The Pesky Piriformis

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As someone who has suffered terribly from a crippling case of sciatica in the recent past I felt compelled to get to know the culprit in order to better understand the crime.  The piriformis muscle is the most powerful player in external rotation of the leg, particularly in classical ballet.   In addition, the piriformis is responsible for abducting the femur (lifting the leg away from the midline) while the hip is in flexion, an important function to transfer one’s weight into the opposite leg while walking.  It lies beneath the gluteus maximus, nestled in with its counterparts in external rotation known as the “deep six.”  The shape of the piriformis resembles a pyramid, its namesake.

The piriformis is one of the “deep six” external rotator muscles in the hip.

What sets the piriformis apart from its fellow external rotators is that it lives above the sciatic nerve, the largest nerve in the body, instead of beneath it.  In the event that the muscle becomes inflamed, goes into spasm, or is chronically shortened, undue pressure is put upon the sciatic nerve that can result in what is commonly thought to be sciatica but is actually piriformis syndrome.  To make matters worse, in approximately 15-30% of the population the sciatic nerve actually passes through the piriformis, dividing it into two parts and increasing the chance of piriformis syndrome. Women are also believed to be at a greater risk, due to the steeper degree at which the femurs angle in to the midline from the acetabulum in female hips.

According to Gabe Mirkin, M.D., in his article aptly titled Pain in the Butt: Piriformis Syndrome: “You probably shouldn’t do any exercise that causes you to bend at the hip while keeping your knees straight, because this will stretch the sciatic nerve.” Ah-hem, Uttanasana 108 times a day, anyone?  Runners and cyclists are also good candidates for this condition due to the repetitive contraction and release of the piriformis muscles while propelling them forward through space.  Sitting at a desk or in a car with the legs apart and externally rotated are also situations that would cause contraction in the piriformis for extended periods of time, irritating to most of us as well as the sciatic nerve.

In my research on the piriformis I came across an amazing and moving article that shed a lot of light on my conundrum.   In How To Get Rid of That Pain In Your Butt by Dr. Clay Hyght, he discusses how common it is to associate symptoms of sciatica with disc herniation, but that it may not be the primary cause at all. Apparently about 50% of people over 30 have herniated disks but don’t know it, so an MRI is likely to find one.  The shots, the surgery, the money, the possible addiction to powerful pain pills, and time it takes to recover, still might not take care of the problem if it is, in fact, the pesky piriformis muscle.  Needless to say I’m glad I trusted my instincts on that one, Wahe Guru!

Before even considering surgery or other invasive treatments for prolonged sciatica, get on a steady regimen of deep, therapeutic massage and physical therapy with a body worker familiar with the elusive piriformis syndrome.  Therapeutic yoga stretches and strengthening exercises for the abdominals, hip-flexors, and pelvic floor are also recommended as piriformis syndrome exercises and treatment, since they might help to take some of the workload off the poor piriformis. An old fashioned dose of R & R wouldn’t hurt either.  Using these self-care techniques can help others, like myself, to finally establish peace in the piriformis.

Read part 2 of this article about the Pesky Piriformis.

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Kate Duyn Cariati

Kate Duyn Cariati found yoga by way of her background in dance and has been a devoted practitioner and teacher ever since. She taught in NYC for many years before moving to San Francisco to help open Laughing Lotus Yoga Center on the west coast. Kate is currently teaching at several yoga studios and athletic clubs in the LA area and is happy to be a part of such a strong yoga community. She is deeply inspired by the refreshing approach and endlessly innovative means that Yoga Tune Up® offers to share her love of yoga.

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Eugenia Wie

Thank you for shedding more light on the piriformis ‘ role in aggravating the sciatic nerve. As someone who deals with chronic sciatica, I’ve learned that not everything always stems from something pinched in my lower back and have found that addressing the piriformis has greatly helped.

Wendy Rodríguez

Thank you for sharing Kate, I had already heard that it is very common to confuse sciatica pain with piriformis syndrome, but I was not sure how it has to do with each other in an anatomical way. I also had no idea that the symptoms of sciatica can be confused with herniated disc problems, which is very common in the population. Unfortunately you go to the doctor and then they want to operate you or they give you pain relievers so strong that they basically keep you sedated and many times this only relieves the symptoms and not the… Read more »

Marta Hanrahan

When clients tell us they have sciatica its usually piriformis syndrome! There is so much to be done to help!

