Piriformis syndrome refers to the sciatic nerve sensations (numbness, tingling, and/or pain) that spreads from the glutes all the way down the leg [1]. Piriformis syndrome results from tension in a tight, hyperactive Piriformis muscle and the force it places on the sciatic nerve.
The sciatic nerve runs from the tailbone and down the entire leg, so symptoms of Piriformis compressing this nerve can be felt all along the leg and even in the foot.
This post shows the top Piriformis syndrome exercises for relieving tension in the Piriformis muscle so it no longer compresses the sciatic nerve - and therefore no longer radiates symptoms in your glute(s) and leg(s).
Piriformis Muscle & Nerve Compression (the root of Piriformis Syndrome symptoms) [2]
Piriformis Syndrome Pain Pattern
Piriformis Muscle Pain Pattern [1] (Sciatica not pictured)
The Piriformis muscle lies deep in the buttocks and connects from the tailbone to the femur. Piriformis functions by rotating the leg outward in external rotation.
The pain pattern above illustrates where pain felt by Piriformis muscle tension can arise, excluding sciatic "Piriformis Syndrome" symptoms. Piriformis Syndrome symptoms can be felt down the entire leg, and even into the foot.
Piriformis Syndrome Exercise 1: Massage
The goal of Piriformis syndrome exercises is to release tension and relax the Piriformis muscle. It is important to keep in mind that the Piriformis is likely extremely tight, sticky, and angry (especially if you have not done Piriformis syndrome exercises before) so it can take a bit of effort to accomplish this.
The first Piriformis syndrome exercise is to massage the muscle. Effective massage will release any rigid, stiff muscle fibers and trigger points that contribute to the tension on the sciatic nerve.
Piriformis massage and trigger point release can be done by the hands of a professional PT or massage therapist, or at home with a purposefully made tool like QL Claw. Here is QL Claw being used on the Piriformis muscle - click the link below to learn more.
Piriformis Massage with QL Claw
QL Claw below the Piriformis Muscle
Piriformis Syndrome Exercise 2: Stretch
After Piriformis syndrome exercise 1 is thoroughly complete, Piriformis will be primed and ready to stretch. Stretching the Piriformis is important to create length in the muscle so that relieves further pressure off the sciatic nerve.
There are a variety of Piriformis stretch exercises you can do, but the seated Piriformis stretch sequence below is my favorite - and generally doable for all levels.
The sequence below stretches the right-side Piriformis muscle. You may feel your Piriformis syndrome symptoms present during this exercise - that is the Piriformis tightening back on the sciatic nerve and entirely normal. If the pain is too great, go back to exercise 1 and iron out all of the knots and trigger points first.
Starting Piriformis Stretch 1 - Keep Note Of The Dashed Lines. You may already feel a Piriformis stretch sitting like this.
Piriformis Stretch 2 - Forward Lean
Piriformis Stretch 3 - Knee Pushed Down
Piriformis Stretch 4 - Knee Pulled In
It is important to work with your body and listen to your comfort level here. Everyone has a different Piriformis muscle length and glute anatomy, and one stretch may feel much better than the others. Stick to the Piriformis stretch that feels most therapeutic and lengthening for you.
Additional Piriformis Syndrome Stretch Exercise [2]
Piriformis Syndrome Exercise 3: Strength
The last set of Piriformis syndrome exercises are strengthening movements. The goal of this set of exercises is to build the glute muscles to prevent Piriformis syndrome from returning.
We want to build the entire buttocks here, not just the Piriformis. A well-functioning glute system is resilient against Piriformis syndrome, and a weak glute system is highly susceptible to developing Piriformis syndrome.
This video has a few of my favorite Gluteus Minimus & Medius exercises that are great for Piriformis syndrome as well:
Other Piriformis Syndrome Strength Exercises:
- Hip Thrust
- Single Leg Deadlift
- Fire Hydrant
- Hip Abductions
- Glute Kickbacks
Piriformis Syndrome Exercise Protocol
To put your Piriformis syndrome exercises into action, here is a general protocol to implement into your life and solve Piriformis syndrome for good.
Exercise Protocol Part 1: Week 1
1 week of massage/trigger point release, for 90 seconds per side, up 1-2 times per day.
This is a lot of volume of massage put into a short period, but often that is what it takes to fully break up and release the Piriformis muscle off the sciatic nerve.
Exercise Protocol Part 2: Week 2
1 week of stretch exercises, for 3-5 minutes per side, 2-3 times per day.
Again, this is a lot of volume, but we are combatting potentially years or decades of tension. If you work a desk job, try sitting in the seated Piriformis stretch for longer periods of time to stretch passively. *Tip: if you do this during meetings, try not to look like you are doing a Piriformis stretch... it can look like you are constipated.
Exercise Protocol Part 3: Week 3-6
4 weeks of strengthening exercises, 3-4 sets performed 2-3 times per week
At this point, you should no longer feel Piriformis syndrome symptoms. If you do, spend more time on massaging and stretching until the muscle is sufficiently off of the sciatic nerve.
Part 3 should be programmed around your lifestyle and goals. If your goal is to be an Olympic weightlifter, you should be training the glutes hard and heavy at least twice per week. If your goal is to play golf without pain, 1-2 sessions of fire hydrants per week can probably get you there.
How Do I Know My Piriformis Syndrome Exercises Worked?
Over time your sciatic Piriformis syndrome symptoms should localize closer and closer to the glute, then eventually go away.
Flexibility should improve, as well as comfort when sitting down or bending over.
Your glute muscles should activate and work better because trigger points and tension prevent muscles from working their best.
Thank you for reading Piriformis Syndrome Exercises! Leave a comment if you feel inclined, or read one of the following articles next:
Sources:
[1] Donnelly, Joseph M. Travell, Simons & Simons Myofascial Pain and Dysfunction: the Trigger Point Manual. 3rd ed., Wolters Kluwer Health, 2019.
[2] Davies, Clair, and Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. 3rd ed., New Harbinger Publications, Inc., 2013.