For an in-depth look at trigger points we recommend Save Yourself From Trigger Points & Myofascial Pain by Paul Ingraham. If you buy this book today you can get a copy of Paul’s other book, Save Yourself From Low Back Pain, for free!
Trigger points in the Piriformis muscle can cause incredibly intense pain that radiates deep through the buttocks. The pain is felt from the sacrum region of the lower back to the buttocks, and through the hip. Trigger points in the Piriformis have the potential to shoot pain into the upper hamstrings as well.
Piriformis TrPs (Trigger Points) can put a twist in the sacroiliac joint (SI Joint) which can cause even more pain than plain old trigger points, which already hurt a lot. A short piriformis can cause pain when rotating the leg inward or turning certain directions on the effected side(s). It can also cause intense pain when trying to spread the legs apart. Piriformis trigger points can also cause a person to walk with a limp or render them unable to walk completely!
The piriformis muscle may also put pressure on the sciatic nerve which will cause electrical ‘pins and needles’ or numbness going down the legs. Sciatic pain is a whole new level of pain all together.
When trigger points are in the piriformis muscle it is hard to find comfort in nearly all positions. Sitting, standing, walking, and lying down can all be unbearably uncomfortable. As you can see, getting rid of piriformis trigger points can be an important job and I’ll explain how to do that later on.
There are generally two places that trigger points form in the piriformis. You can see the piriformis and the trigger points labeled in this picture, the trigger points are in blue:
In the images below this text you can see the approximate location of the trigger points from the outside of the body. Note that in the pictures below you can’t actually see the Piriformis Muscle because it is hidden underneath the gluteus maximus in these images.
The red dots are where the trigger points are usually located, and the blue areas are the common areas of pain associated with them.
Piriformis Trigger Point #1:
Piriformis Trigger Point #2:
Treating Piriformis Trigger Points (Muscle Knots)
Luckily, trigger points are fairly easy to deal with once you understand them and know where to find them. There are many ways to treat your trigger points once you can locate them.
The hardest part is locating the piriformis muscle itself. To do this, first go back and look at picture above that shows the piriformis muscle. Now think of where that would be in your body. Understand what action it performs.
Now lie on your side with your bottom leg straight (or almost straight if it hurts) and with the top leg bent. Now rotate the top leg outward while lying down. Feel in your buttocks for the muscle that’s responsible for this movement. You’ve found the piriformis muscle, good job!
When treating the piriformis muscle be sure to remember that the sciatic nerve basically runs ‘through’ the piriformis muscle and other short hip rotator muscles. When applying pressure to this area, if you feel any nerve pain (zappy, tingly, pins & needles, numbness) then it’s best to back off and only do what is tolerable.
It’s also nearly impossible to hurt yourself when you’re treating yourself, because if it hurts your instant reaction is to stop before causing damage.
Once you’ve located the piriformis you can use your hands or a tennis ball to get to the trigger points. I prefer the tennis ball trick myself.
The Tennis Ball Trick
Get a regular tennis ball or a kong brand dog toy and lie flat on the ground. Now place the tennis ball where the back pocket of your pants would be and relax onto the ball. Roll around on it slowly and carefully until you find a place that hurts more than the rest. This ‘hurt’ should be a sweet ache and should feel good in a weird kind of way. This is a trigger point! Relax your weight with the ball on the trigger point, aim for a pain level of about 8 on a scale of 1-10 with ten being intolerable pain. You should try to stay on the trigger point for at least 30 seconds with a tiny and gentle rocking motion over the trigger point.
You may need to do this for several days to get your trigger points to fully break up, but keep at it and soon they will go away and you will be able to rest on the ball for 30 seconds with no pain. It will actually feel good once you’ve got rid of all of your trigger points!
Don’t go using a cue ball or a golf ball or a marble and wonder why it doesn’t work or that it hurts. Use a tennis ball or a Kong brand dog toy, they are the best kind for this purpose.
You can also squeeze a tennis ball between your buttocks and the wall and try to get to your piriformis that way. It’s almost as good as lying on the ground and can be used if you prefer.
You can also try using a TheraCane which is specifically designed for self treating trigger points. You can get a TheraCane here.
We also recommend the Complete Self Treatment Kit for Trigger Points.
The SI Joint and Piriformis Trigger Points
When a person’s sacroiliac joint is out of place it can create trigger points, and keep trigger points coming back once they’ve been treated. A manual adjustment of the spine and SI Joint may be helpful, but this can only be done by a trusted chriropractor or osteopath. This may help to keep the trigger points from coming back.
It’s important to remember that the sacroiliac joint will often move itself back into place when all of the trigger points in the hip have been released.
Once your trigger points have been taken care of it’s a good idea to start lightly stretching the piriformis muscle. You can learn ways to stretch the piriformis muscle at the bottom of that page. Be careful not to over stretch because over stretching the muscle can cause the trigger points to come right back, so keep it slow and gentle.