Your first question may be “How does the sacrum become torqued?” Many things can create a sacral torsion: a car accident (even a low speed fender bender), jumping out of a tree and landing on one foot slightly ahead of the other one, picking up a suitcase that’s heavier than expected, falling on your backside, etc. The interesting thing about a sacral torsion is that you can have one for years and your body will compensate to provide functional motion. You won’t have a clue there is a problem or have any back pain. Then, one day, you will bend, or twist, or simply move, and you will experience pain. The pain won’t go away and increases with passing time. You feel like you just want to push your fist hard into your butt. You may notice you sleep with your leg folded up under you. That’s your body’s way of trying to calm down the piriformis.
Ok, now to share a very effective solution. A simple Muscle Energy Technique (MET) will correct the sacral torsion. It usually takes just a few minutes. The piriformis will almost always be less tender to palpation immediately. The next step is a Strain and Counterstrain Technique to literally shorten the piriformis as much as possible and hold it there for ninety seconds. This will stop the piriformis spasm nearly 100% of the time. Now is the time to work on restoring pelvic stability so the sacrum remains biomechanically symmetrical (stays aligned and moves correctly). A very important thing for women to know is to refrain from being intimate in the common missionary position for a few weeks until the muscles have strengthened and the pelvis has become stable.
The best muscles to work are the glutes and deep hip muscles in weightbearing positions. Your glutes are the most powerful muscles in the body and muscles weaken when they are not used. Sitting weakens these muscles. If you’ve ever seen the literal pancake bottom of truck drivers you will know what I mean by this statement. No butt means an unstable pelvis and chronic back pain.
Brunswick Physical Therapy is skilled at addressing this issue; both using manual techniques (to correct the biomechanics) and functional strengthening to restore both mobility and stability.