Hip and lower back pain can come as a result of an irritation of the sciatic nerve. This pain can spread downwards and can affect the limbs and the feet. It is something many people suffer from, and the pain can affect your daily routine. Below is a list of 10 exercises for piriformis syndrome to help you get rid of your pain effectively. (1)
The sciatic nerve is located deep in the buttock. Because of its vicinity to the piriformis muscle, constriction or swelling of the muscle may lead to irritation of the nerve and pain. (2)
This muscle connects the top of the femur to the spine, and it’s the main muscle that allows for outward movement of the hip, upper leg, and foot from the body. The sciatic nerve passes beneath the piriformis muscle.
However, in many cases, the sciatic nerve passes right through the muscle and this leads to sciatica symptoms caused by what is known as piriformis syndrome. This leaves them with pain in the lower back and hip region that won’t go away, and this eventually contributes to poor movement and balance.
It is estimated that at some point in life, 4 out of 10 people will get sciatica or irritation of the sciatic nerve.
What is Piriformis Syndrome?
Piriformis Syndrome is a very painful condition that is not so common. It is a neuromuscular disorder that occurs when the sciatic nerve gets compressed by the piriformis muscle and it leads to irritation and extreme pain.
The piriformis muscle is a muscle that is flat and band-like and it is located in a person’s buttocks, near the top of the hip joint. The piriformis muscle is very important for the movement in the lower body because it has a function to stabilize the hip joint and it also rotates the thigh away from the body which makes us able to stand, walk, or run by shifting our weight from one leg to another thus maintaining balance.
The sciatic nerve, on the other hand, is a long and thick nerve in the human’s body. This nerve goes through or passes alongside the piriformis muscle, then goes down the back of the leg, and then it branches off into smaller nerves that finish in the feet. So, nerve compression can be a result of a spasm of the piriformis muscle, a condition known as piriformis sciatica.
Piriformis Syndrome Symptoms
Piriformis syndrome not always has the same symptoms, however, the most common ones include pain in the buttocks that gets more intense when a person sits, especially when the legs are crossed. Other symptoms are:
- severe pain while sitting or squatting
- pain that goes away when you move
- pain that comes from standing, sitting, or walking for more than half an hour
- pain in the opposite sacroiliac joint
- foot numbness
- pain when standing up from squatting or sitting
- pain, numbness, tingling, itching, or burning sensations from the sacrum down the back of the things that oftentimes ceases above the knee.
Piriformis Syndrome Causes
The most common causes of piriformis syndrome and sciatica pain are: hip injury, leg-length discrepancy (when one leg is shorter than the other), abnormal location and development of the sciatic nerve or the piriformis muscle, severe and harmful exercise, prolonged periods of sitting, foot problems, such as Morton’s neuroma, and so on.
The leading cause of sciatica is, as mentioned earlier, constriction in the piriformis muscle, or swelling, both caused by an injury or spasm. Consulting your doctor is highly recommended, as there may be other more serious causes.
Sciatica treatment involves sciatica nerve exercises, medications, and can even lead to surgery. The oral over-the-counter medications given to people who suffer from sciatica pain include acetaminophen, aspirin, or NSAIDs (ibuprofen, ketoprofen, or naproxen).
Patients can also be given muscle relaxants, antidepressants for chronic lower back pain, and pain medications for more severe pain.
In other words, if the whole treatment is taken into account, the therapy can last for as long as the nerve is irritated. This means that if you don’t do something extra about your sciatica, you will most likely spend years on medications.
Fast Relieve From Piriformis
Serving as pain relief exercises, there are some piriformis sciatica nerve stretches that you can try. It’s important to note that you must stay within the comfort limits. This means that in this case, no pain IS gain. If you take it even a bit further, you may complicate your condition.
Also, before you stretch you must warm up. You can do this by taking a walk, marching in place, or climbing up and down a flight of stairs slowly. Whatever warm-up activity you choose, you will need to do it a few minutes before starting the stretches.
Here Are The 10 Piriformis Sciatica Nerve Stretches Relief:
Please note that these exercises must be done within the comfort zone of your body. Any unnecessary pain can lead to complications, so don’t overdo the stretches.
IMPORTANT: Before starting any type of stretches and exercises, you should always consult your spine specialist first.
