This is the absolute definitive best stretch for the piriformis muscle. Anything else is not as good. We went back to the original anatomy and dissections to check how best to put a stretch on this little muscle and this is the result. The video shows how you do it.
To cut through some of the confusion about piriformis and sciatica:
(1) Most sciatica comes from a low back problem and you have to sort that out. A disc or part of a vertebra (spinal bone) pushes onto the sciatic nerve in the low back, which sends the referred pain down the sciatic nerve towards the foot.
(2) After having a low back problem for a while, you can get a SECONDARY trigger on the sciatic nerve as the piriformis goes into spasm and twangs across the sciatic nerve as it passes through the buttock. This secondary trap on the sciatic nerve can stay, even if a low back operation then sorts out the low back problem.
So from the (by then) scarred and shortened (not just spasmed) piriformis, you can get a trap on the sciatic nerve that keeps producing sciatic pain FROM THE CENTRE OF THE BUTTOCK DOWN THE LEG, even when the low back has been fixed. So the piriformis has now become the one remaining problem and needs to be fixed itself. This isn’t difficult.
(3) You can also get a SPECIFIC PIRIFORMIS PROBLEM causing sciatica, without any low back problem at all. This isn’t common – I had it myself after a climbing fall onto ice on my right buttock. I had sciatica from the centre of my right buttock down my right leg for years after that, simply from specific muscle scarring from the impact. Came through physio school in New Zealand and fixed it, and haven’t had a twinge in decades.
So, you have a tight, scarred piriformis muscle twanging across the sciatic nerve as it passes through the centre of the buttock and causing sciatic down the leg from there. This is not difficult to fix. It’s only a muscle.
There is no point in stuffing around with pain killers, pain specialists, medications, acupuncture, trigger points, gyms, exercise or eating well. They may all help a bit, but they don’t get to the core of the problem. You fix it by breaking down the scarring in the piriformis, and stretching the muscle back to normal flexibility. Duh.
You use massage to break down the scarring. This hurts a bit – the sciatic nerve is involved, after all. Massage needs to spend some time loosening up the gluteal muscle fibres over the top of the buttock. When they’ve softened up a bit the massage person can go deeper to get down to the piriformis. A good technique is to put a hot towel over the glute for five minutes, then get in and go deeper.
The piriformis also needs stretching, as shown. A four minute sustained stretch is best – we want real elongation of the tight muscle, not just a 10-second warm-up. It should be done once or twice a day. It usually takes a few weeks for the piriformis to free up reasonably.
Lastly, I do find therapeutic ultrasound also helps – say three sessions at 1.4W/sq.cm continuous for four minutes. It’s a way to use vibrations to break the adhesive fibrosis fibres in a muscle that’s so deep you can’t do that fully with massage. You still need the massage and stretching, though.
Good luck with the work.
‘Piriformis’ translates from the Latin as ‘pear-shaped’, which the muscle is. So when someone says things have gone pear-shaped, you’ll know that exactly what they mean. I love that.
This video shows a bit of practical New Zealand physio expertise. There are other bits of the body we’re covering also, especially upper backs and necks, and costochondritis. If you’ve found it useful, have a look on our YouTube channel for others, or on our website www.backpod.co.nz
Cheers, Steve August; New Zealand physiotherapist with 35 years’ experience.