Month: July 2017

Many people suffer from lower back pain that spreads downward to the limbs and feet. This can often be alleviated by doing a deep piriformis stretch – a stretch that releases tight piriformis muscles, and relaxes the sciatic nerve.

Constriction of the piriformis muscle can irritate the sciatic nerve because they lay in close proximity to each other. By irritating the sciatic nerve, the result is pain (either in the lower back or thigh), numbness and tingling along the back of the leg and into the foot.

What Is The Piriformis?

The piriformis muscle is a small muscle located deep in the buttock, behind the gluteus maximus. It connects the spine to the top of the femur and allows incredible flexibility in the hip region (it’s the main muscle that allows for outward movement of the hip, upper leg and foot from the body).

The sciatic nerve passes underneath this muscle on its route to the posterior thigh. However, in some individuals, the sciatic nerve can actually pass right through the muscle, leading to sciatica symptoms caused by a condition known as piriformis syndrome.

Unfortunately, for a lot of individuals, their sciatic nerve passes through the piriformis muscle, leaving them with pain that just won’t go away (as well as poor mobility and balance).

Causes of Piriformis Syndrome

The exact causes of piriformis syndrome are unknown. The truth is, is that many medical professionals can’t determine a cause, so they cannot really diagnose it. Even with modern imaging techniques, the piriformis is difficult to identify.

Lower back pain caused by an impinged piriformis muscle accounts for 6-8% of those experiencing back pain (1).

Suspected causes of piriformis syndrome include (2):

– Tightening of the muscle, in response to injury or spasm – Swelling of the piriformis muscle, due to injury or spasm – Irritation in the piriformis muscle itself – Irritation of a nearby structure such as the sacroiliac joint or hip – Bleeding in the area of the piriformis muscle

Any one of the above can affect the piriformis muscle, as well as the adjacent sciatic nerve.

Also, a misaligned or inflamed piriformis can cause difficult and pain while sitting and when changing positions (from sitting to standing). I actually stretched too far in a yoga pose once, and irritated my piriformis muscle – this took about 1-2 years to fully heal. I had major pain while sitting, and when changing positions from sitting to standing. I remember it being a huge pain in the butt (pardon the bun), but I just stuck with stretching and trigger point release and eventually it went away.

10 Deep Piriformis Stretches

These piriformis stretches are great for alleviating pain and a triggered sciatic nerve.

It is important to note, too, that over-stretching can actually make the condition worse. Light, gentle stretching is best. “No pain, no gain” does NOT apply here. I over-stretched my piriformis and that’s what made it inflamed for 1-2 years (because I was still doing yoga daily, and over-doing it in stretches).

Make sure you warm up your muscles before you stretch, because you can create a different injury. To warm up, simply walk or march in place or climb up and down a flight of stairs slowly for a few minutes before stretching.

Exercising and stretching the piriformis is well worth it – try it now with these 10 stretches:

1. Supine Piriformis Stretch

1. Lie on your back with your legs flat.
2. Pull the affected leg toward the chest, holding the knee with the hand on the same side of the body and grabbing the ankle with the other hand.
3. Pull the knee towards the opposite shoulder until stretch is felt.
4. Hold for 30 seconds, then slowly return to starting position.

There are many variations of this stretch, but here is a good video to demonstrate:

2. Standing Piriformis Stretch

1. If you have trouble balancing, 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.
2. Lift your right foot off the ground and place the outside of your right ankle on your left knee.
3. Lean forward and lower your chest toward your knees while keeping your back straight. 4. Stop when you feel the glute stretch. 5. Hold for 30-60 seconds, then switch legs and do the same.

3. Outer Hip Piriformis Stretch

1. Lie on your back and bend the right knee.
2. Use the left hand to pull the knee over to the left side. Keep your back on the ground, and as you do so, you should feel the stretch in the hip and buttocks.
3. Hold for 20-30 seconds, and repeat on the other side.

4. Long Adductor (Groin) Stretch

1. Sitting on the floor, stretch your legs straight out, as far apart as you can.
2. Tilt your upper body slightly forward at the hips and place your hands next to each other on the floor.
3. Lean forward and drop your elbows to the floor if you can. You will feel the pelvis stretching.
4. Hold for 10-20 seconds, and release.

5. Short Adductor (Inner Thigh) Stretch

1. For this exercise, sit on the floor and put the soles of your feet together.
2. Use your elbows to apply downward pressure to your knees to increase the stretch.
3. You should feel the stretch on the inner thighs. For a deeper stretch, bend your upper torso forward with a straight back.
4. Hold for 30 seconds, release, and flutter your legs in the same position for 30 seconds.

6. Side Lying Clam Exercise

1. Lay on your side with the hip that needs help on top.
2. Bend your knees and position them forward so that your feet are in line with your spine. 3. Make sure your top hip is directly on top of the other and your back is straight.
4. Keeping your ankles together, raise the top knee away from the bottom one. Do not move your back or tilt your pelvis while doing so, otherwise the movement is not coming from your hip.
5. Slowly return the knee to the starting position. Repeat 15 times.

