Andie MacDowell’s Painful Hip Symptoms Were Actually Piriformis Syndrome—Here’s What to Know
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Leg and hip pain can be frustrating to navigate given that so many different things can cause it. After all, struggling with issues in these areas can be a sign of problems with everything from your mattress to a tight IT band, with plenty of potential culprits in between. Now Andie MacDowell just opened up about being diagnosed with a health condition that caused her intense hip and leg pain—and most people have never heard of it.
It’s called piriformis syndrome, and the 66-year-old said on The Drew Barrymore Show on January 23 that the pain the condition caused was so bad, she thought she would need to get a hip replacement. MacDowell said she experienced pain that “was shooting down my leg,” and suggested her exercise routine contributed to her issue—in particular, a lot of Peloton workouts, per Entertainment Weekly.
However, MacDowell said she discovered, once she got a proper diagnosis, that her “hips are fine.” She worked with a PT for exercises targeting her glutes and her hip muscles. “I just do it every day, and it doesn’t hurt anymore. It’s a miracle.”
The Four Weddings and a Funeral star’s conversation is raising a lot of questions about piriformis syndrome and what causes it. Here’s the deal.
Piriformis syndrome is related to sciatica.
Piriformis syndrome is a neuromuscular condition that happens when the piriformis muscle in the butt, which is flat and pear-shaped, pushes against the sciatic nerve, according to the Genetic and Rare Diseases Information Center (GARD). “The piriformis muscle is deep in the buttock and runs diagonally across it,” Nicholas Anastasio, MD, a physician specializing in physical medicine and rehabilitation at Mercy Medical Center in Baltimore, tells SELF. “It externally rotates your hip.” (Say, for instance, when you move your leg out to the side to step into a car.) The sciatic nerve starts outside of your spine, travels through your pelvis, into your butt, and to the back of each thigh—and the piriformis muscle “sits right on top of that,” Dr. Anastasio says.
Piriformis syndrome mainly causes sciatica, which is a broad term used to describe pain in your lower back or hip that radiates down the back of your thigh and into the leg, per the American Academy of Orthopaedic Surgeons (AAOS). “You get this deep buttock pain, and then can get nerve pain running down your leg,” Dr. Anastasio says. However, he says, unlike with sciatica, folks usually don’t have back pain with piriformis syndrome.
Piriformis syndrome can also cause other uncomfortable symptoms like tenderness, aching, tingling, and numbness in your butt, along with pain when you sit, go up stairs, walk, or run, according to GARD. In fact, according to research in BMJ Practical Neurology, the most common hallmark of piriformis syndrome is pain over the site of the piriformis muscle after sitting for just 15 to 20 minutes.
Being active and exercising can raise your risk.
At baseline, piriformis syndrome is usually caused by damage, irritation, or overuse of the piriformis muscle, according to GARD. That can make the piriformis muscle swell or tighten, putting pressure on the sciatic nerve. Again, this muscle is in your butt—so going hard with exercises that work your glutes or nearby areas could lead to piriformis syndrome.
“Cycling is a big exercise that can cause it, along with horseback riding,” Dr. Anastasio says. “Anything where you’re sitting with the hips open like a book to the outside can be problematic.” This is particularly true if your bike positioning is a little off, and your legs are rotated out when you cycle, Dr. Anastasio says. (Remember, proper positioning involves your hips tracking under your knees, and your knees over the balls of your feet). “Keeping your hips in a neutral position is safest,” he adds.
Even hip abduction machines at the gym that work the butt muscles can aggravate the piriformis muscle, he says. Finally, muscle overuse is also a big potential cause, Dr. Anastasio says. And that’s why running can also be a trigger—particularly if folks have weak glute muscles and tight upper thigh muscles, or if they skimp on stretching or strengthening, per ACSM’s Health & Fitness Journal.
“If there are imbalances in the surrounding muscles, such as weak glutes, the piriformis may overcompensate, leading to tightness and irritation,” Karen VanEtten, PT, DPT, director of Sports Medicine & Rehabilitation Services at Michigan State University. “Over time, this strain can cause microtrauma or inflammation, which places additional pressure on the sciatic nerve, especially if proper recovery or stretching isn’t prioritized.”
If you develop symptoms of piriformis syndrome, it’s important to check in with a pro—because they can help.
Dr. Anastasio stresses that piriformis syndrome isn’t overly common. In fact, it’s considered a rare condition. With that, it’s possible to be misdiagnosed when something else is behind your pain. “I’ve undiagnosed it more than I’ve diagnosed it,” Dr. Anastasio says. “A lot of people are told they have piriformis syndrome when the pain is actually from their back.”
If you do, in fact, have piriformis syndrome, your health care provider will likely recommend that you try to rest the muscle and apply ice to the area. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful, along with cortisone injections if you’re struggling, Dr. Anastasio says. “In chronic cases, Botox can help,” he says.
And—as MacDowell has learned—physical therapy can also be big. “It helps address muscle imbalances and improve posture,” Dr. VanEtten says.
In particular, strengthening (and then stretching) muscles including the piriformis, glute max (the biggest muscle in your butt), gluteus medius (a small muscle in your side-butt), hip abductors (outer thigh muscles), hip adductors (inner thigh muscles), and hamstrings (back of your thigh) is often recommended, per the AAOS. Bolstering your core can also help too says Dr. VanEtten. (Here’s some great stretches and strengthening exercises for sciatica, for instance).
To lower the risk of developing piriformis syndrome or to avoid exacerbating it in the future, Dr. Anastasio says it’s important to practice good form when you’re on a bike or riding a horse. If your bike seat tends to cause your hips to rotate out, he suggests looking for a new one that allows you to keep your hips in a more neutral position.
Finally, while it can be tough to go slow when you have a workout routine you’re excited about, it’s important to avoid going from 0 to 100—balance is definitely key, and allowing your body enough time to rest and recover between sessions is important. Dr. Anastasio says it’s crucial to gradually increase your pace and distance with exercise. “It’s important to have a gradual step-up in your intensity to prevent overuse injuries,” he says.
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Originally Appeared on Self
