Piriformis Muscle Stretch and Physical Therapy

Almost every treatment approach for piriformis syndrome includes a focus on carefully and progressively stretching the piriformis muscle through therapeutic exercises. Physical therapy for piriformis syndrome also includes strengthening exercises to help improve the flexibility and strength of the piriformis muscle as well as strengthening the core or, trunk and pelvic muscles.

Research indicates that most people experience complete symptom relief within 1-3 weeks after starting an exercise program for piriformis syndrome.¹Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/

Stretching Exercises for Piriformis Syndrome

Stretching the piriformis muscle and the surrounding muscles in the hip, thigh, and leg can help reduce pain and discomfort. Elongating and engaging a tight or shortened muscle to loosen the fibers and joints improves the range of motion and function.²Page P. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. Int J Sports Phys Ther. 2012.7(1):109-119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/

To relieve piriformis syndrome pain, stretching exercises that target the piriformis, hamstrings, and hip extensors can help decrease the painful symptoms within these muscle groups and improve the range of motion in the lower back and pelvic region.³Tonley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM. Treatment of an Individual with Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reducation: A Case Report. Journal of Orthopaedic & Sports Physical Therapy. 2010.40(2):103-111. https://www.jospt.org/doi/full/10.2519/jospt.2010.3108There are many ways to stretch the piriformis muscle, including the:

• Supine piriformis stretch
• Cross-body piriformis stretch
• Knee-to-chest piriformis stretch
• 4-point piriformis stretch

A simple and daily stretching routine can help reduce the pain felt by piriformis syndrome.

Read more: Stretching Exercises for Piriformis Syndrome

Strengthening Exercises for Piriformis Syndrome

Strengthening exercises help reduce piriformis muscle pain and also prevent the recurrence of symptoms. Strengthening exercises help improve muscle balance and alignment in the hip, thigh, and leg, reducing the strain on the piriformis muscle and preventing it from becoming tight or spasming. In addition, improving muscle strength and balance allows muscles to properly distribute mechanical force during physical activity.²Page P. Current Concepts in Muscle Stretching for Exercise and Rehabilitation. Int J Sports Phys Ther. 2012.7(1):109-119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273886/^,4Suchomel TJ, Nimphius S, Bellon CR, Stone MH. The Importance of Muscular Strength: Training Consideration. Sports Medicine. 2018.48:765-785. https://doi.org/10.1007/s40279-018-0862-z

Core-strengthening exercises help stabilize the trunk and prevent injury in the lower extremities.⁵Nakai Y, Kawada M, Miyazaki T, Araki S, Takeshita Y, Kiyama R. A self-oblique exercise that activates the coordinated activity of abdominal and hip muscles–A pilot study. Federolf PA, ed. PLoS ONE. 2021;16(8):e0255035. http://doi.org/10.1371/journal.pone.0255035

There are many ways to strengthen the core and gluteal muscles; a few simple ways include:

• Glute bridges
• Seated leg raises
• Walking side-ways with a resistance band
• Front and side planks
• Bird-dog exercise
• Lunges

Strengthening a weak piriformis and the surrounding muscles is an effective way to treat and prevent the recurrence of piriformis syndrome.

Read more: Strengthening Exercises for Piriformis Syndrome

Aerobic Exercises for Piriformis Syndrome

Aerobic exercise is an essential part of any exercise program, as it helps improve cardiovascular health and effectively distribute essential nutrients throughout the body. Aerobic exercise is generally considered most beneficial when done for a minimum of 20 to 30 minutes about 5 times per week.⁶American Heart Association Recommendations for Physical Activity in Adults. American Heart Association. July 27, 2016. Accessed January 13, 2023.

Common forms of aerobic exercises include:

• Walking, jogging or running
• Using an elliptical trainer
• Using a stationary bike
• Swimming and water exercises

Water exercises are particularly beneficial in cases where a land-based exercise program is too painful to perform due to the intensity of the symptoms. Water counteracts the effect of gravity on the body and helps to support the patient’s weight. The buoyancy of the water aids in exercises and stretches for the hip flexors and abductors as they are easier to perform in water because they feel lighter and supported.

Read more: Aerobic Exercises for Piriformis Syndrome

Other Therapeutic Aids and Passive Techniques for Piriformis Syndrome

Physical therapists and other healthcare providers (HCPs) may use certain aids and techniques to supplement active treatment of piriformis syndrome. The commonly used aids are described below.

Massage therapy

Physical therapists and other HCPs may combine exercises with massage therapy for additional pain relief. Massage therapy helps improve blood circulation, which in turn creates a better healing response in the body.⁷Field T. Massage therapy research review. Complementary Therapies in Clinical practice. 2016.24:19-31 https://doi.org/10.1016/j.ctcp.2016.04.005 Specific forms of massage, such as deep tissue massage, active release technique, myofascial release, and others that may include instrument-assisted release and/or resistance during stretch methods, may help relieve pain in the buttock and thigh before or after an exercise session.

Ice and heat therapy

A simple way to help relieve buttock pain is to apply a cold compress or heating pad over the buttock. Ice and heat therapy treatments include:

• Cold therapy and ice massage. Cold therapy helps reduce the circulation and blood flow due to constriction of the blood vessels. This process helps reduce inflammation and swelling and decreases pain through a numbing effect.
• Heat therapy. Heat therapy improves circulation and blood flow due to the dilation of blood vessels. Improving circulation to the affected area can cause an inflow of healing nutrients, calm painful muscle spasms, reduce stiffness, and speed up the healing process.

Heat therapy is usually useful before beginning an exercise program to loosen the tissues and improve flexibility. Cold therapy may be used after an exercise program to reduce soreness from the exercise.

See related: Cold and Heat Therapy for Sciatica

Physical therapy and manual therapies can be effective treatments for piriformis syndrome, particularly for mild to moderate cases. Physical therapy programs are usually tailored on a case-by-case basis according to overall health, the severity of pain, and personal preferences. Additionally, making small adjustments to everyday activities (lifestyle modifications) can effectively mitigate pain. For example, avoiding long periods of sitting and taking multiple short walks for 1-2 minutes throughout the day can prevent constant pain or sudden flares. Using an ergonomic chair and supportive mattress can also provide daily relief.

See Physical Therapy for Low Back Pain Relief

For maximum benefit and pain relief, it is important to comply with the exercise program as guided by the physical therapist and other HCPs. A vast majority of people experience a recurrence of symptoms when they stop engaging in physical therapy and exercises to strengthen and condition the piriformis.¹Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/

If these conservative treatment approaches do not provide adequate pain relief, medication, injection, or surgical treatments may be considered with or without an added physical therapy/conservative treatments.