7. Hip Extension Exercise

1. Position yourself on all fours with your shoulders directly over your hands. Shift your weight a little off the leg to be worked.
2. Keeping the knee bent, raise the knee off the floor so that the sole of the foot moves towards the ceiling.
3. Slowly lower the leg, almost back to the starting position and repeat 15 times.

8. Supine Piriformis Side Stretch

1. Lie on the floor with the legs flat, and raise the affected leg by placing that foot on the floor outside the opposite knee.
2. Pull the knee of the bent leg directly across the midline of the body using the opposite hand or towel until a stretch is felt. Do not force anything and be gentle.
3. Hold the piriformis stretch for 30 seconds, then return to starting position and switch legs.
4. Aim for a total of 3 repetitions.

9. Buttocks Stretch for the Piriformis Muscle

1. Laying with your stomach on the ground, place the affected foot across and underneath the trunk of the body so that the affected knee is on the outside.
2. Extend the non-affected leg straight back behind the body and keep the pelvis straight. 3. Keeping the affected leg in place, move your hips back toward the floor and lean forward on the forearms until a deep stretch it felt.
4. Hold for 30 seconds, and then slowly return to starting position. Aim for a total of 3 stretches.

10. Seated Stretch

1. In seated position, cross your right leg over your left knee.
2. Bend slightly forward, making sure to keep your back straight.
3. Hold for 3-60 seconds and repeat on the other side.

Trigger Points and The Piriformis Muscle

There are many other natural and highly effective remedies for sciatic nerve pain. Trigger point therapy is one of them, and truly one of the best.

According to Myofascial Pain and Dysfunction: The Trigger Point Manual, written by doctors Janet Travell and David Simons, myofascial trigger points (tiny knot contractions) in overworked gluteus minimus and piriformis muscles in the buttocks are the main cause of sciatica and all the symptoms that come with it.

Picking up a copy of the book, or even following instruction in the video below can help release these knot contractions.

Hip and lower back pain can come as a result of an irritation of the sciatic nerve. This pain can spread downwards and can affect the limbs and the feet. It is something many people suffer from, and the pain can affect your daily routine.

The sciatic nerve is located deep in the buttock. Because of its vicinity to the piriformis muscle, constriction or swelling of the muscle may lead to irritation of the nerve and pain.

This muscle connects the top of the femur to the spine, and it’s the main muscle that allows for outward movement of the hip, upper leg, and foot from the body. The sciatic nerve passes beneath the piriformis muscle.

However, in many cases, the sciatic nerve passes right through the muscle and this leads to sciatica symptoms caused by what is known as piriformis syndrome. This leaves them with pain in the lower back and hip region that won’t go away, and this eventually contributes to poor movement and balance.

It is estimated that at some point in life, 4 out of 10 people will get sciatica or an irritation of the sciatic nerve.

The leading cause of sciatica is, as mentioned earlier, constriction in the piriformis muscle, or swelling, both caused by an injury or spasm. Consulting your doctor is highly recommended, as there may be other more serious causes.

Sciatica treatment involves physical therapy, medications, and can even lead to surgery. The oral over-the-counter medications given to people who suffer from sciatica pain include acetaminophen, aspirin, or NSAIDs (ibuprofen, ketoprofen, or naproxen).

Patients can also be given muscle relaxants, antidepressants for chronic lower back pain, and pain medications for more severe pain.

In other words, if the whole treatment is taken into account, the therapy can last for as long as the nerve is irritated. This means that if you don’t do something extra about your sciatica, you will most likely spend years on medications.

Exercises for alleviating sciatica pain

Serving as pain relief exercises, there are some piriformis stretches that you can try. It’s important to note that you must stay within the comfort limits. This means that in this case, no pain IS gain. If you take it even a bit further, you may complicate your condition.

Also, before you stretch you must warm up. You can do this by taking a walk, marching in place, or climbing up and down a flight of stairs slowly. Whatever warm-up activity you choose, you will need to do it a few minutes before starting the stretches.

After you’re done with the warm-up, here are the 10 piriformis stretches for sciatica relief – they are worth it.

Please note that these exercises must be done within the comfort zone of your body. Any unnecessary pain can lead to complications, so don’t overdo the stretches. 

IMPORTANT: Before starting any type of stretches and exercises, you should always consult your spine specialist first.

1. Supine Piriformis Stretch

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1. Lie down with your knees bent upwards.
2. Cross your affected leg over the other leg, by bending it upwards toward your chest.
3. Grab your knee with one hand and the ankle with the other hand and pull slowly toward the shoulder which is in line with your ankle – until you feel a stretch through the glutes in the buttock.
4. Hold for 30 seconds to a minute and release.

Note that you shouldn’t feel a pinch in the front of your thigh. If you do, you will need to stretch your hip flexors first.

