Piriformis syndrome is a compression of the sciatic nerve by the piriformis muscle being tightened, unusually enlarged, without the nerve being entrapped, and causes pain in the buttock and lower back (Kirschner, Foye, & Cole, 2009). Treatment usually consists of stretching the piriformis muscle. Stretches relieve symptoms by increasing the resting length of a tight piriformis and decrease potential sciatic compression through reciprocal inhibition (Gulledge et al., 2014). The two stretches recommended by Gulledge et al. (2014) are supine hip flexion, then adduction, then external rotation, and supine hip flexion, then external rotation, then adduction as both increased piriformis length by 12%.
In addition to stretching, there is some evidence for the use of strengthening exercises. Tonley et al. (2010) state that excess pressure is distributed to the piriformis muscle during excessive hip adduction and internal rotation, due to weak gluteals, and hip musculature. Strengthening these muscles and focusing on proper muscle recruitment patterns, should lessen the load being passed on to the piriformis. In Tonley et al.’s protocol (2010) phase one focused on individual recruitment of the hip extensors through bilateral bridging and side lying clams to work on the hip abductors and external rotators, phase two focuses on weight bearing exercises to increase demands on hip musculature such as squats with bands, side steps, single leg sit to stands, and step downs, and the last phase focuses on functional single leg exercises such as lunges, 45-degree angle lunges, and jumping exercises. The protocol was effective at reducing piriformis syndrome pain.
Gulledge, B. M., Marcellin-Little, D. J., Levine, D., Tillman, L., Harrysson, O. L., Osborne, J. A., & Baxter, B. (2014). Comparison of two stretching methods and optimization of stretching protocol for the piriformis muscle. Medical Engineering & Physics, 36(2), 212-218.
Kirschner, J. S., Foye, P. M., & Cole, J. L. (2009). Piriformis syndrome, diagnosis and treatment. Muscle & Nerve, 40(1), 10-18.
Tonley, J. C., Yun, S. M., Kochevar, R. J., Dye, J. A., Farrokhi, S., & Powers, C. M. (2010). Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: A case report. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 103-111.