Intermediate Piriformis Syndrome Stretching Routine

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Intermediate Piriformis Syndrome Stretching Routine

Piriformis muscle
Piriformis muscle. SCIEPRO / Getty Images

Intermediate Piriformis Syndrome Stretching Routine - Background Info You Should Know

If you have piriformis syndrome, you probably already know it can cause sciatica.  But did you know that it is only one of a number of potential things that can lead to nerve pain down your leg?  Other causes include herniated disc, spinal stenosis, or a tumor that presses on the nerve. 

Although many people attribute their sciatica symptoms to piriformis syndrome, in the scheme of things, it is actually pretty rare..  Authors of an article published in the November 2008 Journal of the American Osteopathic Association report that at least 6% of low back patients - and up to 36% - have piriformis syndrome.  (And females, take heart:  You are 6 times as likely to get piriformis syndrome than males.)

As a syndrome, this condition it presents itself as a cluster of symptoms. Possibly because of this, it is often confused with other diagnoses - in particular, radiculopathy.  Radiculopathy, if you have it, will likely be more serious for you because it is the result of an irritated spinal nerve root, often by a herniated disc.  That said, leaving your piriformis syndrome untreated, may lead to changes in your sciatic nerve.

So if the stretches in this and other articles on piriformis exercise don't relieve your leg pain, speak with your doctor and/or physical therapist about your symptoms.

To learn more about piriformis syndrome, check out my article: What is Piriformis Syndrome?

Piriformis Stretches - Should You Do the Intermediate or Beginner Version?

This article assumes you're past the beginner phase in terms of hip stretches and flexibility exercises.  If that's not the case, you may want to start with Beginner's Level Piriformis Stretching Routine.

Otherwise, consider warming up for intermediate level stretches with beginner moves. Most beginner's stretches are done in the hooklying position.  This is a supine position in which you lie on your back with your knees bent and feet flat on the floor.  The hooklying position is one of the most supported positions to be in, which helps make stretching accessible for beginners and people in pain.  

Another thing that may get in your way of successfully performing intermediate level stretches is the inability to sit on the floor.  Ideally, you're able to do so without slumping (your back.)  If you can't sit upright, start with the beginner's level.  If you still want to try the intermediate level, consider skipping stretch #4 in this series until your hip flexibility has improved enough to allow you to sit upright on the floor without pain or strain.

The next few pages give you a few ideas for warms ups, and then it's off to the races!

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Warm Up for Your Piriformis Muscle Stretch

Hip abductor and rotator stretch.
Hip abductor and rotator stretch.

Warm Up for Your Piriformis Muscle Stretch

As mentioned on the previous slide, even though you're doing intermediate level piriformis stretches, it's still a good idea to warm up with easy moves first.  You might try a few from the Beginners Routine also mentioned on the previous slide, for example:

Or try this outer hip stretch.

Related: Release Your Low Back Tension with this Easy Program

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Piriformis Warm Up - Cross One Knee Over to "Get" the Muscle and Add Abs

Young woman exercising in gym
Austrophoto Austrophoto / Getty Images

Piriformis Warm Up - Cross One Knee Over to "Get" The Hip Muscle On That Side and Challenge Your Oblique Abdominals.

Let's continue the supine warm up with a couple more moves before trying our "hands," so to speak, with more challenging positions.

In this one, you'll stretch your hips and flank, wake up your coordination and work your abs - all at the same time.  Ready?  Here goes:

Instructions:

Lie on your back with your knees bent and your feet flat.  Interlace your fingers behind your head; your elbows should be pointing out to the side (but don't force this if you have limitation or pain in your arms or shoulders.  In that case, simply do your best.)

Put one ankle over the opposite knee, and then gently drop both knees towards the side of the "standing" leg (which is the leg that is receiving your ankle.)  Only go as far as you need to feel the stretch.

 At the same time, bring your arm and head up.  Aim your outstretched elbow towards the top knee.  (To get better ab work, keep it outstretched, which means you'll have to imagine pointing the elbow toward the knee without actually doing so .)  

Slowly return your head, neck, shoulders and upper back to the floor.

Do up to 10 reps and then repeat on the other side.

As you've likely now experienced, warm ups for intermediates are a combination of beginner stretches and variations that may add in coordination and/or strength work. But in the pages that follow, you'll up the ante on the stretch by assuming other, more challenging positions.

 

Related: 7 Great Hamstring Stretches

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Sitting Piriformis Stretch

Woman performing piriformis stretch
Woman performing piriformis stretch. Dorling Kindersley / Getty Images

Sitting Piriformis Stretch

This next piriformis stretch takes place in sitting.  It can be done in a yoga-like fashion or simply as a stretching exercise.  (The yoga version is shown on the next slide.)

