physical therapy

Does stretching actually help piriformis syndrome?

I’ve been seeing several clients right now with complaints of piriformis syndrome. Most of them tried doing figure 4 stretching, pigeon stretching, etc. found online that supposedly relieves symptoms. But yet, they still didn’t get the long term results they were hoping for, and came to me for help. So let’s do a little digging for answers.

So here’s the piriformis. It runs from the front of the sacrum to the femur and it’s main job is to rotate the hip outward. The sciatic nerve runs either under the piriformis or through it. “Piriformis syndrome” occurs when the piriformis gets tight and puts tension on the sciatic nerve, causing pain in the buttocks, hamstring, and sometimes even down to the foot.

So if the piriformis is tight, then stretching should help right? Unfortunately, for some, it’s not that simple.

The underlying question is WHY is the piriformis tight? Is it actually tight, or is it actually being stretched and the overtension is causing the pressure on the sciatic nerve? When we feel tightness, we automatically think that a muscle is tight because it’s too short, so we need to stretch it to lengthen it. However, many times it’s the opposite. The position of the muscle’s attachment points are going in opposite directions, causing the muscle to be pulled at both ends and stretching it, making it feel tight.

There are several red flags that help me figure out what your problem is. When you stand, do your feet turn out or in? Does one turn out and one turn in? Is your weight distributed on the inside or outside of your feet? Do you have increased back extension? Do you stand with more weight on the right foot? Can you touch your toes? Does your ribcage stick up when you lay on your back? This information, along with physical, hands on testing will give me a really good idea of how your pelvis and femur are oriented and what approach needs to occur.

Treatment for piriformis usually entails activation of specific muscles including the internal obliques, glute medius, adductors, and hamstrings. However, special care has to be taken to assure the pelvis is in the correct position when strengthening these muscles. If not, it can aggravate symptoms instead of relieve them. That’s why I don’t recommend things like side leg kicks or clam shells right away. I like activities on hands and knees or up against the wall.

This is one of my favorite exercises I tend to give people that have piriformis syndrome. Please note that this is not always full-proof! As mentioned above, there are many reasons as to what is creating the tension, but this exercise tends to do well with most of my clients. Please note, this is a not a diagnosis or full proof treatment. Every individual is different and requires different treatments based on my clinical findings!

Wall sit with reach.

  1. Start with your back against the wall and put a ball or pillow between your knees. Your feet should be about 8-10 inches from the wall depending on your height.
  2. Flatten your back on the wall by tilting your pelvis forward (posterior pelvic tilt). Keep your weight in the middle of your foot and heel.
  3. Keep the middle of your back (bra-line) on the wall and reach forward so your upper back rounds. You should feel your side abdominals (obliques) engage. Imagine your ribs melting back into the wall.
  4. Take 4-5 deep breaths, in through your nose and out through your mouth. Keep your ribs down and work to keep your abdominals active during both the inhale and exhale. The goal is to feel your abdominals on your sides vs. in the middle of your belly.
  5. If you are having a difficult time feeling your abdominals, try breathing with a straw or balloon. The added resistance will help those muscles activate until you can learn to feel your abdominals on their own.

Do you have a pain in the butt? Feel like I might be the right fit to help you out? Learn more here about my in-person services or here for my online services!

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