Exercises for Piriformis Syndrome (And How Long To Hold A Stretch)
1. Supine Piriformis Stretch
1. Lie down with your knees bent upwards.
2. Cross your affected leg over the other leg, by bending it upwards toward your chest.
3. Grab your knee with one hand and the ankle with the other hand and pull slowly toward the shoulder which is in line with your ankle – until you feel a stretch through the glutes in the buttock.
4. Hold for 30 seconds to a minute and release.
Note that you shouldn’t feel a pinch in the front of your thigh. If you do, you will need to stretch your hip flexors first.
If you don’t feel a stretch in the glutes, you cross your legs as in step 2 and pull the leg which is sitting on the floor by grabbing behind your thigh and pulling the leg toward your chest.
Here’s a video to demonstrate:
2. Standing Piriformis Stretch
Another exercise good for sciatica pain relief is the standing Piriformis stretch.
1. While standing, place the affected leg over the other leg’s knee to get what looks like the number 4.
2. Slowly lower your hips toward the ground at a 45-degree angle, while bending your standing leg’s knee appropriately.
3. Lean forward with your torso and extend your arms parallelly to the ground, while keeping your spine straight at all times.
4. Hold for 30-60 seconds, and switch legs when done.
If you have trouble balancing, you can stand with your back against a wall and distance your feet from the wall by 24 inches. Use the wall as support and follow the steps above.
3. Outer Hip Piriformis Stretch
1. Lie on your back and bend the affected leg upward by placing your foot close to the back of the other leg’s knee.
2. Tuck your foot behind the other leg’s knee and twist your leg to the opposite side with the knee facing or touching the ground.
3. Place the hand which is on the side where the knee is (if you’re stretching your right leg, place the left hand on the knee) and raise the other arm in the air.
4. Slowly start lowering your other arm toward the opposite direction of the knee, with the intent to touch the shoulder to the ground.
5. Stay like that for 20 seconds and switch legs.
6. Return to the lying position and stretch both legs. Bend the two knees together and gently pull them with your hands toward your chest.
You won’t be able to touch your shoulder to the ground at first, and don’t try to achieve that with try 1. The purpose of this exercise is to achieve a stretch in the piriformis muscle, and any stretch that is comfortable is enough.
4. Long Adductor (Groin) Stretch
1. Sit on the floor and stretch your legs straight out and as far apart as you can.
2. Gently tilt your torso forward toward the ground and place your hands on the floor next to each other.
3. Try to touch your elbows to the ground by gently leaning forward. You should tilt forward as long as you feel a comfortable stretch and stop if you feel any pain.
4. Hold for 10 to 20 seconds and release.
If you feel pain in other parts of your legs, such as behind your knees, or your thighs, you should do some other leg stretches before attempting this stretch.
5. Short Adductor (Inner Thigh) Stretch
1. While sitting on the ground, put the soles of your feet together in front of your pelvis.
2. Hold your ankles with the opposite hands (left hand – right ankle and vice versa).
3. Gently push downward with your knees with the effort to touch the ground with them. You need to stop right before any pain occurs, which means that if you feel pain, get back an inch or two and stay there.
4. Hold for 30 seconds, release, and flutter your legs in that position (like a butterfly) for 30 seconds.
If you want a deeper stretch, you can use your elbows to push your knees down, and for an even deeper stretch, you can bend your torso forward while keeping your back straight.
6. Side Lying Clam Exercise
1. Lay on your side, with the affected hip on top.
2. Bend your legs backward to achieve an L shape, while keeping one foot over the other and your legs parallel to each other.
3. Make sure your body and spine are not bent in any way, and that your affected hip is directly on top of the other.
4. Keeping your feet together, raise the top knee upward, while paying attention that the body remains in the original position.
5. Return the knee to the initial position slowly. Repeat 15 times.
7. Hip Extension Exercise
1. Place your hands and knees on the ground (get on the ground on all fours). Your hands need to be in line with your shoulders.
2. Tilt your weight off the affected leg and raise the leg upward (with the knee bent) toward the ceiling.
3. Lower your leg slowly, reaching almost to the starting position. Repeat 15 times.
8. Supine Piriformis Side Stretch
1. Lie on the ground with your back straight and your legs flat.
2. Bend the affected leg upward and place the foot on the outer side of the other leg, near the knee.
3. Using the opposite hand, gently pull the knee of the affected leg across the midline of your body until you feel a stretch. If you feel pain, loosen up the stretch.
