Piriformis syndrome is a condition where the piriformis muscle in the buttocks compresses or irritates the sciatic nerve. Most people with this condition experience numbness, pain, and tingling in the buttocks area and down the leg - much like sciatica. This common ailment is known to affect daily life activities and mobility.
I wondered myself, what is the difference between piriformis syndrome and sciatica? Indeed both conditions hinder sciatic nerve function and have similar symptoms, but the underlying root cause is different. Sciatica is caused by a herniated disc which then puts pressure on the sciatic nerve directly, and as noted earlier - piriformis syndrome is caused by encroachment of the piriformis muscle on the sciatic nerve. (Also check out our page on How to Cure Sciatica Permanently.)
Let’s go over how to sleep with piriformis syndrome (PS) along with some basic information on what it is and the interventions you can do.
How to Sleep With Piriformis Syndrome
So let’s get straight to the good stuff. If you have piriformis syndrome, you can try the following positions to help you catch some Z’s.
- Sleeping on your back: Try lying on your back with a pillow under the knees to relieve any pressure on the buttocks and lower back.
- Side-lying position: If you sleep on your side, try placing a pillow between your knees to keep your spine alignment neutral and decrease any undue strain on your piriformis muscle.
- Fetal position: Just like a baby in the womb - curl up on your side with your knees drawn to your chest. The goal here is the same as the above positions in reducing any pressure on the sensitive area.
If you can find any other position that might help you stay in correct spine alignment while simultaneously keeping pressure off your piriformis, I’d say you’re on the right track to sleeping more comfortably with piriformis syndrome!
Light stretching (if you don’t have any trigger points) and massage before bed can also help you sleep better. It might help to check out our page on lower back stretches in bed! Overall, throwing these into your bedtime routine can help with circulation and muscle relaxation. If you’re also inclined, try and use some CBD cream on the affected area as well!
The Piriformis Muscle Explained
The piriformis muscle works as an external hip rotator and is a deep glute muscle. Anytime you rotate your knee and thigh outwardly (away from your body), you’re using your piriformis muscle! To get more details, read our post dedicated specifically to the piriformis muscle.
Because of its high involvement with daily activity, the piriformis muscle can become irritated with things such as:
- Running or jogging: Especially high-impact or on uneven surfaces can increase the risk of strain
- Sitting for long periods: If you’re sitting on a hard surface with little support, this pressure can also increase irritation
- Climbing hills or stairs
- Repetitive hip movements: Sports that are high impact and require a lot of sudden, lateral movements such as basketball, football, or tennis require PM use.
- Piriformis muscle hypertrophy: This can usually be experienced by weightlifters.
- Injury or trauma
Statistics say that approximately 40 million people a year experience low back pain and sciatica - putting the numbers of those with piriformis syndrome at about 2.4 million a year! [2]
How is Piriformis Syndrome Diagnosed?
According to one study, “Only 21 out of 29 physical medicine and rehabilitation specialists surveyed in the USA believed that the condition exists.” [1] With a full medical history and body exam, individuals with piriformis syndrome complain of tenderness of the piriformis muscle (PM) when pressure is applied.
Nerve conduction studies and imaging procedures can show irregularities in the PM. This abnormality along with the following symptoms may mean you have PS:
- Low back pain
- Buttock pain
- Shooting, burning, or aching down the back of the leg
- Numbness and tingling [2]
- Worsened sciatica pain when sitting
- External tenderness
- Diminished reflexes and strength of the affected side [1]
Additionally, having PS may make it difficult to do the following:
- Get out of bed
- Sit for long periods
- Increased discomfort in the buttocks when doing hip movements [2]
The key to correct diagnosis for piriformis syndrome involves your healthcare provider finding the correct PS-specific signs. A very scholarly definition of PS states, “Piriformis syndrome occurs due to sciatic nerve entrapment at the level of ischial tuberosity.” [2]
Typically the practitioner’s goal would be to attempt to replicate PS symptoms through various stretches, positions, and palpation. In doing so, the physical results can help rule out conditions such as spinal stenosis and lumbar muscle strain.
An often skipped evaluation to come up with a differential diagnosis is internal palpation - in which internal tenderness would also be noted when pressure is applied.
While chronic pain should not be overlooked, know when to see a healthcare provider and know that the advice given here is not meant to replace it. With that said, if you’re thinking of exploring more on your own there is a test you can do at home…
The Piriformis Syndrome Test
If you’re inclined to explore the piriformis syndrome test, I’d encourage you to do so to get more answers. Learning the FAIR test (Flexion Adduction Internal Rotation) can be useful information for the future. Check it out!
After doing the piriformis syndrome test as described in the link above, and determining your test is positive, there are interventions you can try in the next section below.
Management of Piriformis Syndrome
Just as with most muscle strains, rest and (if necessary) medication can be used. Keeping pressure off the affected area along with modified activity is also helpful.
if tolerated, doing stretches and exercises that focus on the range of motion can help decrease irritation. If severe enough, steroid injections straight into the PM can alleviate inflammation and therefore pain.
Surgery is also an option if the above interventions provide little relief. The goal of surgery would be to help take pressure off the nerve, although results may vary.
Piriformis Syndrome Massage
Just like other muscles, you guessed it - there is a such thing as piriformis trigger points. Any accumulated tension can be helped by massage. Since it is a deep glute muscle, you’ll want to seek assistance from a massage therapist who knows deep tissue massage or use a specific tool such as the QL Claw.
If you’re able to get your hands on the QL Claw, we have a page dedicated to Piriformis Muscle Release. The QL Claw is super useful to have at home, because not only can it release trigger points in the PM, but also the quadratus lumorum (of course), gluteus medius, iliac, and psoas. It’s definitely portable, multi-functional, and much cheaper than repeat visits to a massage therapist!
Finally, If you can find relief, methods now would include stretching and strengthening the PM - although generally speaking, this would help all muscles. Try the piriformis stretch below.
Just as an extra tidbit of information, here are some sample exercises you do to strengthen your PM:
- Hip thrust
- Fire hydrants
- Single-leg deadlift
How to Sleep With Piriformis Syndrome: Conclusion
Thanks for reading this page on how to sleep with piriformis syndrome! If your pain has been extremely inconvenient and debilitating, my aim is that the information provided here has given you hope for a pain-free future!
Learning the best positions on how to sleep with piriformis syndrome is only the first step in relieving your pain - and hopefully not just when you’re sleeping! Don’t stop there, get rid of PS when you’re sitting and doing any physical activity too. Sure, you can do fetal position every night but try the other interventions in this post so you won’t be limited during the day! Good luck!
Now that you've read about how to sleep with piriformis syndrome, check out our pages on upper back pain after sleeping, sleeping position for sacroiliac joint pain relief and how to stretch Psoas while sleeping!
Sources:
[1] Hopayian, K., Song, F., Riera, R., Sambandan, S. The clinical features of the piriformis syndrome: a systematic review. European Spine Journal, 2010.
[2] Hicks, B., Lam, J., Varacallo, M. Piriformis syndrome. StatPearls, 2023.