If you don’t feel a stretch in the glutes, you cross your legs as in step 2 and pull the leg which is sitting on the floor by grabbing behind your thigh and pulling the leg toward your chest.

Here’s a video to demonstrate:

2. Standing Piriformis Stretch

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Another exercise good for sciatica pain relief is the standing Piriformis stretch.

1. While standing, place the affected leg over the other leg’s knee to get what looks like the number 4.
2. Slowly lower your hips toward the ground at a 45-degree angle, while bending your standing leg’s knee appropriately.
3. Lean forward with your torso and extend your arms parallelly to the ground, while keeping your spine straight at all times.
4. Hold for 30-60 seconds, and switch legs when done.

If you have trouble balancing, you can stand with your back against a wall and distance your feet from the wall by 24 inches. Use the wall as support and follow the steps above.

3. Outer Hip Piriformis Stretch

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1. Lie on your back and bend the affected leg upward by placing your foot close to the back of the other leg’s knee.
2. Tuck your foot behind the other leg’s knee and twist your leg to the opposite side with the knee facing or touching the ground.
3. Place the hand which is on the side where the knee is (if you’re stretching your right leg, place the left hand on the knee) and raise the other arm in the air.
4. Slowly start lowering your other arm toward the opposite direction of the knee, with the intent to touch the shoulder to the ground.
5. Stay like that for 20 seconds and switch legs.
6. Return to the lying position and stretch both legs. Bend the two knees together and gently pull them with your hands toward your chest.

You won’t be able to touch your shoulder to the ground at first, and don’t try to achieve that with try 1. The purpose of this exercise is to achieve a stretch in the piriformis muscle, and any stretch that is comfortable is enough.

4. Long Adductor (Groin) Stretch

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1. Sit on the floor and stretch your legs straight out and as far apart as you can.
2. Gently tilt your torso forward toward the ground and place your hands on the floor next to each other.
3. Try to touch your elbows to the ground by gently leaning forward. You should tilt forward as long as you feel a comfortable stretch and stop if you feel any pain.
4. Hold for 10 to 20 seconds and release.

If you feel pain in other parts of your legs, such as behind your knees, or your thighs, you should do some other leg stretches before attempting this stretch.

5. Short Adductor (Inner Thigh) Stretch

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1. While sitting on the ground, put the soles of your feet together in front of your pelvis.
2. Hold your ankles with the opposite hands (left hand – right ankle and vice versa).
3. Gently push downward with your knees with the effort to touch the ground with them. You need to stop right before any pain occurs, which means that if you feel pain, get back an inch or two and stay there.
4. Hold for 30 seconds, release, and flutter your legs in that position (like a butterfly) for 30 seconds.

If you want a deeper stretch, you can use your elbows to push your knees down, and for an even deeper stretch, you can bend your torso forward while keeping your back straight.

6. Side Lying Clam Exercise

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1. Lay on your side, with the affected hip on top.
2. Bend your legs backward to achieve an L shape, while keeping one foot over the other and your legs parallel to each other.
3. Make sure your body and spine are not bent in any way, and that your affected hip is directly on top of the other.
4. Keeping your feet together, raise the top knee upward, while paying attention that the body remains in the original position.
5. Return the knee to the initial position slowly. Repeat 15 times.

7. Hip Extension Exercise

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1. Place your hands and knees on the ground (get on the ground on all fours). Your hands need to be in line with your shoulders.
2. Tilt your weight off the affected leg and raise the leg upward (with the knee bent) toward the ceiling.
3. Lower your leg slowly, reaching almost to the starting position. Repeat 15 times.

8. Supine Piriformis Side Stretch

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1. Lie on the ground with your back straight and your legs flat.
2. Bend the affected leg upward and place the foot on the outer side of the other leg, near the knee.
3. Using the opposite hand, gently pull the knee of the affected leg across the midline of your body until you feel a stretch. If you feel pain, loosen up the stretch.
4. Make sure you don’t lift your shoulders and hips off the ground.
5. Hold for 30 seconds, return to the starting position and switch legs. Repeat the whole process 2-3 times.

9. Buttocks Stretch for the Piriformis Muscle

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1. Position your hands and knees on the ground (all fours).
2. Bring the affected leg’s foot underneath your trunk and twist it toward the opposite side, near the hip, while pointing with the knee toward the shoulder.
3. Lower your head, until your forehead touches the ground, and lean your forearms on the ground for support.
3. Slowly stretch the non-affected leg out behind you, while keeping your pelvis straight.
4. Push your hips slightly toward the floor.
5. Hold for 30 seconds and return to the initial position slowly. Repeat 2-3 times.

10. Seated Stretch

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1. Sit on a chair and cross the affected leg over your other leg’s knee.
2. Bring your chest forward and bend slightly forward, while keeping your spine straight at all times.
3. Hold for a couple of breaths and try to bend a bit further (if you don’t feel pain).
4. Stay in this position for about 30 seconds and slowly release. Repeat with the other leg.

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