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Piriformis Syndrome Stretches & Exercises

by Jaydee Vykoukal, PT, DPT March 31, 2022 0 Comments

Woman exercise yogal ball

Piriformis syndrome exercises can help keep muscle spasms, strain, stiffness, and pain in the piriformis muscle at bay. Surrounding glute and hamstring muscles are also vulnerable to painful symptoms so having a solid exercise program that encompasses focus on these areas can help combat discomfort and get you on the path to recovery. Keep scrolling to find beneficial stretches and exercises for piriformis syndrome to add to your routine.

Piriformis Stretches

These stretches target both the piriformis muscle and surrounding lower body muscle groups to improve flexibility.

Seated Piriformis Stretch

This is the most straightforward stretch that you can do to directly address the piriformis muscle. Since it’s done in a seated position, you can do it while sitting at work or even on the couch watching TV in the evenings.

  • Sit on the edge of a chair with good upright posture
  • Bring the outside ankle of the side you want to stretch up to rest on the opposite knee
  • Let the entire leg relax and knee fall toward the floor
  • Lean slightly forward as you bend at the hips, until you feel a stretch deep in the buttocks
  • Hold for 30+ seconds for 2-3 sets on each side 
  • Remember to never force the stretch if it makes your symptoms worse

Supine Figure 4 Glute Stretch

This stretch is similar to the seated stretch above but allows more dynamic movement for addressing any specific sore areas within the piriformis muscle itself.

  • Lie on the ground with the knees bent and feet flat on the floor to get started
  • Once again, bring the ankle of the side you want to stretch to rest on the opposite bent knee/thigh
  • If your hips are extremely stiff, this position may already be enough of a stretch
  • To get a deeper stretch, lift your resting foot off the ground so that you can reach both hands behind your thigh (the thigh that is perpendicular to the floor)
  • Gently pull the thigh closer to your chest while keeping the body relaxed, particularly the upper back and neck
  • Stop when you feel a strong butt stretch and hold for 30+ seconds
  • Repeat for 2-3 sets on each leg
  • You can use a stretch strap as needed if you are having trouble reaching your thigh without straining

Supine Hamstring Stretch with a Strap

The hamstrings are often stiff and sore as piriformis syndrome progresses. This is especially true since the sciatic nerve runs in the same direction along with the hamstring muscles. Stretching this common problem area can yield some much-needed relief. 

  • Lie on your back with a stretch strap
  • Place the foot of the leg you want to stretch in the loop of the strap and secure each end with your hands
  • First, straighten the knee
  • Then, gently lift the entire leg up toward the ceiling as high as you can comfortably go
  • Continue until you feel a hamstring stretch and hold for 30+ seconds
  • Repeat for 2-3 sets on each leg
  • Do not force the stretch, especially if you experience any neurological symptoms  (shooting pain, numbness, tingling, etc) indicating that you are irritating the sciatic nerve 

You can also try this sitting on the edge of a chair. Both positions can yield a good hamstring stretch with good form. Lying on your back to stretch tends to be less irritating to the sciatic nerve and low back at least when first getting started.  

Trunk Rotations

Since the piriformis connects to the low back, the lumbar spine can also feel stiff and sore. Some gentle lower back stretches can feel great as well for addressing back pain. Start slowly with this next exercise since it does require some core strength and coordination.

  • Lie on your back with the knees bent and feet flat on the floor (knees close together or touching)
  • Lift both feet off the ground while keeping the knees bent until the hips are at approximately 90 degrees of flexion (thighs are perpendicular to the floor)
  • Place your arms out at your side as far as is needed for trunk stability
  • Then, gently rotate the knees from one side to the other- going as far as is comfortable for your back
  • If too hard, try rotating the legs while keeping the feet on the floor instead
  • Repeat for 10-15 repetitions for 2-3 sets total 

Foam Rolling

Once you’ve run through a few pain-relieving stretches, you can make even further progress with the use of a massage tool like a foam roller. Foam rolling is such a great option for the larger muscle groups in the legs and can promote further relaxation and healing when done consistently. 

  • To address the piriformis specifically, sit on of the roller on the floor
  • Rotate your body sideways so that glutes on one side are touching the roller
  • Gently roll up and down the glutes, taking care to avoid putting direct pressure on the nearby bones in the pelvis 
  • If you find a particularly sore area, stop and hold for 10+ seconds while focusing on breathing deeply and relaxing
  • Continue for 1 to 5 minutes for the best results
  • To deepen the pressure, try doing a figure 4 stretch while rolling on this area (it takes a little bit of extra coordination)

Additionally, you can roll the hamstrings and inner thigh muscles as needed too.

More Massage Techniques for Piriformis Pain

Piriformis Exercises

Weak gluteal and piriformis muscles are often sore due to overuse and can result in major imbalance of the trunk and hips when standing, walking, and running. Here are a few exercises to get the muscles back in a better state of balance.

Lateral Leg Raises

The piriformis plays an important role in hip abduction strength. Thus, being able to comfortably abduct the hip is important for restoring function and reducing pain.

  • Lie on your side with the hip you want to strengthen closer to the ceiling
  • Bend the bottom leg to stabilize your trunk while keeping the top leg straight and aligned with the rest of the body (a relatively straight line from the toes to the head)
  • Tighten your abs to keep your hips stable and prevent rotation
  • With the knee and toes pointing straight ahead and NOT up toward the ceiling, lift the upper leg sideways and up toward the ceiling- choosing a range of motion that is tolerable
  • Move the leg slowly up and down for 10-15 repetitions on each leg to feel a burn in the butt muscles
  • Repeat for 2-3 sets on each leg (not just the affected leg!)

