Table of Contents

The Symptoms

Fix It & Prevent It

Exercise #1: Fire Hydrant In-Out

Exercise #2: Bodyweight Jump Squats

Exercise #3: Lateral Band Walks

Exercise #4: Glutes Roll

Fix It
Employ dynamic rest. Stop the offending activity (if your pain is moderate to severe,
youll want to anyway). Use upper-body workouts to maintain fitness. Core work will
probably be a problem because your lower back and glutes will hurt. Let the pain be your
guide and back off immediately if you do anything that hurts.
Try an NSAID. An anti-inflammatory like ibuprofen or naproxen can help with swelling
and inflammation.
Stretch your hip rotators. As pain allows, try to gradually open up your hips by stretching
your hip flexors and rotators. These two stretches can help:
Seated Piriformis Stretch
While sitting in a chair with your back straight, rest your ankle on your opposite knee. Then
gently press down on your knee until you feel a stretch in your hip. Hold for 10 to 15
seconds. Repeat several times for each hip.
Lying Piriformis Stretch
Lie on your back with your knees raised and your feet flat on the floor. Put your right ankle
on your left knee. Raise your left foot while pressing down on your right knee until you feel
the stretch in your hip and buttock. Hold for 10 to 15 seconds. Repeat several times, then
reverse the leg positions to stretch the left side and do a few reps.

Prevent It
Many of the interconnected muscles in this regionpiriformis, glutes, hip flexors,
hamstrings, quadssupport one another, and weakness in one area can mess up the works. In
short, if you want healthy piriformis muscles, you need to prioritize total-body fitness.
Read more at http://triathlon.competitor.com/2015/03/training/piriformis-syndrometreatment-prevention-and-exercises_77623/2#BzMKUu7OqKhCpXcD.99

Exercise #1: Fire Hydrant In-Out

Get down on your hands and knees with your palms flat on the floor and shoulder-width
apart. Relax your core so that your lower back and abdomen are in their natural positions.
Without allowing your lower-back posture to change, raise your left knee as close as you can
to your chest (your knee may not move forward much). Keeping your left knee bent, raise
your thigh out to the side without moving your hips. Kick your raised left leg straight back
until its in line with your torso. Thats one rep.

Read more at http://triathlon.competitor.com/2015/03/training/piriformissyndrome-treatment-prevention-and-exercises_77623/3#LpBXwlVF3wMJk5GJ.99

Exercise #2: Bodyweight Jump Squats

Place your fingers on the back of your head and pull your elbows back so that theyre in line
with your body. Perform a bodyweight squat until your thighs are parallel to the floor, then
explosively jump as high as you can (imagine youre pushing the floor away from you as you
leap). When you land, immediately squat and jump again. Hold dumbbells at your side to
make it more challenging.
http://cdn.triathlon.competitor.com/files/2013/06/exercise1270x421.jpg

Exercise #3: Lateral Band Walks

Place both legs between a miniband and position the band just above your knees. Take small
steps to your right for 20 feet. Then sidestep back to your left for 20 feet. Thats one set.
Read more at http://triathlon.competitor.com/2015/03/training/piriformis-syndrometreatment-prevention-and-exercises_77623/5#bSKiFM0vKJWz8hrL.99

Exercise #4: Glutes Roll

Sit on a foam roller with it positioned on the back of your left thigh, just below your glutes.
Cross your left leg over the front of your right thigh. Put your hands flat on the floor for
support. Roll your body forward until the roller reaches your lower back. Then roll back and
forth. Repeat with the roller under your right glute.

More Med Tent articles and videos from Dr. Jordan Metzl.
New York City sports medicine specialist Jordan D. Metzl, M.D. is a 29-time marathon
runner and 10-time Ironman finisher. His new book, The Athletes Book of Home Remedies,
has more than 1,000 tips to fix all types of injuries and medical conditions.
Join in the conversation about everything swim, bike and run.
The piriformis syndrome

The piriformis syndrome is a condition in which the piriformis muscle

irritates the sciatic nerve, causing pain in the buttocks and referring
pain along the course of the sciatic nerve. This referred pain, called
"sciatica", often goes down the back of the thigh and/or into the lower
back. Patients generally complain of pain deep in the buttocks, which is
made worse by sitting, climbing stairs, or performing squats. The
piriformis muscle assists in abducting and laterally rotating the thigh. In
other words, while balancing on the left foot, move the right leg directly
sideways away from the body and rotate the right leg so that the toes point
towards the ceiling. This is the action of the right piriformis muscle.
Stretching the muscle often duplicates the pain. To do the piriformis
stretch, lie on your back, and flex the right hip and knee. Now, while
grasping the right knee with your left hand, pull the knee towards your
left shoulder. This adducts and flexes the hip. In this position, grasp
just above the right ankle with the right hand, and rotate the ankle

outwards. This applies internal rotation to the hip and completes the
stretch. Another way to do this stretch is to stand on your left foot and
place the right foot on a chair, such that the right knee and hip are
flexed at about 90 degrees. Now, using the right hand, press the right knee
across towards the left side of the body while keeping the ball of the
right foot on the same spot on the chair.
Another good piriformis/gluteal stretch is demontrated in the stretching
section.
Anatomically, the piriformis muscle lies deep to the gluteal muscles. It
originates from the sacral spine and attaches to the greater trochanter of
the femur, which is the big, bony "bump" on the outside top of the thigh.
The sciatic nerve usually passes underneath the piriformis muscle, but in
approximately 15% of the population, it travels through the muscle. It is
thought that acute or chronic injury causes swelling of the muscle and
irritates the sciatic nerve, resulting in sciatica. Patients with an
aberrant course of the nerve through the muscle are particularly
predisposed to this condition.
The piriformis syndrome is diagnosed primarily on the basis of symptoms and
on the physical exam. There are no tests that accurately confirm the
diagnosis, but X-rays, MRI, and nerve conduction tests may be necessary to
exclude other diseases. Some of the other causes of sciatica include
disease in the lumbar spine (e.g. disc herniation), chronic hamstring
tendinitis, and fibrous adhesions of other muscles around the sciatic
nerve.
Once properly diagnosed, treatment is undertaken in a stepwise approach.
Initially, progressive piriformis stretching is employed, starting with 5
seconds of sustained stretch and gradually working up to 60 seconds. This
is repeated several times throughout the day. It is important that any
abnormal biomechanical problems, such as overpronation of the foot or other
coexisting conditions, are treated. This stretching can be combined with
physical therapy modalities such as ultrasound. If these fail, then
injections of a corticosteroid into the piriformis muscle may be tried.
Finally, surgical exploration may be undertaken as a last resort.
A good sports medicine physician with experience in caring for athletes
with the piriformis syndrome can help direct appropriate management. With
proper diagnosis and treatment, there is no reason for this syndrome to be
dreaded. Good luck and good training.

Pirifor
mis
Stretch
:

TOP VIEW

Pirifor
mis
Stretch
: VIEW
FROM
UNDERNE
ATH

Place the right knee on the ground roughly

in line with your left shoulder

The right foot should be just in front of the

left knee

Press your hips towards the ground so that

your bodyweight is on your right leg.

As you move down the right knee comes

closer to the left shoulder.

You should feel a gentle pull deep in the

right hip / buttocks.

For further information about overuse injury of the

piriformis muscle read, the piriformis syndrome article.

copyright 1997
SportsMed Web,
Mark Jenkins,MD
last update - 2/97