Piriformis Stretching Routine for Intermediates

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Intermediate Piriformis Syndrome Stretching Routine

Piriformis muscle
Piriformis muscle. SCIEPRO / Getty Images

Hip stretching is one of the best things you can do to relieve sciatica due to piriformis syndrome.  Check out this routine for intermediates.

About Piriformis Syndrome

If you have piriformis syndrome, you probably already know it can cause sciatica. 

But were you aware that piriformis syndrome is only one possible reason for nerve pain that goes down your leg?  Other causes include herniated disc, spinal stenosis, or a tumor that presses on the nerve. 

Although many people attribute their sciatica symptoms to piriformis syndrome, in the scheme of things, it is actually pretty rare. Authors of an article published in the November 2008 Journal of the American Osteopathic Association report that between six and thirty six percent of low back patients have piriformis syndrome.

But females, take heart:  You are six times as likely to get piriformis syndrome than males.

Piriformis syndrome is, in essence, a cluster of symptoms. This is the nature of any syndrome, and may be why priiformis syndrome is often confused with other diagnoses, in particular, radiculopathy.

Radiculopathy is the result of an irritated spinal nerve root, often by a herniated disc. It may cause pain, weakness, numbness and/or electrical sensations that go down one leg. Piriformis syndrome is pressure on on the sciatic nerve due to a tight butt muscle. It too, may cause pain, weakness, numbness and/or electrical sensations that go down one leg.

While radiculopathy tends to be the more serious condition, untreated piriformis syndrome may lead to changes in the sciatic nerve.

If the stretches in this and other articles on piriformis syndrome exercise don't relieve your leg pain, speak with your doctor and/or physical therapist about your symptoms. They may be due to something more serious than a tight butt muscle.

Should You Do Intermediate or Beginner Level Piriformis Stretches?

This article assumes you're past the beginner phase in terms of hip stretches and flexibility exercises. If that's not the case, you may want to start with beginner's piriformis muscle stretches.

Otherwise, consider warming up for intermediate level stretches with beginner moves. Most beginner's stretches are done in the hooklying position, a supine position where you lie on your back with your knees bent and feet flat on the floor. The hooklying position is one of the most supported positions to be in, which may help make stretching accessible for beginners and people in pain.  

Another thing that may get in your way of successfully performing intermediate level stretches is the inability to comfortably sit on the floor.

For intermediate work, ideally, you're able to sit on the floor with your spine upright, without hip or back pain. If this is not possible, it could be a sign that you need beginner stretches for the time being.

If this describes you, but you're determined to work on the intermediate level anyway, consider skipping stretch number four in this series until your hip flexibility has improved.

The next few pages offer ideas for warms ups, and then it's off to the races!

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Warm Up for Your Piriformis Muscle Stretch

Hip abductor and rotator stretch.
Hip abductor and rotator stretch.

Warm Up for Your Piriformis Muscle Stretch

As mentioned above, even though you're doing intermediate level piriformis stretches, it's still a good idea to warm up with easy moves. Try the following: 

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Piriformis Warm Up — Cross One Knee Over

Young woman exercising in gym
Austrophoto Austrophoto / Getty Images

Let's continue the supine warm up with a couple more moves before going on to more challenging positions.

In this one, you'll stretch your hips and flank, wake up your coordination abilities and work your abs — all at the same time. Ready?  Here goes:

One Knee Cross Over Stretch Instructions:

  1. Lie on your back with your knees bent and your feet flat. 
  2. Interlace your fingers behind your head.
    • Your elbows should be pointing out to the side, but don't force this if you have limitation or pain in your arms or shoulders. In that case, simply do your best.
  3. Put one ankle over the opposite knee, and then gently drop both knees towards the side of the "standing" leg, which is the leg that is receiving your ankle.
    • To ramp up the challenge, you might extend the arm that's on the same side as your "standing" leg and then bring your head and the other arm up. Aim your outstretched elbow towards the top knee. 
  4. Only go as far as you need to feel the stretch.
  5. Slowly return your head, neck, shoulders and upper back to the floor.
  6. Do up to ten reps and then repeat on the other side.

As you've likely now experienced, warm ups for intermediates are a combination of beginner stretches and variations that may add in coordination and/or strength work. It's now time to assume more challenging positions.

