Back & Neck Pain Exercise Print Piriformis Stretching Routine for Intermediates By Anne Asher, CPT Updated August 17, 2019 Medically reviewed by a board-certified physician More in Back & Neck Pain Exercise Symptoms Causes & Risk Factors Diagnosis Treatment Living With Prevention Spinal Conditions Hip stretching is one of the best things you can do to relieve sciatica due to piriformis syndrome. If you are new to hip stretches and flexibility exercises, it's best to start with beginner's piriformis muscle stretches. Then you can progress to the intermediate exercises shown here. Piriformis syndrome can cause sciatica, but it 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. Authors of an article published in the November 2008 Journal of the American Osteopathic Association report that between 6 and 36 percent of low back patients have piriformis syndrome. Females are six times as likely to get piriformis syndrome than males. Piriformis syndrome is, in essence, a cluster of symptoms and it 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 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 for piriformis syndrome 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. 1 Warm Up for Your Piriformis Muscle Stretch Hip abductor and rotator stretch. Even though you're doing intermediate level piriformis stretches, it's still a good idea to warm up with easy moves. Try the following beginner piriformis stretches: Cross one leg overKnees to the sideOuter hip stretchEasy back releases Most beginner's stretches are done in the hook-lying position, a supine position where you lie on your back with your knees bent and feet flat on the floor. The hook-lying 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. 2 Cross One Knee Over Austrophoto Austrophoto / Getty Images Continue the supine warm up with a couple more moves before going on to more challenging positions. In the one knee cross overstretch, you'll stretch your hips and flank, wake up your coordination abilities and work your abs—all at the same time. Lie on your back with your knees bent and your feet flat. 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.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. Only go as far as you need to feel the stretch.Slowly return your head, neck, shoulders and upper back to the floor.Do up to 10 reps and then repeat on the other side. As you've likely now experienced, warmups 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. 3 Sitting Piriformis Stretch Maridav/Getty Images The sitting piriformis stretch can be done in a yoga-like fashion or simply as a stretching exercise. To do the stretching version: 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.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.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 the 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. 4 A Version for Yogis Woman on yoga mat performing spinal twist yoga exercise. John Freeman / Getty Images The seated piriformis stretch can be done as a yoga pose. An extra challenge can be had by adding a few simple modifications, as follows: Release the grasp on your knee.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 the 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. 5 Pigeon Pose Woman practicing yoga in pigeon pose. Hero Images / Getty Images The yoga Pigeon Pose is perhaps the most intense all the piriformis muscle stretches. Start on your hands and kneesBring 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.Place your hands on the floor in front of you.Extend the other leg back until it is straight.Lower yourself down until your weight is on your forearms. Modulate the degree of weight that goes into your forearms to help take the pressure off the pose, as necessary.Breathe! Try to take at least five breaths in this position.Repeat on the other side. 6 Both Knees to the 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. Resuming the supine position again, which is lying on your back with your knees bent and your feet flat on the floor.Stretch your arms out straight. Don't lock your elbows. Ideally, your arms will be at shoulder level, but be sure to adjust them lower if you experience pain.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.Stay in this position between five and thirty seconds.Gently return your legs to the original "standing" position.Repeat on the other side.Repeat the entire sequence two to three times. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Boyajian-O'Neill, L., D.O., et. al. Diagnosis and Management of Piriformis syndrome: An Osteopathic Approach. The Journal of the American Osteopathic Association. Nov 2008.