In addition, if you are experiencing recurring hip, knee or ankle injuries it is worth seeing if you can do a full squat and if not, learn to do it.

Here are 3 things you can do to assume a full squat and in doing so, keep your legs and bowels happy and healthy!