Piriformis Syndrome Treatment

by Slava Kolpakov

If I had to choose between the true Sciatica (caused by a bulging disk in the lower back) or the Piriformis Syndrome, I'd choose the latter any day. The PS is usually much easier to treat. It's a muscle that can be stretched and strengthened, while a vertebral disc can deteriorate with few other options for treatment outside of surgery.

I have written about the Piriformis in the past calling it the culprit in the condition I dubbed the "Yoga Butt Syndrome." If you stretch it too much, you'll know what I mean.

The Piriformis Syndrome stands for the Sciatica-like symptoms of the Sciatic nerve pain shooting down one leg. This condition, however, originates in the butt, and not in the lumbar spine.

The Piriformis attaches to the hip bone and the sacrum. It's an external  hip rotator and extensor and lies deep under the Glute. 

Typically, a short and weak Piriformis gets some unexpected exercise, is not able to handle it, and goes into a spasm, thereby entrapping the Sciatic Nerve underneath.

The Nerve is usually located under the Piriformis but sometimes can run right through the muscle as in this image. Whichever way it's entrapped, it hurts like hell.

It's also possible to send the Piriformis into a spasm and aggravate the Sciatic Nerve by prolonged sitting. Often, people report this type of condition after flying on the airplane.

How to Treat It

1. First rule of thumb: Do Not Stretch an Injury.

It's very common for people to start stretching this muscle  to the Nth degree right away. Unfortunately, stretching will only make it worse. Imagine a chronic spasm. Tugging on it will send the muscle into a deeper spasm.

First, the muscles have to be gently coaxed into a relaxed state. Stretching isn't going to do it.

See that guy on the picture - DON'T DO THAT to a spastic Piriformis!

2. Release the Spasm.

What is the cornerstone concept of Massage Therapy?

"Pressure Releases Tension"

Apply some gentle pressure to the Piriformis. You can try to do it yourself, or you can get a skilled massage therapist to release the Piriformis for you.

It's very important not to put pressure on this muscle in a stretched position. You may have seen people sitting on a LaCrosse ball with their leg in external rotation as that previous photograph. I would not recommend doing that.

Instead, apply gentle pressure to a neutral Piriformis as in Prone position (lying face down), or in Supine position with a ball underneath - as in this photo.

This one is easy enough to do yourself.

Rotate the leg at the hip in and out slowly to affect different fibers.

Even better, try to create a slack in the Piriformis with external rotation. A slack in the muscle softens the fibers thereby releasing the spasm.

This photo shows Erik Dalton (a musculo-skeletal anatomy teacher) performing a Piriformis Release. He is rotating the leg in and out, creating pressure and slack. That's the way to do it!

3. Strengthen and Stretch

Finally, once the Piriformis releases, and the Sciatic Nerve entrapment is gone, you should feel no discomfort whatsoever. 

At this point, to prevent this issue from re-occuring, it's important to strengthen and stretch the Piriformis, in that order.

First strengthening will ensure that this muscle is strong enough to handle any load. Yoga and Pilates provide multiple ways of strengthening the Piriformis with external hip rotation and extension exercises. 

Stretching should be done gently and only on healthy tissue. Cross-legged forward bends and Pigeon poses are good stretches for the Piriformis. I would recommend not holding these stretches for too long and keeping them gentle, not deep. It only takes a few seconds to reach maximum length in Piriformis during a stretch. Holding it longer than 10 seconds will start to pull at its attachments . 

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