Amanda Kreuzer

Love this blog! My father inlaw was able to rid his dx “sciatica” through YTU and rolling out daily at 65 years old!

Gilles

Great article and good info on the piriforme. I refused surgery and choose yoga!

Kat

Thank you for such an informative article and differentiating piriformis syndrome and sciatica. I’ve been a recipient of sciatic pain due to a possible herniated disc and was prescribed a lot of stretching but no strengthening work; it’s great that you’ve highlighted this; thank you.

Maki

Kate, Thank you so much for this very informative article. Most of people who does not have this kind of information will be suffering with pain for many years. Sadly medical doctors can’t do much to help remove the cause of sciatica. I myself had several years of sciatica problem from rigorous yoga practice. For me, 10 Rolfing sessions completely fix my problem, which was lordosis(sway back) causing sciatica pain. Knowledge is a power and so as self care is a power. Now I use Alpha Balls on my back, especially on Quadratus Lumborum from the side and some Piriformis… Read more »

Rohan mudholkar

Hi Kate, I read your article on Sciatica. I have a fiend who is suffering from the same pain and was baller dancer. Would you be able to help teach some yoga tune up balls excercises and the studio you teach? I have already given her Totes yoga tube up balls

Erika E Belanger

Since I’ve never suffered for sciatica, this was very helpful… I have a lot of students that do. Good little tricks and things to think about. If the student know they have herniated disks, do these recommendations still apply?

Tracy E.

It was a good reminder to not overdo any pose like uttanasana especially if you have sciatica. It was also refreshing to read about strengthening other muscle groups like the abdominals, hip flexors and pelvic floor to take some of the imbalance off the piriformis.

Regina

I have suffered with Piriformis syndrome. Like you said my MRI showed two bulging disks, yet that wasn’t the problem. I am in that small percentage that Sciatic nerve passes through my piriformis muscle. At the time I didn’t know about YTU. Now I have a few clients that have Piriformis syndrome. I have found using the Yoga Tune Up therapy balls to have my clients aid their own bodies to heal. Also after a long trip in the car the YTU therapy balls are extremely helpful especially in my hip area to recover.

Dani Ibarra

Thank you for this informative article. I teach therapeutics and try to educate my students about the piriformis muscle. So many students I encounter suffer from sciatica pain but don’t go to the doctor, so it becomes challenging to know where their pain is actually stemming from. I’ve found so many YTU and therapeutic applications that can address these areas so they can make it through a self care/therapeutic yoga practice that does not make their condition worse. So grateful the YTU blog, it’s nice to have so many resources available to us. Thank you again!

Irene

I am guilty for self diagnosing myself with sciatica, when I probably just suffer from piriformis syndrome. Thank you for all this information. I will start with corrective exercises and YTU massage balls immediately. It is time to knead that “pesky piriformis”.

Linda Zanocco

In Pilates a great deal of time is spent rolling up and down the spine—vertebra by vertebra. Flat back forward fold is a modification for practitioners with issues such as osteoporosis—or to simply vary the exercise. I now understand why—when I’ve been in yoga classes that exclude spinal flexion—my back feels crunchy. I’ve noticed my favorite yoga instructors cue slight bend of the knees going into or out of forward fold—or they vary the motion—perhaps forward fold down—roll up and vice versa. This is the first time I’ve heard of over-stretching the sciatic nerve by bending at the hip with… Read more »

Keiko Johnson

Thank you for pointing out that such a large percentage of our over 30 population lives with asymptomatic herniated discs. One of my friends confided that she suffered with sciatica for years but resisted her doctor’s suggestions that she take steroid shots, and submit to a slew of radiating diagnostics, possibly leading to a surgical solution. I suspected that the piriformis was to blame because I too suffered for years before discovering the culprit. After two days of pigeon pose, she was pain free. Amazing. Wouldn’t it be great for doctors if Yoga Tune Up® training were a part of… Read more »

Kerstin

The home run point of this article is really that surgery shouldn’t be the go-to option for resolving issues of pain in the body that so many people think it is. I’m so thankful for everything I’ve learned about the body and how the YTU Therapy balls can help mitigate and even resolve the aches and pains and twinges that send people running to their doctor, only to receive a vague diagnosis and prescription for pain medication. The issue is never resolved, gets worse, and expensive surgeries get scheduled. Which in turn can cause further aches and pains and twinges,… Read more »