Piriformis Syndrome - What is it and how to treat it



What is Piriformis Syndrome?
  • Piriformis Syndrome is an overtight Piriformis muscle which then presses on the Sciatic Nerve causing pain and tightness in the buttock sometimes with tingling and burning sensations which can radiate down the back of the leg.  Often people will assume that they have Sciatica due to the similarity of symptoms.


Causes of Piriformis Syndrome?
  • It is usually caused by overuse of the muscle which causes an over tightening of the Piriformis Muscle resulting in pressure on the sciatic nerve.
  • Tight muscles on the inside of the leg (adductor muscles) creating tightness can also inhibit the correct movement of these muscles thereby putting more strain on the Piriformis Muscle.


  • In the intial stages the goal is to reduce pain.  Ice can help reduce muscle spasm and nerve pain in the first day or so.  However longer term heat application is more beneficial as it helps bring fresh blood to the area and helps relax this muscle.
    • Heat should not be applied if there is a suspected muscle tear.
    • If heat is used then it should be applied for 15/20 minutes 2-3 times per day.
    • Do not apply heat pads directly to the skin.
  • Massage
    • Light massage can help release muscle tension and active techniques can be used to stretch the muscle.
    • Massage on the muscles around the Glutes can be beneficial as compensatory tension can arise through changed movement due to pain.
    • At the very least two to three sessions at the start of rehabilitation is a good idea. As the condition improves massage can be performed deeper, but the deeper the massage the longer it should be left between sessions as the muscle will need to recover in the same way as it does with heavy strengthening exercises.
  • Stretching
    • Hold this stretch for around 20-30 seconds and repeat as often throughout the day as possible (2-4 x recommended).


  • Foam Rolling
    • This can help release the Piriformis Muscle.

foam_roller_glutes piriformis.jpg

  • Strengthening
    • Strengthening  should be done on a daily basis immediately followed by stretching exercises as the muscle will be more likely to relax into a stretch if it has been worked and warmed up.

    • The more that you sit then the more often this exercise should be done.  At least 3 times a day.

    • Strengthening the piriformis muscle itself and also the other hip abductor muscles can be helpful in preventing piriformis syndrome recurring.

    • Clam exercise - Lay on your side, bend the knees and position them forwards so that your feet are in line with your spine.

    • Make sure your top hip is directly on top of the other and your back is straight. Keeping the ankles together, raise the top knee away from the bottom one. Work until you feel the muscle starting to fatigue but do not overdo it especially in the early stages. Slow controlled movements are important.


As always if you are unsure of your condition then please seek advice from a professional.


What is the ITB?

The Iliotibial Band or ITB is a thick band of of fascia which connects the outside of the knee to the outside of the pelvis and plays a key role in the movement of the thigh.   Some of the glute and hip muscles attach to it and the ITB co-ordinates how these muscles work and stabilises the knee.



Should you Foam Roll it?

I often get clients who say they have been regularly rolling their ITB and it is so painful.. so it must be doing some good?  Pain does not equal effectiveness.  In fact if an area is painful it is better to avoid this and use the roller around the area rather than directly on it which could potentially cause more inflammation.


The ITB is fascia and not muscle.  Fascia is dense connective tissue made up of collagen fibres which is one of the strongest protein to be found.  The ITB is supposed to be tight as it helps keep the knee in the correct position.   The idea that you can release or relax the ITB through Foam Rolling is therefore a misconception.  What needs to be done is foam roll the muscles surrounding the ITB such as Glutes, Tensor Fascia Lata, Hamstrings and Quads.


Below is a link to some useful tips on how to foam roll.

Top Foam Rolling Tips


What is ITB Syndrome?

This is a condition that is usually caused by friction of the ITB moving across the outer part of the knee due to an area of tension in the hips.  Usually pain comes on during activity and gets worse until it is rested. 


Treatment of ITB Syndrome


Obviously it is important to seek professional advice to ensure that you have a correct diagnosis before you start any rehabilitation programme.


  • Rest and ice around the knee for a few days.
  • In order to maintain fitness do some cross training e.g. swimming to avoid irritating the knee further.
  • Have a sports massage to release any tension around the hips and leg muscles.
  • Stretch often to help keep hips tension free.  This is an important part of the treatment and prevention of ITB Syndrome.

Example Stretch..

TFL Stretch

This stretch lengthens the tensor fascia lata muscle which is found on the outside of the hip. Sit on the floor with one leg out straight. The leg to be stretched is bent and the foot placed on the outside of the other knee as shown. Use your hands to apply pressure as if trying to pull the bent knee across the other one. Hold for 30 seconds and relax. Repeat 3 to 5 times.



Check List To Prevent ITB In The Future
  1. If you haven't already get your running gait checked.  Your style of running could be contributing to tension around the ITB in the hips and glutes
  2. Ensure that your shoes are fit for purpose.  Are they supportive in the right way?  When you have your gait analysed they will tell you which shoes are best for you.
  3. Schedule a visit with a physio or sports therapist to check to ensure that weak hips aren't a contributing factor.
  4. Stretch regularly to help lengthen muscles around the hip and glutes.
  5. Build in time for regular sports massage to help keep the muscles around the ITB tension free.

What is Kinesio Taping and How Does It Work?



What is Kinesio Tape?


  • Kinesio Tape is an elastic adhesive tape which can be worn for up to 5 days after application.

