Follow this cycling PT’s approach to preventing and treating Piriformis Syndrome When Cycling.
What is Piriformis Syndrome?
Piriformis Syndrome is a nerve condition that results from irritation and compression of the sciatic nerve by the deep gluteal muscle known as the piriformis. The piriformis muscle is an external rotator of the hip joint, but it also stabilizes the joint when pedaling, causing piriformis syndrome when cycling if tight or weak.
The piriformis is a triangular muscle that runs from the sacrum to the outer region of the hip. When seated on the saddle, we put direct pressure on the piriformis, a common cause of piriformis syndrome when cycling.
It is closely related to the sciatic nerve—the largest and longest nerve in the body—which sends nerve impulses to our lower extremities allowing us to move and feel. In 80 percent of the population, the sciatic nerve passes beneath the piriformis, and in 20 percent, it pierces directly through the muscle.
Piriformis syndrome occurs when tightness or spasms of the piriformis muscle compresses the sciatic nerve causing pain. Severe achiness, gnawing pain, burning, and pins and needles that travels down the back of the leg worsens with time if not addressed and treated.
It is often challenging to tell the difference between piriformis syndrome and other forms of sciatica. Classic sciatica is generally caused by
spinal issues, like a compressed lumbar disc. Piriformis syndrome is the go-to diagnosis when sciatica is present with no discernible spinal cause for cyclists experiencing pain.
Piriformis Syndrome When Cycling
The sciatic nerve exits the lower spine and travels down the back of your leg to below your knee. As it goes through your buttock region, it passes beneath, or in some cases directly through, the piriformis muscle.
When you pedal, the piriformis muscle contracts and squeezes the sciatic nerve underneath it. Repeatedly contracting and relaxing the piriformis muscle irritates the sciatic nerve and causes severe pain from inflammation. In addition, our body weight on the saddle creates significant pressure on the piriformis muscle, increasing irritation.
Causes of Piriformis Syndrome When Cycling
When the piriformis muscle gets irritated, compressed, or stiffens up, it causes pain in the buttocks and legs. It usually happens because of overuse, prolonged sitting, and activities such as bicycling in the seated position.
Athletes performing forward-moving activities like running and cycling are more susceptible to the disorder. Excessive or prolonged sitting (e.g., the hips flexed while sitting at work) also increases the likelihood of developing piriformis syndrome.
If the hamstring, gluteus maximus, hip flexors, or piriformis muscle is tight, it can restrict the sciatic nerve, which causes sciatica-like symptoms.
Muscle imbalance can cause piriformis syndrome when cycling. When our quads overpower the glutes, piriformis, and hamstrings, they become overworked to compensate for the weakness. Strengthening the specific muscles will correct compensation patterns and release the tension in the piriformis caused by overworking them. In turn, the sciatic nerve is relieved from compression.
Core Weakness is also a factor. Without solid back and abdominal muscles, there is no foundation for strength production by the legs, and an inconsistent and improper pedal stroke can result.
The repetitive nature of an inefficient pedal stroke, especially if improper positioning causes excessive bending of the hip and trunk and the inability for the hip to extend or open up (straighten), irritates, leading to piriformis syndrome when cycling.
Symptoms of Piriformis Syndrome When Cycling
Sciatic pain is the most common symptom of piriformis syndrome when cycling. Cyclists feel a deep ache or spasm in the lower back and buttocks, making it painful to sit on the saddle. It worsens during activities that cause the piriformis muscle to press against the sciatic nerve.
The pain, tingling, or numbness runs down the back of your leg, beginning as an intense, burning pain in the deep buttocks.
Diagnosis of Piriformis Syndrome
Piriformis syndrome symptoms may resemble other medical conditions, including pinched nerves in the lower spine, arthritis in the spine (spondylosis), hip disorder(s), or tumors in the pelvic region. Before trying any exercise program for sciatica caused by piriformis syndrome when cycling, you need to figure out why you’re having pain.
