Piriformis syndrome


Nurse Director
Jun 8, 2007
The North
United Kingdom United Kingdom
Basically, simply a muscle spasm with consequences, piriformis syndrome is far more common than people (including doctors) realise and really is a pain in the butt on two fronts.

First it's extremely distressing and can almost totally disable the sufferer
Secondly it can be a long term problem and difficult to treat

The piriformis is a short, very strong muscle that lies at the back of the hip joint, going from the top of the femur (thigh bone) across the hip to the pelvis. Immediately beneath it and between the muscle body and the bone, lies the sciatic nerve and all its branches. Sometimes the nerve even passes through the actual body of the muscle. It is an external rotator meaning it performs actions such as rotating the leg outwards and backwards.


When the muscles goes into spasm, the nerve is compressed between the hardened muscle and the bone which give rise to the typical symptoms of piriformis syndrome which are:
1. a sharp intense pain in the middle of the buttock that affects almost all movements including getting out of bed, rising from a chair, any bending or stretching
2. radiating pain down the sciatic pathways, commonly called sciatica, which travels down the outer side of the leg, often as far as the ankle and foot. This can sometimes be misleading and lead to suspicions of spinal issues.​


Treatment includes
rest and gentle exercises like short walks and short periods on a stationary bike with no resistance
using over the counter pain killers
icing - get a large gel pack and sit on it!
doing stretches
having treatment including massage from a physiotherapist or chiropractor​

The piriformis stretch:
lie on your back on a firm surface
bend up both legs
raise the affected leg and grasp both hands around the knee
pull the leg up across your body towards the opposite shoulder
you should feel a gentle tug in the area of the piriformis, when you experience this, pull more firmly on the leg to stretch the muscle​

Pirifomis stretch 2.JPG

To apply a little more stretch, use both legs like this

Pirifomis stretch.JPG

You can also roll on a foam bar or ball. Get it on the spot and rock back and forth like so

roller foam stretch.JPG

Piriformis can be an isolated incident or it can recur. But though extremely painful, it is not a serious condition and does not leads to surgical treatment.

NOTE: if you are a THR patient and not less than 8 weeks post op, it should be safe to do these BUT don't do them aggressively and if you get any pain in or near the actual hip joint, STOP IMMEDIATELY!
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Piriformis stretches ...


The piriformis has two broad functions. When the hip is flexed past 90 degrees, the piriformis adducts and internally rotates the femur. When hip flexion is less than 90 degrees, the piriformis abducts and externally rotates the femur.

So, there are two ways to stretch the piriformis, based on these modes of action. If the hip is flexed past 90 degrees, you abduct and externally rotate the thigh. This is the stretch that we are all familiar with.


The other option is internally rotate the thigh, with less hip flexion. That looks like this:


To deepen this stretch, move your feet away from your bottom and apart from midline. It's okay for your knees to touch when doing this stretch and I generally find that to be more comfortable.

Unfortunately, I wouldn’t consider either of these stretches to be particularly knee-friendly.

This one might be better for your knee, but not if you're pressing on it with your hand, like this guy. Press on your thigh instead, if you need to.


You can even rotate your spine, if you have some flexibility there:


With these last two stretches, try varying the flexion of the both the knee and hip to try to get the stretch where you need it.

Good luck and let me know how it goes, if you try any of these stretches. I may have some other suggestions.

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