3 Exercises to Address Piriformis Syndrome
Mangiarelli Rehabilitation physical therapist Sarah demonstrates three exercises to address piriformis syndrome. Piriformis syndrome is a condition that develops due to tightening of the piriformis muscle, which can irritate and compress the sciatic nerve and lead to significant pain in the buttocks, hip, lower back, and back of the leg. The piriformis muscle is a small muscle located in the gluteal region under which the sciatic nerve passes that stabilizes the hip and enables lower extremity movement. Physical therapists can relieve piriformis syndrome pain and restore normal movement and range of motion in the affected area through targeted strengthening exercises, manual therapy, and neural mobilization.
Anatomy of the Piriformis Muscle
The piriformis muscle is a flat, pyramidal-shaped muscle located in the gluteal region near the top of the hip joint. The piriformis muscle connects the lowest vertebrae of the spine with the upper part of the leg, traveling the “sciatic notch,” which is the opening in the pelvic bone that allows the sciatic nerve to travel into the leg. The sciatic nerve runs directly below the piriformis muscle in most people, although some have the sciatic nerve pass directly through the piriformis muscle.
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The piriformis muscle plays an important role in lower body movement. When there is an extension of the hip, the muscle acts primarily as an external rotator, whereas when the hip is in flexion, the piriformis acts as a hip adductor. The piriformis helps to stabilize the hip joint and lift and rotate the thigh away from the body, allowing you to walk, shift weight from one leg to the other, and maintain balance.
Understanding Piriformis Syndrome
Piriformis syndrome is a condition that develops due to tightening of the piriformis muscle, which can irritate and compress the sciatic nerve and lead to significant pain in the buttocks, hip, lower back, and back of the leg. Common symptoms of piriformis syndrome include tingling, numbness, and pain that extends from the low back to the foot; muscle spasms of the piriformis; and muscle tightening and weakness in the buttocks and low back.
Pain can be mild to severe and may worsen when sitting or when performing certain activities like lifting heavy objects or climbing stairs. Piriformis syndrome mimics sciatica symptoms: however, with piriformis syndrome, a person has difficulty sitting or putting weight on the buttocks on one side and experiences sciatica-type pain when the hip is moved and rotated outward against resistance.
Piriformis syndrome can be caused by various factors:
Injury to the piriformis muscle or the surrounding area due to an accident or during sports activity. If the leg is forced to move into an unnatural position when running or jumping, this can injure the piriformis muscle.
Overuse of the piriformis due to intense repetitive training like running or climbing stairs can increase the tension placed on the piriformis muscle, causing the muscle to tighten and spasm against the sciatic nerve.
Anatomical abnormalities like an unusually large or small piriformis muscle or having the sciatic nerve pass directly through the piriformis muscle rather than below or above it.
Abnormal spinal alignment like scoliosis that can place undue stress on the piriformis muscle
Prolonged sitting that can tighten the piriformis muscle
Weak hip and pelvic musculature that causes abnormal movement patterns that place strain on the piriformis muscle
Physical Therapy for Piriformis Syndrome
Physical therapy treatment for piriformis syndrome can include:
Pain management including ice to reduce inflammation and swelling by reducing circulation and blood flow due to constriction of blood vessels. Heat therapy is used to improve circulation and blood flow due to the dilation of blood vessels from the heat, which causes an inflow of healing nutrients, can calm painful muscle spasms, and speed up healing. Heat therapy can be useful before exercising.
Stretching exercises: Relaxing the piriformis muscle through a targeted piriformis stretch can address tightness in the piriformis and release the compression on the sciatic nerve, such as the knee to chest stretch demonstrated in the video below. Stretching the hip flexors and extensors and hamstrings can also improve range of motion in the lower back and pelvic region and relieve pressure on the piriformis.
Manual therapy: soft tissue and joint mobilizations on the lower back, hip, and pelvic region help increase blood flow to the area, reduce muscle spasms in the piriformis, and improve range of motion. A therapist may also do myofascial release to relieve tightness in the piriformis muscle.
Neural mobilization: Neural mobilization involves nerve gliding, which can help to restore normal flow of impulse through the sciatic nerve. Nerve gliding exercises involve using two joints, and movement is performed in such a way that one joint is moved causing elongation of neural structures at one end and shortening at the other end of the joint simultaneously.
Strengthening exercises: Targeted strengthening of the hip muscles is essential as weakness in the hip musculature (hip abductor and extensor muscles) can contribute to piriformis syndrome.
Aerobic training: Cardiovascular exercise such as aquatic therapy, walking, or riding a stationary bike can help to build endurance in muscle groups in the low back and pelvic area to help maintain muscular balance and increase muscular stamina. It also helps improve muscle function by increasing oxygen supply to muscles which reduces muscle tensions and improves range of motion.
Movement reeducation: Movement reeducation aims to minimize stress on the piriformis muscle and the sub-gluteal area and restore stability to the lower extremity.
Patient education: The therapist provides instruction on proper body mechanics and posture to minimize injury risk during daily and sport activities.
Mangiarelli Rehabilitation physical therapist Sarah demonstrated 3 exercises to address piriformis syndrome in the video below:
