Piriformis Syndrome Treatment in St. Thomas, U.S. Virgin Islands

Tradewinds Chiropractic & Wellness treats piriformis syndrome in Charlotte Amalie, St. Thomas. Dr. Bradley Keys, Doctor of Chiropractic, sees residents, captains and crew, cruise passengers and visitors at the VI Medical Foundation Building in Estate Thomas, a short drive from Havensight. This page explains what the piriformis is, why it can feel exactly like sciatica, and how we tell the two apart and treat it.

What piriformis syndrome feels like

The pain starts in the buttock, not the back. It is a deep ache in the middle of one cheek, sometimes with a burning or tingling line down the back of the thigh, and it gets worse the longer you sit. Hard seats are the worst: a helm seat on a long run to St. John, a fiberglass ferry bench, a desk chair, the flight in from Miami. A wallet in the back pocket makes it worse on long drives. Stairs, walking uphill on Skyline Drive and sitting cross-legged can set it off too.

People usually tell us they have sciatica, and they are half right. The sciatic nerve is involved. But the back itself often feels fine, and that is the first clue.

What is usually going on

The piriformis is a small, flat muscle that runs from the front of the sacrum across the back of the hip to the top of the thigh bone. It turns the hip outward and helps steady the pelvis. The sciatic nerve runs directly underneath it, and in some people passes through it. When the piriformis tightens or spasms, it presses on the nerve and you get buttock pain with leg symptoms that look like sciatica.

True sciatica from a herniated disc starts at the spine. Piriformis syndrome starts at the hip. The usual causes: a fall onto the buttock, a lot of sitting, a sudden increase in running or hill walking, a stiff SI joint or hip that makes the piriformis work overtime, or a leg length difference.

How we treat piriformis syndrome at Tradewinds

The exam separates this from a disc problem. With piriformis syndrome there is usually no back pain and no pain with bending forward. The straight leg raise, where we lift your straightened leg while you lie on your back, is often negative or only mildly positive. Pressing deep into the buttock reproduces the pain, and so does stretching the piriformis by pulling the knee across the body or pushing the knee outward against resistance while seated. Reflexes and strength are normal. When the picture points to the spine, we say so and manage it as a disc problem, with imaging when needed.

Treatment for the muscle itself:

• Soft tissue work on the piriformis and the other deep hip rotators, by hand and with instrument assisted soft tissue mobilization. This is the core of it, and it is not comfortable the first time.
• Adjustment of the SI joint and hip, usually with drop table or side-posture methods. A piriformis guarding a stuck joint will not stay loose until the joint moves.
• Stretching, taught in the office and done at home several times a day, especially before and after long sits.
• Glute strengthening. A weak gluteus maximus and medius leave the piriformis doing a job it was not built for. Bridges, clamshells and side steps with a band are the usual start.
• Shockwave therapy for a chronic, knotted piriformis that has not responded to hands-on work. See our shockwave therapy page.

All services are listed on the services page, and a first visit is described on what to expect.

Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands.

Most cases ease within a few weeks once the muscle is released, the joint is moving and the stretching becomes a habit. The people who relapse go back to eight hours on a hard seat without breaks. We set a plan with a re-check date, and if the pain is not changing we look harder at the spine.

When you should see someone else

The red flags are the same as for sciatica. Go to the emergency room for:

• Loss of bowel or bladder control
• Numbness in the saddle area (groin, inner thighs, around the rectum)
• Weakness in the leg or foot that is getting worse, or a foot that drags
• Symptoms in both legs at once

Beyond those, buttock pain with fever, a history of cancer, unexplained weight loss, or pain that wakes you at night needs a physician and imaging. Pain after a hard fall onto the hip should be x-rayed, which we do on site.

Visitors and crew

Crew on a delivery or a week of charters spend long hours at the helm and come in with exactly this, and so do visitors after a long flight and a day in a rental jeep. We can usually see you the same week and send you off with a stretch routine. See boat and charter crew.

Getting seen

Tradewinds Chiropractic & Wellness is at the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802. Call (340) 690-4994 or email info@tradewindschiropractic.com.

Hours: Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun.

We take walk-ins and same-day appointments. We have more than 180 five-star Google reviews.

Questions patients ask

Where can I get piriformis syndrome treatment in St. Thomas?

Tradewinds Chiropractic & Wellness in Estate Thomas, just east of Charlotte Amalie, treats piriformis syndrome with soft tissue work on the muscle, adjustment of the SI joint and hip, stretching and glute strengthening. Dr. Bradley Keys examines you first to rule out a disc problem. Call (340) 690-4994.

I have buttock pain that feels like sciatica. Can a USVI chiropractor tell the difference?

Yes, that is what the exam is for. Piriformis syndrome usually has no back pain, a negative or mild straight leg raise, normal reflexes and strength, and pain when we press on the buttock or stretch the muscle. Disc sciatica starts at the spine and shows up on nerve tension testing. If the exam points to the spine we say so and manage it that way.

Why do I get deep butt pain when sitting in St. Thomas, and what helps?

Sitting compresses the piriformis and the sciatic nerve under it, and hard seats (helm seats, ferry benches, office chairs, airplane seats) make it worse. Getting up every 30 to 45 minutes, taking the wallet out of your back pocket, and a piriformis stretch help right away. Releasing the muscle and getting the hip and SI joint moving fixes the underlying cause.

How long does piriformis syndrome take to get better?

Most cases ease within a few weeks once the muscle is released, the joint is moving and stretching becomes a habit. Long-standing cases with a knotted muscle take longer, and shockwave therapy is an option there. We set a re-check date and look harder at the spine if the pain is not changing.

Should I stop sitting or exercising with piriformis syndrome?

Do not stop moving. Walking on the flat and swimming are usually fine. Cut back on long sits, hill running and deep squats until the muscle calms down, and break up any sitting you cannot avoid. We give you a stretch and glute program to do at home, and we add load back as the buttock pain settles.