An injury to bones, muscles, tendons, bursae (pads between the tendons and bones), the hip joint, or the sciatic nerve can cause similar symptoms. There are a few basic rules of thumb to rule them out.
- You may have injured your hip joint or suffered a stress fracture in your pelvis or femur (long thigh bone) if you experience pain hopping on one leg. An x-ray usually reveals a joint injury, but only a bone scan shows a stress fracture.
- If you experience pain in your buttock when you stretch your legs out straight, then you may have a torn muscle or tendon running down the backs of your thighs.
- If you feel pain when you touch the outside of your hip or the lowest point of your pelvis (the part that touches a chair when you sit), you might have irritated your bursae (bursitis).
- If your lower-leg pain radiates into your buttocks and extends down to your feet when you bend backward, you may have a herniated disk pressing against your sciatic nerve.
Consult a sports medicine physician, physical therapist, or athletic trainer when in doubt. Ifyour healthcare professional thinks that something else is responsible for your symptoms. In that case, he or she may want to order CT and MRI scans or other diagnostic tests.
When all other potential causes have been ruled out, your healthcare professional will point to piriformis syndrome when cycling as the culprit. It’ll be a sure bet when you tell him you’re a cyclist and that the pain worsens the longer you sit in the saddle. He or she will test your strength and flexibility in certain muscles to confirm the diagnosis.
Treatment for Piriformis Syndrome
If the pain is the result of a recent injury or is acute (sudden onset within ~24 hours) with swelling, control the symptoms by following the ‘PRICE principle’ (an acronym which stands for Protect, Rest, Ice, Compression and Elevation) immediately for the next 2 to 3 days.
Check your bike fit: Pain in the hip is due to positioning, which causes the rider to bend excessively at the trunk or causes the hip to flex. You can correct this by adjusting the crank length, handlebar size and position, saddle height, and fore-aft position to avoid exceeding the athlete’s range of hip motion at the top of the pedal stroke.
Focus on a comfortable cadence and smooth pedal stroke, and avoid pushing too hard during the downstroke.
Follow a consistent and effective recovery strategy.
Address muscle imbalances through a focused strengthening and stretching plan, ensuring only to perform exercises that can be done pain-free and without residual soreness.
Prevention of Piriformis Syndrome When Cycling
Suppose the changes you have made to your cycling setup doesn’t provide the results or eliminate the pain you are experiencing. An expert bike fit performed by a certified professional is essential.
A progressive periodized training and recovery plan is important for many reasons, and it’s vital when piriformis pain interferes with your performance and enjoyment. Take the rest out of the saddle you need to decrease pressure on the piriformis and ease inflammation.
If your hip pain is persistent, worsens, or significantly interferes with cycling, seek the assistance of a Sports Medicine Physician or Physical Therapist. An expert biomechanical and musculoskeletal assessment is never a bad idea.
A Four-Step Piriformis Syndrome When Cycling Plan
Step One: Perform a Foam Roller Routine
Step Two: Perform a Stretching Program
Adding hip flexor, adductor, piriformis, and hamstring stretching to your daily routine will counteract the adverse effects of prolonged periods in the saddle. Here’s how:
Step Three: Perform a Muscle Activation Routine
Muscle activating your glutes before riding will stimulate inactive muscle groups to improve their function. Focus on the glute muscles and visualize them to fire. It will improve contraction strength through enhanced fiber recruitment.
Concentrate on the muscles you’re trying to activate in your mind. Perform each exercise slowly and control the movement through a full range of motion. The goal is to warm up and engage the specific muscle groups without fatigue. Follow this link to learn more.
Follow These Glute Muscle Activation Tips
Activation exercises are simple motions to isolate and activate a specific muscle group. A quad dominance routine targets the glutes and spinal muscles to help you feel them contract and know they’re engaged and ready. Here are a few tips you can use along the way.
- The key to pre-activation is waking up and activating the proper muscles by concentrating on a full contraction.
