Piriformis syndrome is an unpleasant and sometimes debilitating disorder that is thought to result from the piriformis muscle interfering with and irritating the sciatic nerve. This however, is rarely what is happening in your body. The piriformis muscle is a deep-seated muscle involved in hip movement and rotation. What is called Piriformis syndrome is characterized by pain in the buttocks of the affected side and the hip of the other side when the piriformis muscle is damaged, spasms or seizes up. It is thought that since this muscle runs directly above, or sometimes surrounds the sciatic nerve, this can cause the muscle to flatten or squeeze the nerve, causing pain, tingling, numbness, or weakness in the lower extremities. Instead, the pain is caused by many injuries over many years to the piriformis tendon and your other gluteal tendons and attachments. Check out where you are specifically tender, and you likely have more that is tender than just your piriformis tendon.
Often, the most effective ways to relieve pain and disability symptoms from a flare-up of your piriformis syndrome, as well as prevent the recurrence of symptoms, is physical therapy. To the extent that these techniques work, they unkink the fascia in your gluteal tendons and muscles. We’ve outlined 10 ways you can help ease and correct the symptoms of piriformis syndrome:
1. This one is all-around one of the most common stretches in physical therapy for back pain: Lie on your back with your knees bent, feet on the floor. Slowly bring the knee of the affected legs towards your chest with your hands while imagining your lower back sinking into the floor. Hold for at least 20 seconds.
2. Another common stretch used in back pain therapies for what is thought to be sciatica, piriformis syndrome, and other hip issues is a variation on #1. Lie on your back with your knees bent, feet on the floor. Put the ankle of the affected foot on the knee of the other. Hold in place and use your hand to pull your legs towards your chest. Imagine your lower back sinking into the floor. Hold for at least 20 seconds.
3. Four-Point Stretch: Start on all fours. Tuck the affected leg towards your chest, trying to make the leg parallel with your chest. Slowly lower your hips by pushing the other leg back and straightening it. Hold for at least 20 seconds, and do twice, but interspersed between other stretches.
4. Passive Lumbar Rotation: Lie on your back with your knees bent, feet together on the floor. Slowly, and keeping your feet and knees together, tilt your legs to one side until you feel a stretch. Hold. Repeat on the other side. Do this to an extent where you feel a stretch, but not so much that it hurts to return your knees to the neutral position.
5. Simple Seated Stretch: This stretch is basically #2, but rotated 90 degrees. Sat on a chair with your feet on the floor shoulder-width apart and your back straight, place the ankle of the affected leg on the knee of the other and slowly lean forward until you feel the stretch but it isn’t painful. Hold for 30 seconds. Try to do 2 or 3 times.
6. Another effective stretch that targets a spasming piriformis muscle directly is a standing 90-degree forward bend. Knees straight but not locked; arms hanging loose, relaxed, bend over until your chest is parallel to the floor (or as close as you can get to it). The key to getting to the piriformis muscle specifically with this stretch for relieving your back pain is to keep your spine completely straight the entire time. This stretch is also a good static exercise that will gently strengthen your lower back and girdle muscles over time, which may help prevent overloading the piriformis muscle as often in the future.
7. Hip Extension: Start on all fours. Raise the affected leg up, keeping your knee at a 90-degree angle and your back straight, including a neutral neck position. Slowly lower the leg. Do 3 sets of 10-12 reps.
8. This stretch allows you to target the injured piriformis muscle directly while also stretching your hamstrings and strengthening those lower back and girdle muscles again. Sit on the floor with your spine straight and legs out straight and together in front of you, cross the affected leg over the other one and slowly bend forward, imagining pulling your lower back towards your belly button. Hold for 10 seconds. Do 10 reps.
9. Adductor Stretches: You can do the long version of this stretch (sat with legs out straight in a wide V position) or the short version (Butterfly Stretch: sat with bottom of feet together with knees rotated outward and towards the floor). Get in position and lean forward, spine kept completely straight, until you feel the stretch but aren’t in pain. Hold for 30 seconds. Do twice, but interspersed between other stretches. Because the piriformis muscle is integral to hip rotation, sometimes stretching the hips can help your piriformis muscle release.
10. This is another hamstring-piriformis combo, and is a great addition to any physical therapy routine for back pain. Beginning in the same position as #8, slowly pull the unaffected leg towards your groin as far as is comfortable, resting the bottom of your foot against the inner thigh of the affected leg. Reach towards the affected leg, which should be straight out in front of you. Keep your lower back pulled in; you should feel this stretch in your hamstrings and buttocks, and if you can get deep enough, also your lower back on the affected side. Hold for 30 seconds. This is another one that’s good to do 2 or 3 times, but interspersed between other stretches/exercises.
Important Things to Remember with Stretches for Piriformis Syndrome
A couple last thoughts: Never stretch to the point where you’re in pain; you can damage the piriformis muscle more, as well as other muscles and tendons. Also, you may feel strange sensations while stretching. These originate from free nerve endings located in between the fascia cords and kinked strings in the muscles. Doctors are still not taught about the significance of these nerve endings. These strange sensations can feel like a nerve with burning and tingling and even numbness. Be careful, and slowly back off the stretch if you experience any of these. Our last tip for DIY physical therapy for piriformis syndrome and back pain is to be diligent about doing these stretches two or three times daily.
One of the biggest problems with most of these stretching techniques and positions, is that they try to stretch the muscle by pulling on the ends. Imagine… pain comes from a knot of fibers in the middle of the shoe lace… what happens to the knot when you pull on the ends?
You can learn more about stretching in my book: Winners’ Guide to Pain Relief. Check out our book and rubber therapy ball at our online store.