4. Make sure you don’t lift your shoulders and hips off the ground.
5. Hold for 30 seconds, return to the starting position and switch legs. Repeat the whole process 2-3 times.
9. Buttocks Stretch for the Piriformis Muscle
1. Position your hands and knees on the ground (all fours).
2. Bring the affected leg’s foot underneath your trunk and twist it toward the opposite side, near the hip, while pointing with the knee toward the shoulder.
3. Lower your head, until your forehead touches the ground, and lean your forearms on the ground for support.
3. Slowly stretch the non-affected leg out behind you, while keeping your pelvis straight.
4. Push your hips slightly toward the floor.
5. Hold for 30 seconds and return to the initial position slowly. Repeat 2-3 times.
10. Seated Stretch
1. Sit on a chair and cross the affected leg over your other leg’s knee.
2. Bring your chest forward and bend slightly forward, while keeping your spine straight at all times.
3. Hold for a couple of breaths and try to bend a bit further (if you don’t feel pain).
4. Stay in this position for about 30 seconds and slowly release. Repeat with the other leg.
Piriformis Syndrome VS. Sciatica
Even though these two terms are oftentimes used as synonyms, they are not the same and they are different when it comes to their symptoms, causes, and their treatment. They both inflict pain in your leg, buttock, or lower back, but the underlying cause for the pain is different for piriformis syndrome and sciatica.
- Piriformis syndrome as I said, is a condition where your sciatic never gets compressed and irritated by your piriformis muscle. The sciatic nerve gets close to this muscle and therefore, the symptoms of piriformis syndrome can transmit to your sciatic nerve by traveling from your hip and buttock towards your leg.
- Sciatica is caused when spinal stenosis or a herniated disc compresses or irritates one or more nerve roots in your lower spine since these nerve roots are merged together and form the sciatic nerve.
And while piriformis syndrome can be a result of any changes in the anatomy of the piriformis muscle or the sciatic nerve, sitting for a long period of time, or injury of your buttock or hip, sciatica is a result of a series of problems that affect and damage the lower spinal nerve roots, such as spondylolisthesis, spinal stenosis, or herniated discs.
If the cause of the pain is piriformis syndrome, then the hip and buttock pain is more present than pain in the lower back. If the cause is sciatica, however, the pain in the leg is more prominent than the lower back pain. In sciatica, the affected leg also feels heavy. Moreover, in piriformis syndrome, when the person sits for long periods of time, the pain increases. In sciatica, the pain minimizes when the person raises the affected leg while lying down.
Piriformis Muscle Stretch And Physical Therapy
When it comes to stretching as a way of curing piriformis syndrome, there are numerous stretching exercises you can do using hip extensors or hamstring. These tools will help you relieve the pain and better your motion. Here are two simple piriformis stretches you can do:
- Lie on your back. Bent your knees while your both feet lie flat on the floor. Then, pull your right knee up to your chest, grasp it with your left hand, and then pull it towards your left shoulder. Hold the stretch for 5 seconds. Repeat with the other leg.
- Lie on your back. Bent your knees while your both feet lie flat on the floor. Rest your right leg ankle over your left leg knee. Then, pull your left thigh towards your chest. Hold the stretch for 5 seconds. Repeat with the other leg.
Do these exercises at least 3 times a day.
It is very important to stretch the hamstrings i.e the large muscle on the back of your thigh, in order to heal any type of sciatic pain. Here are 2 simple exercises that will help you do just that.
- Bring two chairs and place them face to face with each other. Then, sit on one chair and put the heel of your leg on the other chair. Then, by leaning forward, bend at your hips until you feel your thigh stretching. Then hold the stretch for 30 seconds. Repeat with the other leg.
- Lie on your back. Your legs should be straight. Then pull one leg up and straighten it by holding onto a towel that you have previously wrapped behind your foot. Pull until you feel your thigh stretching. Then, hold the stretch for 30 seconds. Repeat with the other leg.
Repeat these exercises 3 times every day.
