Are you a runner? No apparent injury but now you feel lower body pain?


A retrospective survey of 2886 runners reported an overall injury rate of 46%. Injured runners were more likely to be male and to run six days per week and more than 30 miles each week.  No single reason have been given as the primary cause of these injuries; suggesting that many running injuries are multifactorial.  Prior history of injury, incomplete rehabilitation, chronic long distance training program, and obesity have been highly correlated with reinjury.  

What is Piriformis Syndrome?

The piriformis muscle is an important external rotator of the hip muscle that crosses the sciatic nerve.  It's believed that the sciatica-type pain occurs when the piriformis muscle becomes hypertonic and compresses this nerve. Some studies have correlated piriformis syndrome in the runner with foot overpronation, gluteal muscles weakness, hip abductors weakness, and tightness of the hip adductors.  However, “piriformis syndrome” remains controversial and difficult to diagnose.

What are the symptoms?

  • gluteal (buttock) pain - deep ache that may radiate to the side of the thigh, back thigh and down the leg
  • low back tightness and pain
  • running uphill makes it worse
  • prolonged sitting tend to cause dull ache but lying flat seems to relieve it
  • internal rotating your hip can exacerbate this pain (FAIR test, Flexion/ Adduction and Internal Rotation)

Do I need special test?

Consulting with your physician will guide what additional test(s) may be required.  Imaging (X-ray, US, MR) may be necessary for differential diagnosis like gluteus medius tendinopathy, femoral neck stress fracture, labral tear, and, less often, radicular pain from the lumbar spine often seen in runners.

How is it treated?

The goal is to reduce the pain and ease your symptoms:

  • Rest your hip and avoid activities that exacerbate the pain
  • ICE (cold gel pack, bag of ice, or bag of frozen vegetables) your glutes after exercising (AVOID placing it directly on skin)
  • Take pain relieving medication (start with OTC include acetaminophen (sample brand name: Tylenol) or ibuprofen(sample brand names: Advil, Motrin)
  • Stretch and strengthen the muscles around your hip and knee
  • Physical Therapy to correct body's biomechanic and strengthen the weak supporting muscles
  • Steroid and Botox injection are possible options but will need to be discussed with your physician

What can I do to prevent it?

  • Replace worned out sneakers (it's more cost effective than your medical expense)
  • Gait analysis can be very beneficial to pinpoint the kink in your kinetic chain
  • Refrain from running on uneven surface for long periods of time 
  • If doing track work, alternate directions to prevent overuse of one side of your body 
  • Add off day or recovery days in between long spurts of intense training days

Your sport medicine physician can better explain the functional anatomy of your hip and how it correlates with your hip muscle weakness.  Correcting this gap will help decrease your race time and prevent future injury.  It's not just the injury of an aging process!


Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation.

Tri-Quoc Pham M.A. is ACSM Certified Personal Trainer and a 4th year medical student at Arizona College of Osteopathic Medicine

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  2. Filler AG, Haynes J, Jordan SE, et al. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine 2005; 2:99.
  3. Lewis AM, Layzer R, Engstrom JW, et al. Magnetic resonance neurography in extraspinal sciatica. Arch Neurol 2006; 63:1469.
  4. Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am 2004; 35:65.
  5. Bovens AM, Janssen GM, Vermeer HG, et al. Occurrence of running injuries in adults following a supervised training program. Int J Sports Med 1989; 10 Suppl 3:S186.