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Sitting Piriformis Stretch

Woman performing piriformis stretch
Woman performing piriformis stretch. Dorling Kindersley / Getty Images

This next piriformis stretch takes place in sitting. It can be done in a yoga-like fashion or simply as a stretching exercise. (The yoga version is shown on the next slide.)

Sitting Piriformis Stretch

  1. Sit upright with both legs extended in front of you.
    • One key to sitting upright while on the floor is to try to distribute your weight equally between the sitting bones.
      • Sitting bones are the two hard knobs on the bottom of your pelvis. You'll likely know them by the way they feel — with enough pressure, they can really hurt.
  2. Bend one knee and cross that lower extremity over the other, placing the foot on the floor next to, and on the inside edge of, the knee that's outstretched. Wrap your opposite arm around the bent knee. It's okay to also place your other hand on the floor behind you to help you maintain the position.
  3. Check again to be sure your weight is equally distributed between your two sitting bones.
    • This is challenging for a lot of people because as soon the hip joint has to flex, as it does when you bring your leg over to the other side, chronic piriformis muscle tension, along with tension in one or more of the other hip muscles can make you automatically lift your hip to accommodate. Don't let this happen, if possible.
      • The more well-aligned your are in this stretch, the better your results will likely be.
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Sitting Piriformis Stretch — A Version for Yogis

Woman on yoga mat performing spinal twist yoga exercise
Woman on yoga mat performing spinal twist yoga exercise. John Freeman / Getty Images

Add Challenges to the Sitting Piriformis Stretch

As stated earlier, the seated piriformis stretch can be done as a yoga pose. Extra challenge can be had by adding few simple modifications, as follows:

  1. Release the grasp on your knee.
  2. Raise the newly freed arm straight up.
    • Go just to the point of pain or limitation — don't try to push past that.
    • Don't lock your elbow joint; instead, keep a slight bend.
      • This is to protect the joint from wear and tear or strain.
    • Keeping good form in this position as described above makes the work harder.
      • It's also one of the best ways to keep your weight equally distributed between the two sitting bones.
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Stretch Your Piriformis in the Pigeon Pose

Woman practicing yoga in pigeon pose
Woman practicing yoga in pigeon pose. Hero Images / Getty Images

More Yoga — Stretch Your Piriformis in the Pigeon Pose

And finally, we come to perhaps the most intense all the piriformis muscle stretches. This one, also taken from yoga, is called pigeon pose.

  1. Start on your hands and knees
  2. Bring one leg in front of your body so that the knee is bent and the outside of the lower leg and foot is resting on the floor.
    • ​​The hip is bent, as well.
    • If possible, position your leg so that your knee is in line with your hip joint. This may not be possible if you are very tight in your hip muscles and/or iliotibial band. In that case do the best you can.
  3. Place your hands on the floor in front of you.
  4. Extend the other leg back until it is straight.
  5. Lower yourself down until your weight is on your forearms.
    • Modulate the degree of weight that goes into your forearms to help take pressure off the pose, as necessary.
  6. Breathe!
    • Try to take at least five breaths in this position.
  7. Repeat on the other side.
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Piriformis Muscle Cool Down — Both Knees to the Side

A woman in the supine position twists her spine by bringing her knees to one side.
Supine spinal twist. cirkoglu

For this intermediate level piriformis flexibility routine, you not only stretched the muscle, but you added in ab work, balance challenges and challenges to your coordination. Congratulations!

Now it's time to cool down.

  1. Resuming the supine position again, which is lying on your back with your knees bent and your feet flat on the floor.
  2. Stretch your arms out straight.
    1. Don't lock your elbows.
    2. Ideally, your arms will be at shoulder level, but be sure to adjust them lower if you experience pain.
  3. Drop both knees to one side.
    • Keep your knees at hip level or higher.
    • Keep both sides of your upper back and both arms equally contacting the floor.
      • In other words, when dropping your knees over, don't allow the arms or shoulders on the opposite side to ride up.
  4. Stay in this position between five and thirty seconds.
  5. Gently return your legs to the original "standing" position.
  6. Repeat on the other side.
  7. Repeat the entire sequence two to three times.
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