Piriformis Syndrome: Can I Keep Running With It?

I have developed a mild case of piriformis syndrome. I have significantly increased my amount of stretching, but have continued running. Is it OK to run with piriformis syndrome or am I going to make it worse. Also, is it OK to use a Nordic Trak with piriformis syndrome?

– Dave, Allentown, PA

Answer by Dom: Hi Dave,
Thanks for your question about piriformis syndrome. I see you sent this in quite a while back. It somehow got lost and suddenly popped up again, so sorry for the delay in answering you. With a mild case you can often keep running, but only on strict terms — and the Nordic Trak comes with the same rules.

Piriformis syndrome is a real pain in the butt. Literally, because that's where the pain is. The piriformis is a small muscle deep in the buttock that helps rotate your hip. The sciatic nerve, the thick nerve that runs from your lower back down the back of your leg, sits under it. When this muscle is tight or irritated, it can squeeze your sciatic nerve — and running loads it repeatedly. As with anything that gets squeezed and pushed around, if you do it repeatedly, it can start to hurt.

Most experts would advise you to stop running or to cut back considerably to give your sciatic nerve a chance to recover. I'll be straight with you: that is the safest route. But it sounds like you want to keep running, so here is how to do it sensibly.

1. Can you run on it? The pain rule
2. How to run while it settles
3. The Nordic Trak and cross-training
4. Find the cause
5. Relief, and when to get it checked

Can you run on it? The pain rule

You need a simple test, because "mild" is easy to talk yourself into. Score the buttock pain out of 10 during your run. My advice to you: pain of 0-3 that settles within 24 hours is acceptable. Stay in that zone and you are not making it worse.

Stop the run if you get any of these:

1. Sharp pain, or pins and needles down the back of the leg.
2. Buttock pain that builds the further you run.
3. A morning after that feels worse than the day before.

That last one matters most. The nerve often complains the next morning, not mid-run. If you wake up stiffer and sorer after a run, you went too far — and the next run should be shorter or skipped. Keep a one-line note after each run: score during, score next morning. Two weeks of those notes will tell you more than any amount of guessing.

How to run while it settles

Think of the next 2-3 weeks as a consolidation period, not a training block. Here is what I'd recommend:

1. Drop speed work and hills completely. Both load the buttock hard.
2. Cut your run lengths by 30-50%. If you normally run 10 km, run 5-7 km.
3. Run easy pace only, on flat ground. Avoid camber, uneven trails and soft sand.
4. Run every other day, so the nerve gets a full day off between runs.
5. Shorten your stride slightly. Overstriding makes the buttock work harder.

Once you have had two or three weeks with scores of 3 or below and calm mornings, build up progressively: add 10% to your weekly mileage, then reintroduce hills before speed. A mild case often settles within several weeks if the cause is dealt with. I can't promise that for you, though. If it flares, step back a level — no heroics.

The Nordic Trak and cross-training

You asked about the Nordic Trak, the cross-country ski machine. It is gentler than running because there is no impact, but it isn't automatically safe. The long, gliding stride drives your hip into full extension, which can irritate the buttock when the piriformis is already angry.

Start with 10-15 minutes at low resistance. Shorten your stride so the leg never locks out behind you. Then check how you feel the next morning, using the same 0-3 rule. If it is calm, add 5 minutes per session. If it bites, leave it for a week.

Your other options are cycling, swimming and pool running. Swimming and pool running are the kindest — no impact, no sustained hip bend. Cycling is fine too, but keep the saddle sensible and the effort easy, because a low, hunched position can aggravate this area. Sessions of 30-40 minutes, 2-3 times a week, will keep your fitness ticking over while the nerve settles.

Find the cause

Running may not be the culprit — or not the only one. Understanding what is causing it is really the key to deciding how much to run. Chances are though that your running does have something to do with it.

Run through this list:

1. Cycling: is your saddle too high, too hard, or are you riding long hours?
2. Sitting: long desk days, car journeys, or a wallet in your back pocket pressing on the buttock.
3. Hip stiffness: do you struggle to rotate your hip or sit cross-legged?
4. Build-up: did your mileage or intensity jump recently?
5. Shoes: anything new or worn out?

Fix the cause and your recovery speeds up. Ignore it and you can stretch all day while the nerve keeps getting squeezed. Take the wallet out of your pocket today — it costs nothing.

Relief, and when to get it checked

Stretching to loosen up the muscles and nerves in that area is definitely a good idea, so keep it up. Do the piriformis stretch for about 30 seconds, three times each side. Add glute bridges and side-lying leg raises, 2 sets of 10 each, to strengthen the hips. If you sit a lot, stand up and walk for a couple of minutes every hour. Massage helps too: use a ball or a masseur on the buttock muscle, but don't press hard on any spot that sends pain or tingling down your leg.

I'm a running coach, not a doctor, so please book a physio or doctor if:

1. There is no improvement after 2-3 weeks.
2. The pain travels below the knee.
3. You have numbness, weakness or night pain.

Back pain together with any change in bladder or bowel control is urgent — go to A&E, don't wait.

Dave, you caught this early, which is a big advantage. Be strict about the pain rule, keep your runs short and easy for a few weeks, and you give yourself a good chance of coming through it.
Best of luck with your running.
Kind regards,
Dom

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