Physical Therapy For Piriformis Syndrome
Physical therapy can be of great additional help for curing piriformis syndrome. A chiropractor, physiatrist, a physical therapist, or another qualified health practitioner, will make a program of different motion and stretching exercises designed just for you and your problem in order to help you stretch the muscle and thus decrease spasm.
Passive Techniques For Treating Sciatica
Cold And Hot Packs
Frozen or heated packs containing gels, beads, or granules have proven to be helpful in alleviating pain when you place them over the painful and sore tissue.
The hot packs can relieve the pain by relaxing the stiffness of the muscle by improving blood flow and reducing muscle tension. Cold packs, on the other hand, relieve the pain by producing a numbing effect thus reducing the swelling and the pain. Moreover, cold packs reduce the chemical reaction that causes pain and inflammation.
Apply cold or hot therapy for 15-20 minutes with a 2-hour break in between the applications. Put a towel between your body and the pack to avoid injuring your skin.
Transcutaneous Electric Nerve Stimulation (TENS)
This therapy is applying electric current directly to the sensory nerves by using a transcutaneous electric nerve stimulation unit (TENS) thus creating a tingling sensation that minimizes the pain, mostly in the lower back area.
Neuromuscular Electric Muscle Stimulation
This is a therapeutic method that uses different amplitudes and wavelengths in order to reduce the contraction of the muscle and improve its function and movement.
Finally, stretching together with physical therapy and the other passive techniques can help you get rid of sciatica pain and piriformis syndrome if you are persistent.
8 Exercises To Avoid With Piriformis Syndrome
There are also some piriformis syndrome exercises you should avoid that can aggravate your pain or irritate the piriformis muscle.
Piriformis syndrome is a nagging chronic pain condition, and the piriformis muscle gets very sensitive when the hip muscle doesn’t function or is unbalanced.
An additional trigger and tension may make the muscle spasm, even more, when you are in pain.
The pain also inhibits the muscles that play the primary role in the body, such as the gluteus maximus in this case and some other hip muscles, and will try to compensate, which leads to even greater pain and spams. There are some exercises that can aggravate the pain and make addition tension and muscle spasm.
So, let’s go for the list of the 8 exercises to avoid:
1. Avoid Sitting Exercises
If your problem is caused by sitting for long periods, you should avoid sitting exercises. If you do an exercise while sitting on a chair, you should consider an exercise that can be done while lying on the floor.
It would help if you also stopped stretching the muscle if you have been stretching it, as sometimes it may worsen the symptoms.
2. Clam Exercise
In addition, some other prescribed exercises can worsen the problem, such as Clam exercise, although it is a very popular and fantastic strengthening exercise. It is because it involves the hip’s external rotation, and this movement actually causes piriformis. This way, you activate it even more and your piriformis is already overworked. So it is always best to exercise the muscles around the piriformis, but not the piriformis itself.
When you sit on a bike and do not have back support, you put additional stress on the lumbar spine and hips. The hip flexors are the muscles that are used when cycling, but they tend to be very tight and overworked as we sit most of the time. So, the cycle bent posture exacerbates the existing hip imbalance and does additional pressure on the spine and hips.
4. Some Gym Exercises
If you are an athlete, you should avoid any exercises in a seated position, such as:
- Riding a bike
- Using a recumbent stepper
- Upper body ergometer
Also, runners should probably cut back on running and start using cross-trainers instead.
5. Exercises with high-intensity movements
Your body is not in a condition to handle any high-intensity moments, especially jumping, which can cause additional pressure on the hips. Additional plyometric exercises to avoid are:
- Stair climbing
6. Side-lying leg lift
This simple move triggers the thighs, but you can easily make a mistake and move your hip joint and not your back by rotating the leg out. This will trigger even bigger pain and make it worse.
7. Intense scratching and foam rolling
Runners and athletes should avoid intense scratching and foam rolling. of the piriformis as this will tighten the muscle even more. Try scratching just the opposite leg, gently releasing any tension of your non – painful leg.
Is Walking Good For Piriformis Syndrome?
In general, yes, but you should cut on your distance or pace if you notice that your pain aggravates.
Always Remember Pain Is The Messenger
You should monitor your progress and exercises and see how your body communicates with you. If you have reduction and pain and greater mobility, you are making progress.
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