THE PIRIFORMIS MUSCLE

The Piriformis muscle is a tiny muscle located deep in the buttocks behind the gluteus maximus. This little muscle is just one of a group of six muscles known as the "Deep Six Lateral Rotators of the Hip" and can be the source of a big pain in your butt!

The piriformis muscle is the most superficial of the deep six lateral rotator muscles. This small muscle originates on the lateral aspect of the sacrum and inserts into the greater trochanter of the femur. The action of the piriformis muscle is lateral (external) rotation of the hip.

Piriformis syndrome, a very common condition seen by Massage Therapists, is six times more common in women than men. It can be one cause of (sciatic) low back, butt or leg pain and can often be mis-diagnosed as disc herniation or hamstring tendonitis which also presents with leg pain.

Piriformis Muscle (Red) and Sciatic Nerve (Yellow) Posterior View

Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve. The sciatic nerve is the largest nerve in the body and at it's largest point is about the width of ones thumb. The sciatic nerve originates in the low back (lumbar region) and angles toward the middle of the buttock then extends down the mid-lateral part of the leg. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the piriformis muscle or passes over the piriformis or splits and passes around the piriformis. A problem arises when the piriformis muscle becomes tight or inflamed and compresses the sciatic nerve. The symptoms of piriformis syndrome often presents as a deep aching in the low back, buttock and thigh on the involved side. Numbness or tingling or 'shooting pain' down the lateral portion of the leg.

Left: Piriformis Muscle (Red) and Sciatic Nerve (Yellow) Posterior View (Refresh browser to repeat animation)

People with an aberrant course of the sciatic nerve through the muscle seem particularly predisposed to piriformis syndrome. However, irritation and contraction of the piriformis muscle can also be a result of faulty footwear, spinal mechanics, poor posture or sitting habits, gait disturbances, or over pronation of the foot. The piriformis muscle can become shortened if the leg has been externally rotated for an extended period of time as when driving long distances with the right foot on the gas pedal, or by improper form when running or walking. Once diagnosed, treatment of the shortened muscle can commence. Specific massage treatment for the piriformis muscle is often very effective but stretching of the piriformis muscle can also reduce or control the aches and pains of a shortened muscle.

Piriformis Muscle
Posterior View

Sciatic Nerve
Posterior View

There are several ways to stretch the piriformis muscle. The most familiar stretch for the piriformis is the following:

To Stretch the RIGHT piriformis muscle…

Instructions:

  1. Start by lying on your back with your legs bent.
  2. Cross your RIGHT leg over your left so your right ankle rests about midway up the thigh (your left foot still on the floor) in a figure four position.
  3. Push your RIGHT knee away from you until your arm is straight.
  4. Alternatively, you can grab the shin of your left leg and pull it up off the floor toward your chest while pushing your RIGHT knee away from your body.
  5. To stretch the Left Piriformis muscle, switch sides and repeat. (Substitute LEFT for RIGHT and vice-versa where indicated.)

Note:
All stretches should be performed slowly, concentrating on the muscle being stretched. A stretch should feel like a stretch and should not 'hurt'. Do not 'bounce' a stretch. A stretch should be held for a minimum of 20 seconds but preferably 30-60 seconds. Repeat stretch 3-5 times for the affected area, twice a day.

If you would like more information on the Piriformis muscle or more stretch exercises for this muscle; please contact me by email at audrey@audreysmassage.com and I will provide you with additional information and alternative methods of stretching this muscle.