3 Piriformis Syndrome Stretches to Ease Back Pain and Sciatica

Improve Range of Motion | Reduce Pain

By Coach E

3 Piriformis Syndrome Stretches to Ease Back Pain and Sciatica

It’s estimated that up to 50% of people suffering from low back pain have a slipped, bulging or herniated disc. [1]

Lumbar disc herniation is one of the main causes of sciatica, with symptoms affecting the lower limbs like:

  • Pain
  • Tingling
  • Numbness
  • Weakness

But, there’s another lesser-known cause for these symptoms coming from a muscle known as the piriformis, which is located in the gluteal region. [2]

This causes a lot of confusion, as it appears having buns of steel can actually induce the symptoms of sciatica pain in the lower back and limbs.

Lucky for you we’re going to explain how an overworked and tight piriformis can affect your sciatic nerve. We’ll also go over 3 simple piriformis syndrome stretches to reduce your pain and improve mobility.

What is the Piriformis?

The piriformis is a flat triangular muscle originating at the anterior (front) side of the sacrum, passing through the greater sciatic foramen (opening of the pelvis) and attaching itself to the greater trochanter (top of the femur).piriformis syndrome stretches for piriformis strengthening

The piriformis has a few roles in hip function:

  1. Stabilization – securing the head of the femur to the acetabulum (hip socket) and maintaining pelvic balance when walking
  2. Abduction – Opening the legs
  3. Rotation – Internal and external rotation of the femur (thigh)

The piriformis is a unique muscle in that its function in rotation completely changes based on the position of the hip.

When the hip and femur are in neutral or extended position the piriformis acts as an external rotator.

For an example of external rotation in the neutral position, take a look at the ballerina below. You can also see external rotation in the stance made famous by silent film legend, and penguin lookalike, Charlie Chaplin.

piriformis strengthening

piriformis strengthening stretches

When the hip is flexed at 90° or above, the piriformis reverses its function and works to internally rotate the femur. This is because, when flexed, the line of pull by the piriformis is changed, illustrated in the images below.

This is because, when flexed, the line of pull by the piriformis is changed, illustrated in the images below.

piriformis syndrom stretches hip flexion(Images courtesy of learnmuscles.com)

To see what internal rotation in a flexed hip position looks like, sit down on a chair and squeeze your knees together as tight as you can while pushing your feet apart.

What is Piriformis Syndrome

To explain piriformis syndrome, we have to first look at the sciatic nerve.piriformis syndrome stretches sciatica

The sciatic is the main nerve of your lower body and connects the nervous system to the skin and muscles of the lower limbs.

The sciatic nerve passes beneath the piriformis, out through the greater sciatic foramen and all the way down the back of the leg.

When the piriformis spasms, tightens or swells up from overuse, it compresses and impinges the sciatic nerve. [3]

Think of your sciatic nerve as a hose. The function of the hose is to let water pass through and if you step on it, the hose won’t work as well as it should. This is kind of what your piriformis is doing to the sciatic nerve. When the nerve is compressed, it doesn’t function as it should and leads to uncomfortable sensations and pain.

Piriformis syndrome is also referred to as pseudo sciatica because the symptoms are similar to those caused by disc herniation and bone spurs. [4]

These symptoms include:

  • Pain in the butt
  • Radiating pain or ‘pins and needles’ down the back of the thigh, knee and calf
  • Reduced hip mobility
  • Pain during activities like running, walking, climbing stairs, etc.
  • Pain when sitting for extended periods

As symptoms of piriformis syndrome mimic sciatica, you should first rule out lumbar disc herniation or sacroiliac dysfunction as the cause before addressing the piriformis.

If you’re pain is caused by an issue with the discs, then there are a few popular exercises you’ll definitely want to avoid.

Now if you have the above symptoms, you can get a little closer to targeting the piriformis as your problem if you also test positive in the following 2 tests:

1. Tenderness or Pain in the Glute

  1. Sit down (if you’re already sitting you FAIL! j/k)
  2. Poke at the side of your butt just above where your butt meets the chair

Positive Test: you have tenderness in the area where you poke.

2. Pain When Activating the Piriformis

  1. Cross one foot over your other leg
  2. Push the knee of the leg that’s crossed down by activating the hips

Positive Test: you experience greater pain and/or an increase in your symptoms.

I first noticed the tightness of my right piriformis when training Brazilian Jiu-Jitsu…

I had my opponent in the guard and he tried to pass on my right side. I quickly threw my right leg up over his neck and worked for the triangle choke.

Unfortunately, because my right hip was so limited in external rotation, I couldn’t get my leg in the proper position to cut off the flow of blood to my opponent’s brain, so I lost it, and my opponent took side mount.