Key Features are:-

  • Latex Free
  • Hypoallergenic
  • Water Resistant
  • Doesn't restrict range of movement
  • Tension on the tape enables relaxation or stiumation of muscles
How Does Kinesio Tape Work?
  • It can alleviate discomfort by lifting the skin (decompression). This lifting effect enables an increase in space around the muscles/soft tissue and nerves which can help reduce pain and inflammation.  The tape decreases pressure in the area while enabling an effective blood flow around the taped area.  An assessment by your therapist will determine how the tape is applied and what additional treatments may be required.
  • The direction as well as the amount of stretch applied to the tape or the muscle are all key to the individual treatment.
  • Kinesio Tape can be applied in a number of ways and the way it is applied has the ability to re-educate the neuromuscular system due it's sensory effect and it can reduce inflammation and promote improved circulation and healing.
CASE STUDY - Plantar Fasciitis
The Objective of K-Taping for Plantar Fasciitis
  • The main aim of this taping is to take pressure of the Plantar Fascia to relieve inflammation and pain and enable better movement.
  • Often the tape can also be applied over the achilles and up the calf to reduce tension which can often be a factor in Plantar Fascia pain.
  • It is important to get professional advice before taping to ensure that this is the right approach.  Taping can often be used in combination with Soft Tissue Techniques to provide a better outcome for recovery.
  • Alongside taping and soft tissue treatment your therapist should be able to advise on rehabilitation exercises to enable a faster recovery.

Plantar Faciitis Taping


What is Plantar Fasciitis and How To Treat It





Plantar Fasciitis is a common cause of heel pain.  Symptoms can come on gradually over time and often be worse in the morning.


  • Gradual onset of pain under the heel which can also move up to the foot arch.
  • Pain is usually worse in the morning as the foot has been relaxed overnight and the Plantar Fascia becomes shortened temporarily.
  • Moving around tends to ease the pain as the tissues warm up and stretch out.

What is the Plantar Fascia?

  • It is is a thick band of tissue that runs from the heel to the front of the foot


  • Plantar Fasciitis tends to be more common in sports such as running, dancing and jumping where more load is put through the Plantar Fascia.
  • Inflammation of the fascia causes pain at the heel attachment which can then radiate along the bottom of the foot.
  • Overuse injury is usually the cause of Plantar Fasciitis but there are a number of factors that can increase the possibility of developing it such as:-
    • Having a high arched foot.
    • Tight muscles in the hips, hamstrings and calves.
    • Wearing flat or hard soled shoes.
    • Overpronation of the foot which is where the foot rolls inwards and can then over stretch the Plantar Fascia.


As always if you are not sure whether you have Plantar Fasciitis please seek advice from a professional before starting any self treatment.

  • Ice - in the initial stages aim to ice for 10 minutes every hour.  This can reduce to 3 times a day once the pain has lessened.
    • Never put ice directly onto the skin.  Wrap in a wet tea towel before applying.
  • Rolling a ball under the foot to help stretch the Plantar Fascia.


  • Stretching the calves off a step or against a wall. Aim for 3-5 times a day and hold each stretch for at least 30 seconds.

 calf stretch pf.jpg


  • Stretch under the foot by bringing your toes towards the front of your leg.

pf toe stretch.jpg

  • ´╗┐Wear Supportive Footwear such as trainers or comfortable shoes.
  • Taping - this can help protect and support the Plantar Fascia until there is minimal pain.


  • Massage - when the condition has become less painful deep tissue techniques can be used to relax and stretch the fascia.  Treatment around the calves and achilles will also help relax the surrounding muscles.

The Benefits and Importance of a Good Nights Sleep


Today's world is busier than ever and we have numerous demands on our time and we often sacrifice sleep in order to fit everything in!


But it is important not to let these demands on our attention get in the way of our sleep as it is vital to our wellbeing.


Sleep can be affected by a number of things including caffeine, stress, alcohol and technology.  It is recommended not to drink too much caffeine or alchohol prior to bedtime and to have an "electronic free hour" before lights out to enable a better sleep pattern.


There are number of benefits to getting a good nights sleep, but here are my top 5:-


1. Healthy Heart

Sleep keeps your your heart healthy!  Lack of sleep has been linked to issues with blood pressure and cholesterol which can be also be linked to heart disease and strokes.


2. Stress Reduction

Lack of sleep can  make your body go into a state of stress.  This makes the body go on high alert which can cause high blood pressure.  If you do find you tend to get stressed and find it difficult to get to sleep then you may want to seek out some relaxation techniques to help.


3. Reduces Inflammation

When you have too little sleep this can raise inflammation levels in the body.  This can create a greater risk for heart conditions as well as other diseases such as diabetes.


4. Memory Improvement

Sleep plays an important part in a process called "memory consolidation".  Your body may be resting but the brain is still busy processing your day, linking events and memories.

Deep sleep is really important to ensure that your brain can make these links and memories. 


5. Body Repair

Sleep helps the body repair itself.  During sleep the body is hard at work repairing damage caused by stress, ultra violet rays and other harmful exposure.

How Much Sleep Do We Need?


Adults = 7-9 hours per night

Teenagers = 9 hours

Young Children = 10 hours

Babies = 16 hours


Oh and apparently napping makes you smarter!.. Napping during the day is great for overall health and has been found to make people more productive.  People who nap at work (not at their desks!) have been shown to demonstrate lower levels of stress.  Another excuse to sleep!