The piriformis muscle is located deep in the buttock, in close proximity to the sciatic nerve. When the piriformis muscle spasms or becomes tight and/or inflamed, it can cause irritation of the sciatic nerve. This irritation leads to sciatica-like pain, tingling, and numbness that run from the buttock and down the leg and sometimes into the foot.
Piriformis Syndrome vs. Sciatica
The primary symptom of piriformis syndrome is pain along the sciatic nerve, so it is often thought that piriformis syndrome causes sciatica.
However, piriformis syndrome does not originate at a lumbar nerve root, so it is not technically a radiculopathy or considered sciatica. Instead, with piriformis syndrome, the piriformis muscle causes irritation and sciatic pain further down the sciatic nerve. That said, the term sciatica is often used and understood in reference to pain caused by the piriformis muscle.
Piriformis Muscle Stretches
Stretching the piriformis muscle may be necessary to relieve the pain along the sciatic nerve that results from piriformis syndrome, and can be done in several different positions.
A number of stretching exercises for the piriformis muscle, hamstring muscles, and hip extensor muscles may be used to decrease the painful symptoms along the sciatic nerve and improve range of motion in the hips.
Stretching exercises commonly recommended to treat sciatica symptoms from piriformis muscle problems include:
- Supine piriformis stretch. Lie on the back with the legs flat. Bending the knee, pull the affected leg up toward the chest and hold behind the knee with one hand, grasping the ankle with the other hand. Leading with the ankle, pull the knee towards the opposite knee until a stretch is felt. Do not force the ankle or knee beyond a comfortable position. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of 3 stretches.
- Cross-body piriformis stretch. Lie on the back with the legs flat. Place the foot of the affected leg on the floor outside the unaffected knee. Using the opposite hand, pull the knee of the bent leg straight across the body using the opposite hand until a stretch is felt. Do not force the knee to the floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of 3 stretches.
- Knee-to-chest piriformis stretch. Lie on the back with both legs bent, then place the ankle of the affected leg on the thigh of the other leg near the knee. Using both hands, gently pull the unaffected foot off the ground until a stretch is felt in the affected buttock. Hold stretch for 30 seconds, then slowly return the foot to the ground. Aim to complete a set of 3 stretches.
- 4-point piriformis stretch. Begin on all fours. Tuck the affected leg in front of the body so the calf is essentially parallel to the shoulder. Straighten the knee of the other leg and lower the hips toward the floor until a deep stretch is felt in the affected hip. Do not force the body to touch the floor. Hold stretch for 30 seconds, then unbend the affected leg. Aim to complete a set of 3 stretches.
While typically only one piriformis muscle causes sciatic pain, it is generally advised to complete stretches in both muscles, on both sides of the pelvis. Be sure to stretch only as far as is comfortable and to stop a stretch if it causes pain; if a painful stretch is continued, it can injure the muscle further and exacerbate symptoms.