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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Lesley

Great information to keep in mind. the other common reference that I have heard is that you should lengthen the hamstrings to help sciatic, I would probably pass on that piece of information now if I was told that.

Elise Fabricant

So many people in my world are complaining of sciatica these days. When researching the causes of sciatica in preparation for a class I was teaching on it, I confused myself more! It seems that the most common cause of sciatica is a tight, short piriformis, followed by a herniated disk. However, for us yogis I believe the piriformis is more likely to be over-stretched (too many hipflexion/knee extension poses). Can a long or weak piriformis still be the cause of sciatic pain? If so, deep massage and ball rolling would probably be substituted by strengthening, yes? How does one… Read more »

Open Your Hips, One Stretch at a Time | So You Think You Can Yoga

[…] another. In other words, your hip flexors could be very tight, yet you might naturally possess more external rotation in your hips than the person next to you making certain poses like pigeon pose more accessible and poses like […]

Gabrielle Acher

Hi Kate. Thanks for the great article about the piriformis. As of late I have started to hear a lot of complaints from my yoga students due to what they call ‘sciatica’ when many have not actually visited a doctor for correct diagnosis. Your article has further deepened my knowledge of the ‘deep six’ and the reminder of what not to do (forward bends in knee flexion) and what to do (strengthening the abs, hip flexors and pelvic floor) and of course, get those Yoga Tune Up Balls out!

Nikola Michaud

I have a hockey-player/technical analyst coworker that has a very unhappy sciatic nerve and I thought of him when I saw the title of your article. Thanks for making a great case of what might very well be piriformis syndrome. I’ll be forwarding him the link to get here and, hopefully, he can get rid of his aches in pain because of it.

Thanks
Nikola

Erin

Great information. Knowing that an aggrevated piriformis can present as sciatica will help me offer potential relief to one of my newer students who indicated she suffers from sciatica. Some work with the yoga tune up balls should help and bring some awareness to this “pain in the butt” muscle.

Bev Hotchkiss

Great article on the piriformis. I love the pyramid analogy. I hadn’t heard that one before. i have a student who suffers from sciatica and although I have done a fair bit of research on both sciatic and piriformis disease, it was good to be remind of what not to do (forward bends) and what to do (strengthening the abs, hip flexors and pelvic floor. I have also started doing some Restorative Yoga on her to induce deep relaxation 🙂

Megan

Thanks for the very informative article. How interesting that 15-30% of the population has their sciatic nerve passing through the piriformis AND women are more likely to suffer. I’m wondering if the steeper angle of the femur from the acetabulum is also called the “Q Angle”?

Rachel

Thanks for the great article! After having studied and performed ballet for many years (all in external rotation of the leg) I am now curious if I have ever suffered from piriformis syndrome. I also found it very helpful that you described the shape of the piriformis like a pyramid, its a good visualization to explain to people especially because it is beneath gluteus maximus.

Nicole Quibodeaux

“I have sciatica”- I hear this statement almost every week when I teach my classes and ask anyone if they have injuries or conditions prior to starting class. I started reading about what exactly sciatica was and how I could respond to the student who would tell me this. Thanks for an accessible article that I can add to my research and make me a more well-rounded teacher.

Terry Littlefield

Recently, I have been rolling out my piriformis and flutes due to sacrum issues, etc. I cannot believe how much it is helping to get in through the glutes and release the tension that I literally sit on all day:)

Heather Lindsay

Piriformis used to cause me much pain. I used to call it the dragon in my hip. It took about a year to find the trick to making mine happy. This was before I started using therapy balls but now if the dragon hiccups I am on the floor rolling.

Yelimar

Thanks so much for sharing your research. I have a client suffering from lingering pain in her piriformis. She sits all day. It may very well be that she is sitting with her thighs externally rotated for many hours a day. Will do some assesments next time we meet to see if her inner thighs are weak making her compensate with her external rotators. Thanks!

Sharon Brock

Thanks, Kate! Very helpful as I have this syndrome, too. The foam roller is my friend. Hope you’re well 🙂

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Linda

I wonder how much of sciatica is caused by (or greatly exacerbated by) an imbalance in the hamstrings?I say this because if I am going to experience sciatica symptoms it is most likely going to happen when I’m sitting on an airplane on a long trip after a few days of too little attention to my physical well-being. Often there no time for yoga or exercise in the final days leading up to a long trip. Then a long drive to the airport in the wee hours of the morning, and not enough sleep. In these instances, a well-placed Miracle… Read more »

Kristina

Kate-thanks for this! I haven’t experienced this pain while practicing, but have felt it while driving and working at my desk. I hadn’t heard of piriformis, but will certainly mention this to my yoga teacher, chiropractor and massage therapist. I completely agree that self-preventative care is the best approach.

