Piriformis Syndrome Strength and Stretch Routine

Piriformis Syndrome Strength and Stretch Routine

Sciatic nerve
Sciatic nerve. BSIP/UIG / Getty Images

Piriformis Syndrome Strength and Stretch Routine

Piriformis syndrome occurs when the piriformis muscle, which runs from one side of your sacrum to the outside of your hip (on a knob of bone called the greater trochanter) entraps, compresses or otherwise irritates your sciatic nerve.  The sciatic nerve is the longest nerve in the body, running (and branching into smaller nerves as it does) from your lumbar and sacral areas all the way to your lower leg

To learn more about piriformis syndrome, check out my article: Piriformis Syndrome.

If you see a physical therapist for your piriformis syndrome, you'll likely get a home exercise program that targets the muscle with stretches.  

Fair enough.  Most experts believe that a tight piriformis is to blame for this uncomfortable type of sciatica.  

But it's also possible that, based on your body's routine biomechanics, your piriformis is chronically overstretched. Overstretched muscles have a tendency to tighten up, and in this case, can indeed put pressure on the sciatic nerve, and cause symptoms.

Overstretched Piriformis Syndrome

How can your piriformis muscle become overstretched, to begin with, and what does that mean when you're trying to get rid of the sciatica symptoms?

A 2010 case study published in the Journal of Orthopedic Sports and Physical Therapy reported on the program and progress of a patient with this overstretched type of piriformis syndrome.  The authors, stating that most piriformis syndrome research and treatment plans ignore the possibility that an overstretched muscle can cause this type of sciatica, observed that the patient tended to internally rotate and adduct the affected hip.

Translated this means that instead of balanced hip and leg alignment, his leg was sort of "stuck" in a turned in position that was also too close to the midline of his body. Generally, a misalignment such as this is caused by weak muscles on the sides and back of the hip, along with tight inner thigh muscles.

Related: Try these Groin and Inner Thigh Stretches

The piriformis contributes to this "stuck" position because of its location at the side of the hip (as mentioned above.)  And remember, the sciatic nerve runs under the piriformis, which means as the muscle tightens up in response to too much stretch, it can compress the nerve below it.

Hacking. C., Jones, J., et. al. Sciatic nerve. Radiopaedia.org website. Accessed: March 2016. http://radiopaedia.org/articles/sciatic-nerve-1

Tonley, J., DPT., et. al. Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report. Journal of Orthopedic and Sports Physical Therapy. Feb 2010. Accessed: March 2016. http://www.jospt.org/doi/pdf/10.2519/jospt.2010.3108

Add Strengthening to Your Piriformis Program

Ab exercise with hip sretch
Ab exercise with hip sretch. Dorling Kindersley / Getty Images

To mitigate, the therapists devised a 3-phase strengthening program.  The first phase consisted of two exercises you can learn about on the following pages.  If you think you have an overstretched piriformis (which makes the muscle tighten up) consider adding one or both of these to any stretching routine you may be doing for your tight piriformis.

If you're just getting started, or you have a lot of pain, you might try this easy stretching routine for piriformis syndrome. Quick 'n' Easy Stretching Program for Piriformis Syndrome

Do the stretches and strengtheners once or twice per day, if you can. Hold the stretches for 5-30 seconds each, and perform the strengtheners slowly to get the maximum benefit.

Hip Bridge for Piriformis Strength

Hip bridge exercise
Hip bridge exercise. Dorling Kindersley / Getty Images

Hip Bridge for Piriformis Strength

The first exercise in the patient's program was the good 'ole hip bridge.   This is done by simply lying on your back with your knees bent and your feet flat on the floor.  Then, pressing your feet into the floor, push your butt up in the air.  Stay for a few seconds, and gently come down.  Repeat up to 10 times.

Lower Extremity Alignment

The key to doing this exercises for your piriformis syndrome is to keep your lower extremities well-aligned.  Try not to allow either or both knees to knock in towards the other.  This will help you "get" the muscles at the side and back of your hip.

As the patient in the case study was progressed, the therapists gave him a more challenging version of the bridge.  They had him put an exercise band around his thighs, and instructed him to push out against the band as he brought his hips up and down.

Related:  Take your Hip Bridge to the Next Level

Side Lying Clam Shells for Piriformis Syndrome

Clams shells and leg lifts
Clams shells and leg lifts. Ruth Jenkinson / Getty Images

Side Lying Clam Shells for Piriformis Syndrome

The other exercise given to the patient with the overstretched type of piriformis syndrome was a beginner's strengthener known as the side-lying clam shell.  All you do for this one is lie on your side comfortably, with one hip/leg stacked on top of the other.  

Keeping your top foot on top of your bottom, lift just your top knee up to point towards the ceiling.  Then slowly bring it back down to the start position.  You should feel this right in the piriformis muscle.

A slightly more challenging exercise that is similar to the claim in what it does is the side lying leg lift, shown above.

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