Question
Hi,
I've had tightness in my right glute for the past few weeks (the symptoms seem to match those of piriformis syndrome), and I also occasionally get a calf cramp in that leg as well. Could this be due to the calf having to compensate for the tight piriformis?

Also, can piriformis syndrome be caused by some sort of bad posture? I've had a tight right shoulder area for a while and my school chiro seemed to think it was due to bad posture, so I was just wondering if this could be similar.

Thanks,
-Jon

Answer
Hi Jon,

True piriformis syndrome is rare.  The most common cause for the combination of back-butt-calf pain is sciatica caused by a disc bulge.  You did not mention back pain.   Nerve impingement in the lumbar spine, from a disc or bone spur, can often skip the lower back and only cause pain in the buttock and leg.   Often there are other symptoms, like numbness or tingling in the leg or foot/toes.   Your hip, the ball and socket joint, can also be a cause of buttock pain and calf pain.  In a study of a large number of people with confirmed hip joint problems, their pain drawings were all superimposed, and the combined drawing showed pain mostly in the buttock and thigh, and also in the back of the calf.  Cramping, like a charlie horse, is one thing.   The feeling of tightness, without the muscle actually grabbing in a cramp (spasm), is something different.   Cramping alone can be from mineral imbalance, e.g. calcium or magnesium, or from previous injury, or from sciatic nerve impingement (e.g. disc protrusion against the nerve).   Also, yes, if a little piriformis muscle (about the size of mini chicken drum stick, but flat like a lollipop) has an adhesion sticking it against the sciatic nerve that runs under it, you can get butt pain and calf pain.   The simple way to know is with physical examination.    If you really have piriformis syndrome, then simple digital pressure right on the piriformis will light up your calf cramping and also cause buttock pain, and, anesthetic injection into the muscle will turn off your symptoms altogether.    Doubtful it's related to posture, although bad posture and ergonomics do play a role in causing muscular and joint pain.   Just sit hunched over your computer for hours and see how long you can do that without developing some pain...     I do not know what you mean by a "school chiropractor."    I don't know how old you are or if you have any previous back injuries, etc.   Regardless, a really good hands-on physical examination should help point in the direction of piriformis, lumbar disc/sciatic, or hip joint as likely causes.    Then, if the treatment is on target and you get relief, then that confirms the diagnosis.   In other words, if the doctor's diagnosis is "piriformis" and treatment to that muscle alleviates your pain, then yes, it was the piriformis.     

'Hope this was helpful,

Dr. G'