The piriformis is a muscle that causes a problem for many people. Besides stretching this muscle, it is important to address someone’s posture and the muscular imbalances that may be leading to this persistent piriformis pain.
What is Piriformis Syndrome?
A true piriformis syndrome is a disorder that occurs when the sciatic nerve is compressed by the piriformis muscle. This causes pain and/or numbness and tingling that is felt anywhere from the buttocks down the back of the leg to the bottom of the foot. This is the pathway of the sciatic nerve. This is different than when a disc herniation is compressing the sciatic nerve.
Where is your piriformis muscle and what does it do?
Simply put, the piriformis originates on the front of your sacrum and inserts on the upper border of your greater trochanter (end of bone just above your groin crease you feel when running your fingers up the outside of your leg). The piriformis externally rotates your femur (turns your leg outwards) and abducts your leg (take it away from your midline). When your hip is flexed (bent up towards you) above 70-90 degrees, the piriformis muscle becomes an internal rotator due to the change of angle between its origin and insertion.
Why does the Piriformis become a problem?
Although the problem may involve issues elsewhere in the body, there are generally some common features:
tight piriformis muscle
tight adductors (inner thigh muscles)
When stretching these muscles, hold your stretches for 3 breaths, breathing into your tight muscles and exhaling, relaxing your tight muscles and repeat for 3 sets.
weak glutes, both gluteus maximus and gluteus medius
Work up to 30 reps with good control, exhaling on exertion. Progress to standing and more functional training once you are strong and stable in these more supported postures.
weak core muscles
Hold this posture for 10 breaths with good control before progressing to more functional movements.
mechanical control issues
This Warrior III pose is great for training your support leg. Your foot and hip have to be still, no wiggling. Your unsupported leg is working with strengthening your buttocks muscles. Erector spinae and anterior core muscles are helping to keep your upper body straight. Shoulders feel great range of motion and training to keep lots of space between your ear and your shoulder. Hold for 5 breaths.
Ideally, you want to have your upper body balanced on top of your lower body. The centre of your ear should lie above the centre of your shoulder which should lie above the middle of your outer thigh. That bone you found earlier on the outside of your upper thigh…it should lay directly above your outside ankle bone. If you find where your two collar bones join together at the centre at your sternum (breast bone), that piece should lie directly above your pubic bone. Have someone take a picture of you from the front and the side, in your normal posture, and then compare this to a picture of someone with good posture. It can be quite an eye opener!
The easier issues to address are:
stretching the piriformis and the adductors
strengthening the glutes and the core
The more challenging issues to address are:
poor foot control
poor hip control
improving overall posture awareness
Its important to find out whether you are walking on your feet efficiently. Are you an over pronator? does your foot supinate too much? are you weightbearing evenly through both feet? You might need help with this assessment.
Since your piriformis connects to your greater trochanter, which is the outer part of bone attached to your femur, it has some say in how well aligned your hip will be. A piriformis that is too tight may push the head of your femur too far forward causing alot of tension to be felt in the front of your hip as well as in your buttocks region. With your hip in this less than efficient position, movement and support for movement will be changed. Stretching your tight muscles is a great start but you must also learn how to control your hip movements so this problem not only goes away but stays away.
As you can see, there can be many more pieces to the piriformis puzzle and changing just one of them may not work or may work, but might not stay. Start with having a good, overall posture assessment and make your postural changes that are indicated. Follow with your stretches, strengthening and your movement pattern changes and this will give you the most success!