Julia Ho

I too have suffer from yoga butt! A tight periiformis is definitely one of the culprits of this injury. I am now always mindful when I do any forward bends, making sure I always engage my quadraceps–the synergist muscles.

David I

Great blog Kate, thanks for posting. Yoga Butt! Cause that’s what happens when we have tight hammies and are bending over at the hips hundreds of times and keeping our knees straight. That and slight possibility of over tugging on nerve endings in spine can lead to severe nerve damage over time. After a few months of working on my hamstrings I kept on wondering why my Yoga poses weren’t able to eliminate piriformis. I tried everything, in the end it was some trigger point self massage that took my yoga pain in the butt right out within two weeks… Read more »

Nicolette

So informative! Great blend of good old fashioned information and some very simple solutions. I’m pretty sure, after reading this, I’ve been exacerbating this condition all on my own- like I am my own personal pain in my butt ? ! Definitely going to lay off the deep forward folds and that overt sensation- chasing I’ve been doing trying to stretch stretch and OVERstretch my way out of pain. Suggestion of R&R and massage is probably exactly what I needed to hear. It’s amazing how many people quickly recommend other quick fixes like cortisone injections or surgery (especially for what… Read more »

jodie

Thanks for posting this. I am just now dealing withthis same problem. It really is a pain in the butt. I have been heating and stretching, getting massages and hopefully it will go away soon so that I can get back to my running, Pilates etc.

Catherine L

I had a brief stint with sciatic pain and often feel a little nerve sensation when sitting too long on a plane. Exercise has relieved a lot of my symptoms. After learning in my anatomy clas with Sarah and in Kate’ss restorative yoga class, I take the Yoga Tune-Up balls and suggest to everyone I know this is a miracle worker and money saver on massages, on the piriformis and IT bands.

My Plight with Piriformis Issues « SCYogaGirl
Emily Burritt

Last night at Kate’s YTU class, we rolled out our glutes and piriformis muscle using YTU balls. Wow! My piriformis is sensitive and I think my classmates were as well given all the groaning going on. Even though rolling out the piriformis can be painful (in a good way), I can really feel the difference in my hips afterwards.

chau

Thank you for clarifying on an important issue to be aware of when advising students. Hip work is difficult in the beginning, but we can be encouraging that much can be reversed with yoga therapy 🙂

Carole

I’ve frequently heard people refer to their sciatica but have never known to what that term actually referred. This blog illuminates on and gives a name to some of the experiences I have had in the past as a runner. Knowing that it is a common symptom that can be easily prevented with some self-care is a relief and will help me in helping students who run.

Andrea Penagos

Reading about sciatica always hits close to home for me. My mother has intense sciatic pain due to herniated lumbar vertebrae, which is enough to create a huge “pain in the butt” for anyone, but your article makes me wonder how her piriformis may or may not be contributing to her constant discomfort. The next time I see her, I’m translating and sharing this information because I’m not sure that how much her doctor’s have made this information available to her, and the more she knows her own body, the more angles she’ll have to tackle her pain. Thank you… Read more »

alan

The Sciatic nerve can take differing routes at the Piriformis muscle. I was surprised to learn from Grant’s Anatomy that in 12% of their dissections the peroneal division of the nerve passed through the muscle and it one case (out of 210 dissections) the peroneal division of the nerve passed above the Piriformis. With a tight muscle and a nerve passing through it, the situation could become quite painful. Careful work with the YTU balls makes a lot of sense to start releasing the muscle. At 12%, one person out of each eight in class could have a branch of… Read more »

Sherry Matwe

Wonderful article, Luckily I do not have any of the pain that propelled you to investigate. But I listen to people who are working at correcting these pains in the but. Your article outlineing the deep six was helpfull to me. What struck me was your description of activities that could trigger or aggrivate the sciatic nerve and this piriformis syndrome – most of those activities are done all the time by just about anybody, I mean who doesn’t catch themselfs in bad posture even when reading blogs about posture he he. Not to meaniton just regular active people who… Read more »

Tracy Crooks

Thank goodness for YTU therapy balls! I know this discomfort all to well and see it in many of my students that spend their days seated at desks. Often the pain is preventing us from working on strengthening the back, core and hip flexors, but YTU exercises and deep massage relieve the pain and bring so much needed release to chronic piriformis syndrome

Luisa

As a cyclist I know too well the pain experienced when my piriformis gets tight – ouch. But I have also learned a few years ago the importance of massage and self massage with the Yoga Tune Up balls. I stretch, and then massage as many muscles as I can after each ride to ensure an enjoyable day after my ride. This article is a great reminder of the importance of looking after our muscles after we have exercised.

