Why Modern People Suffer From Piriformis Pain — And How Collapsed Arches Quietly Create It

My dear reader,

If there is one muscle that has suffered more from modern civilisation than any other, it is the piriformis.

A small, deep, quiet muscle…

…turned into a modern-day martyr.

I see it every week in my Marylebone clinic: runners, lifters, cyclists, office workers, “very active but very stiff” people — all pointing to that deep, annoying pain in the glute, sometimes radiating down the leg like a moody nerve with trust issues.

Most of them blame:

• sitting

• running

• deadlifts

• “tight glutes”

But the real story is far more interesting — and far more elegant.

The piriformis pain pandemic starts much lower in the body.

It starts…

at the foot.

The Forgotten Connection: Your Arch → Your Hip

Let me draw the line clearly.

When the arch collapses (overpronation):

The foot rolls in →

The tibia internally rotates →

The femur follows →

The knee drifts inward →

The hip falls into internal rotation & adduction →

The pelvis shifts →

and the deep hip external rotators – especially the piriformis, together with gluteus medius and gluteus maximus – work hard to resist this inward collapse and rotational overload.

It becomes the last guard at the gate.

A small, deep stabiliser suddenly becomes responsible for:

• preventing the femur from collapsing inward

• stabilising the pelvis

• controlling excessive rotation

• keeping gait from falling apart

It was never designed for this.

So it spasms.

Tightens.

Overworks.

Becomes tender.

Presses on the sciatic nerve.

And starts your personal chapter of the modern piriformis saga.

Why This Happens So Much Today

Because our foundations — the feet — are no longer working the way nature intended.

Early humans walked barefoot on:

• uneven ground

• rocks

• slopes

• sand

• grass

• roots

• logs

• branches

Every step trained the foot intrinsics.

Every surface strengthened the arch.

Every day reinforced natural alignment.

Today?

We live on flat, hard pavements.

We wear supportive shoes that do too much.

We sit more than we walk.

We stand with weight collapsed inward.

We run in cushioned footwear that removes proprioception.

We train the glutes but forget the feet.

The result:

Foot intrinsics switch off → arches collapse → piriformis becomes the innocent victim.

Modern Piriformis Pain: The Anatomy Behind It

The piriformis has two key roles:

• External rotation of the femur (in neutral / extension)

• Helping to stabilise the hip during gait, together with the other deep rotators

But when the arch collapses and the leg keeps falling into internal rotation, the piriformis is dragged into damage-control mode. It starts to:

• contract more than it should

• work overtime through the day

• try to fight the internal rotation and pronation chain

• help stabilise the hip on every step

• compensate for underactive glutes

• absorb rotational forces it was never meant to handle alone

Imagine asking a violinist to carry a piano.

That’s what modern posture does to your piriformis.

What I See in Clinic (JANMI Pattern)

Most piriformis pain cases come with:

• overpronating feet

• weak arch stabilisers

• knee valgus (“knees falling inward”)

• APT (anterior pelvic tilt) or pelvic asymmetry

• overactive TFL

• weak glute medius

• tired deep rotators

• stiff lower back

• one-sided foot dominance

When I release the piriformis, clients feel relief — but only temporarily.

The big transformation comes when we also:

• activate foot intrinsics

• strengthen the arch

• improve glute medius

• release the calf–Achilles–plantar chain

• correct pelvic mechanics

• restore natural gait rhythm

This is the JANMI approach — treating the whole chain, not the “angry muscle”.

Why the Piriformis Suffers in Modern Life

Because every part of modern life promotes:

• collapsed arches

• foot immobility

• rotational collapse of the knee

• internal rotation of the femur

• sitting on compressed glute tissues

• weak hip stabilisers

• stiff thoracic spines

• shallow breathing (yes, breath affects hip stability too)

We are living with ancestral hips and modern shoes.

And the piriformis is the one caught in the middle.

The Good News

Once you understand the chain…

You can reverse the chain.

I see it every week:

• Unload the foot → piriformis relaxes

• Strengthen the arch → hip stabilisers activate

• Wake the glute medius → piriformis stops compensating

• Release the calf → foot alignment improves

• Mobilise the pelvis → nerve irritation drops

• Integrate natural gait → pain disappears

When the body is treated with evolutionary logic, it responds beautifully.

Paulius Jurasius

London's Postural Pain Clinic