For those of you unfamiliar with BJJ, most chokes involve cutting off blood circulation to the brain, not restricting breathing by attacking the trachea.

And while it sounds vicious, another thing to note about most BJJ players is that they quickly learn to be humble, because even if you’ve got 40 pounds on your opponent, and the strength of an ox, if he’s got more skill than you, you’ll quickly realize being dominant isn’t about brute force.

I’ve definitely been on the bad side of this, but that’s a story for another day.

3 Piriformis Syndrome Stretches to Ease Sciatica and Back Pain

Stretching the muscle requires us to take it to its lengthened range (and a bit beyond).

Knowing what we know about the changing rotation functions of the piriformis, we need to apply different stretches to target both positions:

  • In neutral extension, we want to internally rotate the hip to lengthen the piriformis
  • When the hip is flexed, we want to externally rotate the hip to lengthen the piriformis

Don’t go too aggressively with piriformis syndrome stretches, or anything else that may aggravate the sciatic nerve.

If the piriformis is compressing the sciatic nerve, aggressive stretching can make the problem worse!

Standing Piriformis Step-Behind Stretch

This first stretch works to lengthen the piriformis by internally rotating the hip and femur in the neutral position.

  1. Stand tall making sure you maintain neutral posture
  2. Step one foot behind the other and internally rotate it so that your toes move inward towards your other foot and your heel rotates outward
  3. Place the heel of your other foot on the outside of the pinky toe of the foot that is internally rotated to help hold the rotated position
  4. Squeeze your quads, glutes and abs to lock your pelvis in place
  5. Grab a wall, door frame or a pole with the arm on the same side as your internally rotated leg and use it to support the stretch
  6. Turn towards the side of the internally rotated leg, just enough to feel the stretch
  7. Hold the stretch for about 30-60 seconds and repeat 2 times per side

Beginner and Advanced Piriformis Stretches

This next stretch will be your go to move for improving range of motion and lengthening the piriformis when the hip is in a flexed position.

There are two piriformis syndrome stretch progressions for you to run through. Make sure you’re comfortable doing the beginner version before moving on to the more advanced variation.

Beginner Piriformis Stretch:

Sciatica Stretches - Beginner Piriformis Stretch

  1. Sit down on a bench, or chair, with good posture making sure not to slouch or bend the spine unnaturally
  2. Cross one leg over the other so that your ankle is sitting roughly over the other knee
  3. Place your hands on the knee of the elevated leg and gently push down until you feel the stretch
  4. Maintain good posture throughout the stretch
  5. Hold the stretch for about 30-60 seconds and repeat 2 times per side

Advanced Piriformis Stretch:

piriformis syndrome stretches Advanced Piriformis Stretch

  1. Stand with a bench horizontally aligned in front of you
  2. Place one leg on the bench so that your ankle is inline with your opposite hip
  3. Using your hands on the bench to support you, gently lower your knee so that the lateral aspect of your shin and knee is flush with the bench and your rear knee is touching the ground
  4. Drive your knee into the bench by activating your hip
  5. Hold the stretch for about 30-60 seconds and repeat 2 times per side
  6. Maintain good posture and breathe comfortable throughout the stretch

Dynamic Pigeon (Advanced)

Now that you’ve been able to reduce tightness in the piriformis with static stretching, it’s time to take it one step further, and add a dynamic variation to the mix.

The benefit dynamic stretching has over static piriformis syndrome stretching is that it builds strength and stability as you move in and out of the position.

Not only is flexibility important, but piriformis strengthening will also work to reduce pain and develop proper hip function.

Make sure you run through the previous static stretches before diving into this dynamic variation to avoid aggravating the piriformis or injuring the lateral aspect of the knee.

Piriformis Syndrome Stretches Dynamic Pigeon

  1. Stand tall with a nice straight natural posture
  2. Take a step back with one leg to land in a wide lunge
  3. Place your hands on the ground in front of you for support as you lower your rear knee to the floor and your front knee laterally to the ground
  4. Keeping the weight on the outside of your front foot, and push yourself back up into the lunge
  5. Stand up by driving your front foot into the ground
  6. Make sure you move through this exercise with control so you’re not rushing through any part of it
  7. Repeat the exercise on the other side
  8. Perform anywhere from 6-10 reps per side

Piriformis syndrome can be annoying, but it doesn’t have to place limitations on your lifestyle. The 3 stretches covered in this article will improve range of motion in the hips and reduce pain caused by your piriformis impinging the sciatic nerve. Do these stretches every day as part of your warm-up, cool down or just when you need to kill some time and relieve the pain in your back and lower limbs.

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.