Piriformis Muscle - To Stretch or Not to Stretch

Piriformis pain is one of two most common yoga injuries. (The other one is a rotator cuff injury related to overdoing Up-dog-Down-dog transitions.)

As massage therapists, we see the Piriformis discomfort often enough that I dubbed it the "Yoga Butt Syndrome."

It's pretty consistent. A new client calls and mentions that they do yoga on a regular basis, and before they say it, I ask: "Do you have an achy discomfort in your butt?" 

"Yes!" they say surprised, "How did you know?"

I see the pattern. I also understand what happens in a yoga class and why it happens. 

You see from the image that the Piriformis is a deep muscle that lies under the Glute Maximus and attaches to the sacrum (base of the spine) and to the head of the femur (hip bone). 

When the Piriformis contracts, it pulls those two points closer together, thereby rotating the hip and the leg outward (external hip rotation). This muscle is a powerful hip rotator, but it also assists in hip extension (moves the leg backward). 

You stretch the Piriformis by doing the opposite movement of contraction: hip flexion with rotation. 

Notice it's tendinous attachment at the hip bone. That is where most injuries happen. 

Imagine the cross-legged position in yoga. The hips are in flexion, which puts a slight tug at the Piriformis attachments. They are also in external rotation, which twists the muscles, putting a little more strain at the attachments. For an average person, this should not be a problem. 

Now imagine bending forward in that cross-legged position. This takes the strain to a whole new level. You may feel a pretty good (and welcome) stretch in your butt in this cross-legged forward bend. 

Yoga practitioners like to hold that pose for a while, leaning and relaxing their body weight deeper until their forehead, or even their chest touches the floor.

What happens to the Piriformis in that position? 

It's stretched to its maximum length. It's also twisted because of the external hip rotation. 

Overtime, in response to the sustained pull, the attachments at the hip bone will start to lengthen and micro-tear. The body heals the micro-tears, but once healed, they are more susceptible to further tears. The next time you hold that pose for a long time, the tear is a little bigger. This process goes on until you have a significant irritation, and a tear, at the hip bone attachment. 

How do people try to 'fix' it? 

By stretching it more, of course.   

Is that the right thing to do? 

Absolutely not. Stretching caused it in the first place. Yet, somehow, the intuitive thing for most of us is to stretch the discomfort. Hence, it never goes away. We re-tear it every time we stretch it deeply. 

Then, how do we fix it? 

1. First off, stop stretching the Piriformis. This means: no cross-legged pose for a while, minimize forward bends. Avoid poses like the Pigeon, or the Number 4 stretch, which will insure it does not heal. 

2. Then, strengthen it. Contracting the Piriformis will help the body heal it faster. Tighten the tear and build a stronger muscle in the first place. 

3. Finally, get a massage. Your massage therapist can break up adhesions forming around the hip bone attachment, and create more blood flow to speed up healing. 

Not to Do (while healing): 

By: Slava Kolpakov


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