Andie MacDowell’s Painful Hip Symptoms Were Actually Piriformis Syndrome—Here’s What to Know

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“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.