Additionally, you can also try a clamshell exercise from this position to promote more balanced glute strength. This time, both knees are bent and you lift the top knee up toward the ceiling while keeping the feet together.

Standing Hip Abduction with a Loop Band

This is another hip abduction strength exercise that requires a little more dynamic stability and coordination. Thus, it’s a great progression for increasing your tolerance for standing activities and beyond.

  • Grab a loop band and place it around your ankles at about mid-shin
  • Stand near a wall or chair for balance if needed
  • If you can stand near a mirror for visual feedback this can help you ensure you are keeping good mechanics since it’s important that your hips stay level throughout this exercise (no dropping or tilting)
  • Tighten the abs and stand with the feet approximately hip-width apart
  • Shift your weight into one leg while you lift the other leg sideways
  • Take care to keep your toes and knee cap pointing straight forward (not rotating outward) while lifting
  • Return the foot to the ground and alternate back and forth between each foot
  • Repeat 10-15 times for 2-3 sets on each leg
  • Progress the resistance of your band as needed

Glute Bridges

The classic bridge move helps promote adequate glute activation and strength with hip extension-based movement. This exercise will help ensure a proper balance between all of the stabilizing gluteal muscles to reduce strain on the piriformis.

  • Lie on your back with the knees bent and feet flat on the floor
  • The feet should be about hip-width apart
  • The heels should be 6-12 inches from your buttocks (the closer the heels are to your butt, the more flexibility is required in your hips)
  • Tighten the abs and squeeze the butt as you lift your buttocks off the ground
  • Lift as high as is comfortable without pain or arching the back
  • Hold for 3-5 seconds before returning to the starting position with control
  • Repeat 10-15 times for 2-3 sets on each leg
  • You can progress to longer holds or single leg bridges as needed

Double Leg Taps

Weak core muscles can leave the piriformis vulnerable to more strain than it is built to endure. Thus, regular core strengthening is always good for any type of hip pain. There are a ton of options for focusing on trunk stability and strength, here is just one of many to try that is effective since it addresses the hard-to-target lower abdominals.

  • Lie on your back with your feet flat on the floor and back in neutral (flat or with a slight curve is okay)
  • Tighten your abs (while still being able to breathe and keep the upper body relaxed)
  • Lift both feet so that your hips are at 90 degrees
  • Keep your legs in this position as you alternate bringing one foot down toward the ground to tap the floor
  • As your legs move, you should be able to keep your abs tight and low back in neutral- if not you need to modify how far you are reaching
  • Alternate the legs for 10-15 repetitions on each side 
  • Repeat for 2-3 sets total

There are tons of other great options for keeping the abdominals and entire trunk strong, so don’t feel like you are stuck with only one or two options. Other favorites include planks or dead bugs.

Activity & Exercises to Avoid Piriformis Syndrome

Which activities and exercises to avoid completely depends on what is causing the pain in the first place. Common culprits include:

  • Prolonged Sitting

    Since many of us spend 8 or more hours sitting for work, recreation, and more- this is the most common aggravating position. While it may be impossible to totally avoid sitting, you can take frequent breaks and make sure that you are sitting in an ergonomic friendly position without leaning.

    How to Sit with Piriformis Pain

    How Piriformis Affects Sleep

  • Single-Leg Activity with Poor Biomechanics.

    If you stand on one leg and you notice you can’t hold your hips level (known as a Trendelenburg sign), this is a clue that your glutes are weak and the culprit of your piriformis pain. Avoid standing and balance activities that are too difficult and you can’t control the level of your pelvis.

  • Prolonged Running or Walking

    Excessive running with less than ideal mechanics can leave your piriformis feeling tight, weak, and/or painful. Review your mechanics with a movement expert like a physical therapist. They can help you assess your stride length, stride width, cadence (speed), and muscle coordination to see if anything needs to be adjusted and optimized.

Benefits of Stretches & Exercises for the Piriformis

There is a lot to be gained from a regular exercise program for the piriformis. Let’s review some of the top benefits of a home exercise program:

  • Increase blood flow to the piriformis muscle to promote relaxation, reduce inflammation, and help with healing
  • Reduced muscle tightness to decrease pressure on the nerve that causes sciatic pain
  • Pain relief
  • Promote optimal muscle balance of surrounding muscles to reduce muscle strain
  • Improve mechanics with daily activities to reduce pain with common moves like running and walking
  • The key to a long term recovery when combined with other home treatment remedies
  • Increased tolerance for the activity to allow for optimal weight management and fitness
  • Better overall health

Movement for Piriformis Pain

The body likes to move, which is why too much sitting is the most common culprit of piriformis pain. Thus, it should make sense that regular movement and activation of the trunk and hip muscles is beneficial for a sustainable recovery. Start with exercises that are pain-free and progress to more dynamic stretches and strength moves when possible. Most importantly, always focus on good form to restore hip and glute balance and ask for help as needed.

You should notice a gradual improvement in symptoms over time with a well-designed exercise program. If not, or if your symptoms get worse, it’s time to give your healthcare provider or physical therapist a call for further medical advice.

Resources:

https://www.sportsinjuryclinic.net/sport-injuries/hip-groin/buttock-pain/piriformis-syndrome-exercises

Products for Hip Pain

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Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT



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