Lower back pain is very common and can be the result of a variety of causes. One of these isn’t usually the primary suspect but it occurs more often than one might think: constriction of the piriformis muscle.
This small slim muscle is behind the gluteus maximus, connecting the spine to the top of the femur. If the piriformis muscle tightens, gets pulled, becomes inflamed, or spasms, an effective piriformis stretch can restore muscle function and relieve pain.
What is the Piriformis?
The piriformis is a difficult muscle to get to—the largest muscle in the body is in front of it. The piriformis allows to move the hip, upper leg, and foot outward from the body. This muscle covers the sciatic nerve (the largest in the body) that runs from the lower back down into the legs.
In some people, the sciatic nerve runs through this muscle. Sciatica is a condition in which the sciatic nerve is pinched in some way, causing pain.
The piriformis is not only important for hip and leg movement but it is a key part of our overall balance while upright. One end of the piriformis is attached to the front part of the sacrum, the triangular bone at the base of the spine. It’s the only pelvic muscle that attaches to the front of the sacrum, providing balance between the pelvis and legs. Its counteraction with the psoas muscle at the front of the pelvis and the gluteus maximus at the back maintains stability. An impeded piriformis limits both mobility and balance.
What Causes Piriformis Syndrome?
Surprisingly, piriformis syndrome is a somewhat controversial condition in medical circles. It seems that medical professionals can’t determine a cause, so they have trouble defining and diagnosing it. The piriformis is difficult to see, even with modern imaging techniques.
The term for a collection of sciatica conditions coined in 1947, “piriformis syndrome” wasn’t identified as a specific problem. Since then, lower back pain caused by an impinged piriformis muscle has been determined a true condition in itself and accounts for 6-8 percent of experiences of lower back pain. (1)
Numbness, tingling, and/or severe pain can occur if the piriformis puts pressure on the sciatic nerve. This can manifest itself as a dull ache or shooting pains in the back, hip, buttocks, and legs. (2) Also, a misaligned or inflamed piriformis can cause difficulty and pain while sitting and when changing positions (e.g., from sitting to standing).
What a Healthy Piriformis Can Do For You
Because of its key function in hip and leg mobility, a fully functioning piriformis will not only reduce the potential for sciatica but will keep you mobile. In fact, walking, cycling, running, dancing, and many other activities require a healthy piriformis.
“Here is a way to feel the piriformis muscle at work. Stand with your feet together, your knees bent and your butt stuck out a little. Put your hands on your butt and draw your knees apart slightly. Your piriformis muscle should be working beneath your big gluteal muscles,” writes Core Walking (3)
Exercising and stretching the piriformis takes a conscious effort but it’s worth it. Following are some piriformis stretches you can do to give this often-overlooked muscle some attention:
How To Get a Deep Piriformis Stretch With These 12 Exercises
1. Supine Piriformis Stretches
A) Lying stretch
Lying on your back, place your hand on the same side of one knee, with the other hand on the raised heel.
Gently raise the knee toward your shoulder and cross the calf across your body toward the opposite shoulder.
Hold for 5 seconds, then release.
Repeat with the other leg. As you get used to this piriformis stretch, extend the holding time of the stretch up to 60 seconds.
B) Similar to A) but without the crossover:
Raise one knee and the same-side hand toward the shoulder on the same side.
Cross your calf across the body but keep the knee in line with the shoulder on the same side.
Hold for 5 seconds, then release and repeat on the other side.
C) For a deeper stretch:
While lying on your back, bend both knees and place one ankle over the opposite leg, just above the knee.
Raise the bottom leg off the floor toward your chest until you feel the pull in the pelvis.
Hold for 5 seconds.
Slowly release the lower leg back to the floor, straighten the top leg, and switch sides.
2. Standing Piriformis Stretch
This exercise will stretch your piriformis and your glutes. You’ll involve the piriformis muscle as your weight shifts and pelvic balance is engaged. Remember that your glute muscles cover the piriformis, so it’s a good idea to exercise them together rather than trying to isolate one or the other. If doing this piriformis stretch hurts your joints, skip it.
Stand with your back against a wall and walk your feet forward 24 inches. Position your knees over your ankles, then lower your hips 45 degrees toward the floor.
Lift your right foot off the ground and place the outside of your right ankle on your left knee.
Lean forward and lower your chest toward your knees while maintaining a straight back.
Stop when you feel a stretch in your glutes.
Hold for 30 to 60 seconds, then switch legs and do the same.
3. Outer Hip Piriformis Stretch
This exercise will stretch the muscles required to rotate the hip outwards.
Lie on your back and bend the right knee.
Use the left hand to pull the knee over to the left side. Keep your back on the ground as you do so. You should feel this in the hip and buttocks.
Hold the stretch for 20 to 30 seconds, repeat 3-5 times, and stretch 3 times a day.
4. Long Adductor (Groin) Stretch
Sit on the floor and stretch your legs straight out, as far apart as is comfortable.
Tilt slightly forward at the hips and place your hands next to each other on the floor, about a foot in front of your torso.
Lean forward and drop your elbows to the floor (or as far down as you can go). You will feel a stretch in the pelvis.
Hold 10-20 seconds, then release. Pause and repeat.
The legs’ adductor muscles are those of the inner thigh: long adductors attach the pelvis to the knee and short adductors go from the pelvis to the femur.
Because these muscles are connected to both the pelvis and the leg, it’s important to loosen the thighs as well as the pelvic and gluteal muscles to relieve tension in the piriformis.