Sit upright with both legs extended in front of you. One key to sitting upright while on the floor is to try to distribute your weight equally between the sitting bones.  (Sitting bones are the two hard knobs on the bottom of your pelvis.  You'll likely know them by the way they feel - with enough pressure or time in the sitting position, they can hurt.)

Bend one knee and cross that lower extremity over the other, placing the foot on the floor next to (and on the inside edge of) the knee that's outstretched.  Wrap your opposite arm around the bent knee.  It's okay to also place your (other) hand on the floor behind you to help you maintain the position.

Check again to be sure your weight is equally distributed between your two sitting bones.  This is challenging for a lot of people because as soon the hip joint has to flex, as it does when you bring your leg over to the other side, chronic piriformis muscle tension, along with tension in one or more of the other hip muscles can make you automatically lift your hip to accommodate.  But don't let this happen, if possible.  The more well-aligned your are in this stretch, the better your results will likely be.

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Add Challenges to the Sitting Piriformis Stretch - A Version for Yogis

Woman on yoga mat performing spinal twist yoga exercise
Woman on yoga mat performing spinal twist yoga exercise. John Freeman / Getty Images

Add Challenges to the Sitting Piriformis Stretch

As I mentioned earlier, the seated piriformis stretch can be done as a yoga pose.  In this case, you're also adding some extra challenge by letting go of the grasp on your leg and raising one arm.

To intensify your work in this position, release the grasp on your knee, (as discussed earlier) and raise that arm straight up (but don't lock your elbow joint.)  Keeping your form in this position is what makes you work harder, and one of the best ways to ensure that is to (also discussed earlier) keep your weight weight equally distributed between the two sitting bones; otherwise, you'll likely get less stretch to the piriformis.

Related: Tips for Successful Back Healing

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Stretch Your Piriformis in the Pigeon Pose

Woman practicing yoga in pigeon pose
Woman practicing yoga in pigeon pose. Hero Images / Getty Images

Stretch Your Piriformis in the Pigeon Pose

And finally, we come to the doozie-most of all the piriformis muscle stretches.  This is another one that is taken from yoga (called the pigeon pose.) So again, be a yogini, or simply take it on as an exercise.  

Starting on your hands and knees, lower yourself down so that one leg is extended to the back.  Bend your front hip and knee.  If possible, position your leg so that your knee is in line with your hip joint.  This may not be possible if you are very tight in your hip muscles and/or iliotibial band.  In that case do the best you can.

Place your hands on the floor in front of you to help support your. weight.  You can use them to modulate how much weight goes into your hips, taking more weight onto your hands when the stretch becomes too much, and less when you think you can go deeper.

Another way to modulate the stretch is lean your trunk forward towards the floor to take the pressure off, and rising your trunk up when you think you can take more.

Related: Yoga for Back Pain

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Piriformis Muscle Cool Down - Both Knees to the Side

A woman in the supine position twists her spine by bringing her knees to one side.
Supine spinal twist. cirkoglu

Piriformis Muscle Stretch Cool Down - Both Knees to the Side

For this intermediate level piriformis flexibility routine, you not only stretched the muscle, but you added in ab work, balance challenges and challenges to your coordination.  Congratulations!.

Now it's time to cool down.  Do so by resuming a supine position again (on your back with your knees bent and your feet flat on the floor.)  Stretch your arms out straight (but don't lock your elbows.)  Ideally, your arms will be at shoulder level, but they certainly don't have to be if this causes you pain or strain.

Take both knees over to one side, but this time, keep your knees at hip level, and not lower.  Also, keep both sides of your upper back and both arms equally contacting the floor.  In other words, when dropping your knees over, don't allow the arms or shoulders on the opposite side (to where your knees are pointing( to ride up when you drop your knees.

Stay in this position between 5 and 30 seconds, then gently return your legs to the original "standing" position. Repeat on the other side.  Repeat the entire sequence 2-3 times.

Related: The 7 Best Workout Routine Hacks for People with Back Pain

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Intermediate Piriformis Stretch Sequence - Sources

Architectural view of a big library with lots of books.
Architectural view of a big library with lots of books. Carl Bruemmer / Design Pics/Perspective/Getty Images

Source:

Boyajian-O'Neill, L., D.O., Mclain, R., D.O., Coleman, M., D.O. thomas, PhD. Diagnosis and Management of Piriformis syndrome: An Osteopathic Approach. The Journal of the American Osteopathic Association. Nov 2008. Accessed April 2016. http://jaoa.org/article.aspx?articleid=2093614

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