What is the Piriformis Muscle?
Chances are you have most likely heard about this muscle but you weren’t sure exactly what it does or why it’s important when dealing with back and leg pain. The piriformis muscle sits underneath the glutes and attaches to the sacrum and the greater trochanter of the femur. Its functions include external rotation of the hip, hip abduction and hip extension.
What Causes Piriformis tightness?
There are a number of reasons the piriformis muscle can become tight. The most common reason the piriformis compensating for weak muscles. The piriformis will compensate for weakened gluteus maximus, gluteus medius and hamstrings (biceps femoris) muscles. Being a smaller, deeper muscle, the piriformis is meant to assist the larger muscles, not be the primary mover of the actions it performs.
That muscle compensation ultimately leads to an overworked muscle and can result in adhesion and trigger point formation. Referred trigger point pain from the piriformis includes the glutes, thigh and SI Joint.
Other causes of piriformis tightness:
Sitting with your legs open prolonged periods at a time: Your hips are externally rotated when you sit with your legs open. Having the external rotation for hours at time can cause your piriformis to be overactive. This seated posture is more common for men whereas women typically sit with their legs closed or crossed.
Later stages of pregnancy: For some women whom develop the “waddle walk” their hips become externally rotated as they walk. This causes the piriformis to be under constant stress and will often cause a mid to high level of sciatic nerve pain.
Sitting on your wallet: Sitting on your wallet can compress against your piriformis placing it under constant stress and potentially caused nerve irritation.
What Are The Results of a Tight Piriformis Muscle?
The results of a chronically tight piriformis involve low back pain, sacroiliac joint dysfunction, compressive pathology and IT Band tendinitis. These results can cause dysfunction and pain in the lumbar spine, knee and hip joint. A chronically tight piriformis muscle can also develop trigger points.
Sciatica is a symptom that can be caused from piriformis trigger points and tension as well. Whenever a client comes in and describes what’s to be believe as sciatica, if there is no history of spinal injuries, one of the first muscles I palpate is the piriformis. If you look a the illustration below, the piriformis sits right on top of that sciatic nerve and for some people that sciatic nerve actually runs right through the piriformis muscle tissue.
You can imagine what happens to that nerve as the piriformis gets tighter and tighter…it starts to get compressed by the muscle which can cause that numbness and tingling sensation down the leg and into the calf. If not treated or managed, that irritability can have lingering effects down the leg where the sciatic nerve innervates.
How to Release the Piriformis
So how do you release the piriformis? I believe using a lacrosse ball is one of the best ways to get deeper into the muscle tissue. It will most likely be pretty tender and painful initially so be sure to ease into the muscle as comfort allows. If you do feel any sensation down the leg, hold it on that spot until you feel the sensation subside. After you feel significant release, be sure to stretch. There are a few different ways to release this muscle but I posted the seemingly most effective way to get a good piriformis stretch.
Now, if you have trouble with knee flexibility or if you have knee replacements, these methods will probably not be ones you will be able to do. Two alternatives to release the piriformis: sitting on a lacrosse ball using a firm chair, or standing, placing the lacrosse ball against the wall and rolling it along the piriformis muscle.
Use lacrosse ball to release the muscle
Stretch–Hold for 45 seconds or longer
Remember, simply releasing the piriformis is not enough to help prevent further issues occurring with this muscle. You must also strengthen your gluteus medius, gluteus maximus and hamstring muscles!