Piriformis syndrome is a generic diagnosis for pain in the literal butt, about where your back pocket would be. It’s so generic that the name has been changed to ….
Deep gluteal syndrome, which is even more generic sounding.
I’ll discuss more on that later. I’ll cover the exercises I like to treat this condition, and later on i’ll discuss what it is and how to determine if you actually have it.
For deep gluteal syndrome syndrome, we are specifically talking about (mostly) hip internal rotation.
4 Exercises we like for hip mobility
1. Quadruped rock back
2. Reverse Clamshell
3. Seated Hip Flexion Isometric
4. Prone Hip Internal Rotation
#1 Quadruped rock back
start on your hands and knees
push butt to heels using hands
don’t let your back round excessively
hold 10 seconds while breathing in the nose, out through pursed lips to promote relaxation
#2 Reverse clamshell
comfortably lay on your side
place a towel roll or small pillow between the knees to keep your hips more neutral
rotate the top leg towards the bottom leg, the foot should automatically go towards the ceiling
hold 10 seconds while breathing in the nose, out through pursed lips to promote control
#3 Seated Hip Flexion Isometric
start by sitting comfortable with the hips at 90 degrees
lift the hip towards the ceiling
don’t let the low back round excessively
hold 10 seconds while breathing in the nose, out through pursed lips to promote control
#4 Prone Hip Internal Rotation
start on your stomach with a small object between the knees to keep the hips neutral
slowly rotate the knees towards each other, the feet will fall out
hold 10 seconds while breathing in the nose, out through pursed lips to promote relaxation
Perform these deep gluteal syndrome exercises 2 sets of 15 reps of each exercise, and hold each rep for 10 seconds. These can be done 2-3 times a week.
What causes deep gluteal syndrome, a.k.a, piriformis syndrome?
The traditional idea is the Sciatic nerve is compressed because of overuse of the piriformis muscle.
Over time the piriformis muscle gets shortened and/or stiff, so any time you use the muscle, the compression causes pain in the butt or pain that goes down the leg.
There’s only about a 10% chance (SOURCE) the piriformis muscle is the cause of your problem.
The reason for the small percent chance is because there are so many structures back there that could be the source of the nerve compression besides just the piriformis muscle.
The medical community is actually trying to distance itself from the term sciatica since it is not specific. It does not tell WHY or WHAT is the cause. Don’t expect this to happen anytime soon.
Deep Gluteal Syndrome (DGS) DGS is the (new) preferred name insurance is more likely to reimburse since there is some structure deep in the gluteals that could be compressing the nerve. Assuming the source is not the disc.
It could be both – disc + nerve compression. Not uncommon for back pain to be causes by multiple things.
Don’t worry about what the condition is actually called, that’s a debate for academics and the insurance companies. The treatment DOES NOT CHANGE.
Diagnosing Piriformis Syndrome, or Deep Gluteal Syndrome
You can (kind of) confirm you actually have Deep Gluteal Syndrome, versus pain from a herniated disc, with the following 3 tests.
Seated piriformis stretch test (starts 2:00 in)
The test is positive for deep gluteal syndrome if it recreates YOUR symptoms and pain in the SAME location.
If these are all all negative then likely your issue is disc related, so the nerve compression is at the spine, not somewhere along the path of the sciatic nerve.
Important to note the tests in the video are done by a therapist on ANOTHER person, but you can get close enough. If all 3 are positive, that’s good enough.
Prognosis and Summary
If you’ve battled piriform…
…ugh, I mean Scia….
…I mean Deep Gluteal Syndrome and nothing seems to work, this probably will. This is a targeted approach to the hip lateral rotators and a great way to improve hip internal rotation ROM and strength, something lacking in most people anyway.
You may notice reduce pain after 1 session, and you’ll likely notice a difference in overall pain in 2-3 weeks if it’s actually DGS.