5. Short Adductor (Inner Thigh) Muscle Stretch
You’ll feel this stretching exercise at the top of the inner thigh.
If you can’t yet put your feet together, place them as close together as you comfortably can and be careful with the angles of your knees.
As you incorporate it into your routine, you’ll be able to move your feet closer to your body for a more intense piriformis stretch.
Sit on the floor and put the soles of your feet together.
Use your elbows to apply a gentle downward pressure to your knees to increase the stretch.
You should feel a stretch on the inside of the thigh. For a deeper stretch, lean forward, keeping your back straight.
Hold this position for 30 seconds. Release and flutter your legs for 30 seconds.
Repeat 3-5 times in a row and stretch 3 times a day.
6. Muscle Energy Technique
This is a very effective piriformis stretch but requires a partner who should be a trained professional (massage therapist, physiotherapist, a specialist in sports medicine, etc.).
Lie on your front belly and bend one leg.
The doctor will rotate the bent leg outwards as far as it will comfortably go.
He’ll then apply gentle pressure to the piriformis as the athlete moves his/her foot from side to side for about 30 seconds.
7. Resistance Band Abduction
This is a great glute stretch. Using a resistance band increases the range of motion and provides an isometric stretch for muscles that are otherwise hard to reach. (4) Resistance bands come in different strengths so you can start with a looser one and move to a tighter one as you become more toned and accustomed to the exercise.
Stand with one end of the band tied around the right ankle and the other end attached to a fixed object, close to the floor.
Move the right leg out to the side, away from the body, keeping the knee straight.
Once you get as far as is comfortable, slowly return the leg back to the center.
Repeat 15 times and gradually build this up to 2 sets of 20 reps.
8. Side Lying Clam Exercise
Better known as a sciatica exercise, this piriformis stretch will work your glute muscles, piriformis, and loosen the lower back.
Lay on your side with the hip to be worked on top.
Bend your knees and position them forward so that your feet are in line with your spine.
Make sure your top hip is directly on top of the other and your back is straight.
Keeping the ankles together, raise the top knee away from the bottom one. Remember, don’t
move your back or tilt your pelvis; all the movement should be coming from the hip.
Slowly return the knee to the starting position. Repeat 15 times initially and gradually build up to 2 sets of 20.
9. Hip Extension Exercise
Position yourself on the floor on all fours with your shoulders directly over your hands. Shift your weight slightly off the leg to be worked.
Keeping the knee bent, raise the knee off the floor so that the sole of the foot moves towards the ceiling.
Slowly lower the leg, almost back to the starting position and repeat. Repeat 15 times initially and gradually build this up to 2 sets of 20.
This is another piriformis exercise that will stretch both pelvic and glute muscles.
10. Supine Piriformis Side Stretch
A side stretch will open up the lower back, relieving tension along the sciatic nerve.
If you are experiencing sciatica, it’s important to stretch gently so that you don’t injure or inflame the area around the nerve.
Lie on the floor with the legs flat. Raise the affected leg and place that foot on the floor outside the opposite knee.
Pull the knee of the bent leg directly across the midline of the body using the opposite hand or a towel, if needed, until a stretch is felt. Do not force the knee beyond stretch or to the floor.
Hold the piriformis stretch for 30 seconds, then slowly return to starting position.
Switch legs. Aim to complete a set of three stretches.
11. Buttocks Stretch for the Piriformis Muscle
Begin on all fours. Place the affected foot across and underneath the trunk of the body so that the affected knee is outside the trunk.
Extend the non-affected leg straight back behind the trunk and keep the pelvis straight.
Keeping the affected leg in place, scoot the hips backward towards the floor and lean forward on the forearms until a deep stretch is felt. Do not force the body to the floor.
Hold the piriformis stretch for 30 seconds, then slowly return to starting position.
Aim to complete a set of three stretches.
Stretching the glute muscles will reach into the piriformis—you’ll feel the muscles tense from back to front as you move.
This is an intense piriformis stretch and it’s easy to push too hard too fast. Take it slowly and stretch with controlled movements.
12. Seated Stretch
This is an effective lower-body piriformis stretch that will engage all muscles in your pelvis and lower back. It’s a good sciatica stretch too.
While in a seated position, cross your right leg over your left knee.
Bend slightly forward, making sure to keep your back straight.
Hold this stretch for 30-60 seconds, then repeat on the opposite side.
When exercising, it’s best to work the entire area and all connected muscles. They support each other and so they must work together. Sciatic pain that is caused by an injured or misaligned piriformis muscle can be relieved by releasing the surrounding muscles.
In the context of the stretches above, you are trying to reduce pain, not increase it. Stretch slowly and if it hurts, modify your extension or don’t do it. You should feel muscle tension but not pain when exercising. “No pain, no gain” doesn’t apply here. You can end up sending a muscle into spasm or pulling it, resulting in more pain and a longer recovery period.
“A gentle stretch relaxes the muscles, letting them release and grow longer. But too intense a stretch can actually create an inflammatory response…meaning your body is trying to repair damage. Any time you cause pain, you actually cause tissue damage,” warns Best Health Mag (5)
Holding a stretch for more than 15 seconds at a time can cut off oxygen to the muscles. The more intense the piriformis stretch, the less time you should hold it. (6)
You shouldn’t stretch cold muscles; doing so can cause injury. Do at least a moderate 5-minute warm-up first to loosen muscles and connective tissue before stretching. You can find a warm-up routine here.