Nancy

This really hits a nerve with me, well, potentially! After practicing ballet until the age of 15 i went on to pursue martial arts and other more rebellious past times. However, the tight external rotators stayed with me. I’m duck -footed! I had become resigned to the fact that this is just the way MY hips are. I did not imagine that my yoga practice was affected. After all, i could stand with feet parallel in tadasana in comfort. It was not until delving into YTU that i realized the imbalance this represents and the potential injury waiting to happen… Read more »

Dagmar Khan

Amazing article,thank you.I have shared this info with one of my student few months ago who suffers with sciatic pain for many years and she has truly found massaging into her piriformis to be a very easy and accesible solution to aleviate the pain on day-to day basis.

Trish

So interesting!! I feel like this may be what is causing me pain in the upper leg whenever I do Trikonasana on the right side. I am going to try some of these techniques and see if it helps. Thanks!!

rcm

Interesting. This is helpful preventative information.

Hayden

This explains why Parsvottanasana relieves my pain every time.

Laura H.

I had never heard of piriformis syndrome before! Very good to know.

Jaime S

I read Kate’s article for 2 reasons: 1) I love Kate! She is my inspiration for embarking upon the yoga teacher training journey and 2) in 2003 I, too, suffered from a crippling case of sciatica from both piriformis aggravation and a herniated L5-S1 disc.

Aura Carr

One of my chiropractors thought I was suffering from the piriformis syndrome. Now that arthritis is the primary culprit, I fine regular massage work invaluable. I am looking forward to using the Tune Up Balls in the morning and making space in my body.

subir

it makes sense to be really cautious when working out tightness in the external rotators of the hip. as anyone with an injury to this area can tell you, excessive rotation is felt immediately as pain in the knees. it seems like tightness in the adductors can also undermine attempts to release the deep external rotators in poses like supta baddha konasana. if problems with the piriformis or other rotators stems from some kind of bone injury, odds are the muscles all around the hip will have to be worked in concert before any one of them will fully release,… Read more »

Kate

Yes, I totally agree Christine! They tend to avoid stretching the piriformis too, because it hurts…

Christine

What is so frustrating for me is that so many clients are told they have sciatica but use it as a crutch to avoid exercises when if only they stretched their piriformis they’d be much more comfortable.

JT

Thanks for the article. YTU balls are a god-send!

Lindsay

I love this article – chock full o’ great facts. Thank you so much, I am definately going to reference it as a teaching tool for my students. I found the statistic on disc herniation especially interesting…..%50! Lets lower those numbers 🙂

Taina

This is certainly knowledge everyone should have but few people do. After suffering from sciatic a handful of times, I assumed the paint hat began bothering for me last year was the same one. I was fortunate that someone was able to explain piriformis syndrome to me after seeing me self massage. Time to study my muscles!

CSK

so interesting. i had never heard of the piriformis before our YTU weekend, but now i think about it whenever i do uttanasa or find my legs exterally rotated when i sit in front of my computer.

Martin

Great blog Kate, I did not know that I could blame my piriformis for my “pain in the butt”after long car rides and now I also know what I can do to cure or avoid it (besides rolling on these balls :))

Zvia

Great article, Kate! I am just learning about the piriformis and its relationship to the sciatic nerve. I found it so interesting that the sciatic nerve runs behind the piriformis making it possible for inflamation of the piriformis to compress the sciatic nerve (and cause pain!). As I am both a runner and a cyclist, I am glad that you mentioned that both of these activities contract and release the piriformis. Thanks for your suggestions of self-care techniques.

Anne

How incredible, Kate! As a fellow former “bun-head” (yes, ballet junkie), I can absolutely relate to the intense awareness of the external rotation of the leg and the beautiful (err, painful) awareness it brings to the piriformis. It’s been your outstanding adjustments in twisted standing poses – e.g. Twisting Half Moon (Parivrtta Ardha Chandrasana) – that have brought awareness to the tightness in the piriformis, which limits internal rotation of the thigh. Thanks for shining a spotlight on this issue!

Maura

This is remarkable information. If more people knew that a deep external rotator could be the crux of their chronic pain which is readily treatable with YTU massage balls and corrective exercise, it could save people thousands of dollars. And who knew that some of us have a piriformis superior and inferior! Amazing.