- Take it slow and controlled, making each repetition deliberate for a maximal contraction through a full range of motion.
- Focus on really thinking about the muscles you’re trying to activate.
- Maintain constant tension through the band during all phases of the movement
Step Four: Perform a Strengthening Routine
A program focused on improving and maintaining glute and hip extensor strength and addressing the core will prevent piriformis syndrome when cycling and improve performance. Follow this link to the Training & Performance page of The Zommunique’ to learn how.
Sidelying Elastic Band Clamshell
While lying on your side with your knees bent and an elastic band wrapped around your knees, draw up the top knee while keeping your feet together as shown. Do not let your pelvis roll back during the lifting movement.
Hip Abduction with Elastic Band
Lie on your side and align your body as straight as possible with a band around the thighs just above the knees. Flex the foot and lift the leg to the side, hold momentarily, and lower slowly to the starting position.
Clamshell Bridge with Elastic Band
Start on your back with knees bent and feet flat on the floor. Brace your abdomen and perform a bridge holding it at the top. Take a small breath and as you exhale pull your thighs apart as shown and inhale as you return to the start position. Perform the required repetitions and then keep your abdomen tight as you lower back down the floor.
Fire Hydrant with Elastic Band
Start in a quadruped position with an elastic band around your thighs. Hands should be directly under your shoulders and knees directly under your hips. Next, raise your leg out to the side as shown. Maintain a straight upper and mid-back as you rotate your hip outward while concentrating on your glutes.
Quadruped Bent Knee Hip Extension with Elastic Band
Start in a quadruped position, on your hands and knees, with a band around your knees. Hands should be directly under your shoulders and knees directly under your hips. Begin by extending your leg back, with your knee bent at 90 degrees. Make sure to keep your core engaged and squeeze through your glute at the top of this motion. Bring your leg back to starting position. Try to keep your weight center and do not use your back in this motion.
Quadruped Alternating Upper and Lower with Elastic Band
Start on your hands and knees with your hands directly under your shoulders and knees under your hips. Wrap an elastic band around each foot. Extend one leg while making sure the lumbar spine is held still throughout the movement and not allowed to arch. Extend the leg until it is straight as shown. Reach with the opposite hand with or without holding a weight.
Standing Hip Extension with Elastic Band
Place an elastic band around your ankles. With straight knees, move the target leg back and then slowly return.
Standing Clamshell Squat with Elastic Band
Start with a band placed directly above the knees and feet shoulder-width apart. Sit back into a deep squat and push the knees out and back to neutral in a slow and controlled movement repeatedly while still keeping good form. Be sure to concentrate on your glutes with your knees over your feet and your toes visible at all times.
Lateral Monster Walk with Elastic Band
Place a looped elastic band around both knees or ankles. Next, bend your knees and step to the side while keeping tension on the band the entire time. After taking sidesteps to the side in one direction, reverse the direction taking sidesteps until you return to the starting position.
Standing Clamshell with Elastic Band
Start by placing a band just above both knees. While maintaining a slightly squatted position slowly rotate one leg up and out from your body while keeping the opposite leg as still as possible. Slowly return to starting position and repeat.
Conclusion: Piriformis Syndrome When Cycling Doesn't Have To Be A Pain in the A--
Piriformis syndrome is a common cause of hip and leg pain that can impair performance and the enjoyment of riding. Luckily, through knowledge of its underlying cause, it can be treated and prevented. Follow a sensible training and recovery plan to avoid overtraining your piriformis and the surrounding musculature.
Take the rest you need to ease the pain. Ensure that your hip flexors, hamstrings, and piriformis are flexible. Perform focused strengthening exercises to address muscle imbalance. A proper bike fit is essential.
If all else fails, seek guidance from a healthcare professional. But don’t give up. Piriformis syndrome when cycling doesn’t have to be a pain in the a–!
Has piriformis syndrome when cycling ever been a pain in your a–?
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!