Piriformis Syndrome Wiki

Piriformis syndrome is very common and can cause severe pain. The Piriformis Syndrome Wiki is the definitive source of proven stretching exercises for the relief of piriformis syndrome.

Learn how the Stretch Therapy Method can help you overcome piriformis syndrome from the comfort of your own home. The deep causes of this common problem are discussed.

Cat Like Back Pain

An Introduction to Stretching for Piriformis Syndrome

Piriformis is a deep hip muscle, lying underneath the larger gluteus maximus. Piriformis is described as an external hip rotator in the textbooks, but its main function is to work with the adductors to stabilise the femur’s movement in the hip joint, as happens when we walk, for example.

In about one-fifth of the population, the peroneal branch of the sciatic nerve passes directly through this muscle rather than passing below it. Recent research suggests that smaller branches of parts of the sciatic nerve can pierce piriformis as well, one source claiming that this is found in up to 37 per cent of the general population. If this muscle is in spasm or simply very tight, enough clamping force can be produced on parts of the sciatic nerve to cause pain in the muscles behind the hip joint and sciatic pain down the back of the leg.

Typical histories include long periods of sitting, either in an office chair, or driving a car or truck. This pain can feel the same as sciatica caused by disc impingement. If a patient has disc pathology (found in at least half the adult population without back pain), a diagnosis of nerve-impingement-induced sciatica may be made without there being any causal relationship between the pathology and the symptoms.

There’s more (and chapter 11 of Overcome Neck & Back Pain goes into this problem in much more detail) but this will get us going: it is in everyone's best interest to stretch those muscles from time to time to make sure that no problems occur in this area.

Because everybody spends most of their working life sitting these days, keeping piriformis loose has become more important. In fact, when Kit first wrote the book Overcome Neck & Back Pain, a seated hip stretch which works piriformis was included in the short list of exercises that could be done every day, which we referred to as “The Daily 5”. The main reason for this recommendation was the observation that normal work had changed from more manual to more sedentary in the decades preceding the book’s publication, and that piriformis-related problems seem to be on the rise.

With the first publication of Overcome Neck & Back Pain (1995), Stretch Therapy put piriformis on physical therapists' problem muscles radar. As well, over the 30-odd years that Stretch Therapy has been in business, we have invented the world's best piriformis exercises and our teaching work around the world has popularised this approach to dealing with piriformis syndrome.

If you do a search on piriformis exercises you will find that the vast majority of them stretch the femur end of this muscle, by some variation of bringing one thigh up to the opposite shoulder. We have found that moving the end of piriformis that attaches to the sacrum to be far more powerful and far more effective in remapping what the brain thinks is the right length–tension relationship for this muscle. We have a number of variations of this exercise that are suitable for everyone. All the important piriformis exercises can be found on this Wiki.


Table of Contents

What Causes Piriformis Syndrome?

In about one-fifth of the population, the peroneal branch of the sciatic nerve passes directly through this muscle rather than passing below it. Recent research suggests that smaller branches of parts of the sciatic nerve can pierce piriformis as well, one source claiming that this is found in up to 37 per cent of the general population. If this muscle is in spasm or simply very tight, enough clamping force can be produced on parts of the sciatic nerve to cause pain in the muscles behind the hip joint and sciatic pain down the back of the leg.

Noted researchers and authors Travell and Simons, in their seminal text Myofascial Pain and Dysfunction: the Trigger Point Manual, in their detailed chapter on piriformis syndrome noted that only several grams compression force on the sciatic nerve was sufficient to create pain downstream of the site of impingement. Piriformis is capable of just such impingement if your sciatic nerve passes through its fibres rather than below the muscle itself.

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Piriformis Syndrome FAQs

Where is the piriformis muscle, and what are the symptoms of piriformis syndrome?

Piriformis is a fan-shaped muscle that arises from the medial border of the sacrum, the triangular centre bone of the pelvis, and attaches to the femur. So, from an owner’s perspective, piriformis is behind the hip joint, and very deep.

Piriformis syndrome can mimic all the symptoms of full-blown disc-induced sciatica. In plain language, what this means is extreme pain down the leg, possibly affecting the outside of the calf muscle as well, and can even affect the foot – numbness in the toes or even loss of muscular action. In addition to this, piriformis syndrome can be a deep, diffuse, unrelenting ache behind the hip. It can vary from annoying to incapacitating – when the author experienced piriformis syndrome personally, he was not able to be a passenger in a car for any longer than 20 minutes before having to get out of the car and move around. The hip joint pain can be extreme.

How do you distinguish between disc-induced sciatica and piriformis syndrome?

Any time you experience hip pain that does not go away or pain that goes down the leg including into the calf muscle or the feet, suspect piriformis syndrome. Make sure you try some of the free piriformis exercises found on this Wiki before going to see a practitioner however because very likely you'll be able to do something about this problem yourself.

What does a tight piriformis feel like?

Tight piriformis makes the whole hip joint feel tight; it can produce the most tremendous pain; and it can limit all movements of the hip joint, too, especially flexion.

How is piriformis syndrome diagnosed?

Piriformis syndrome is diagnosed with difficulty – no MRI, CAT scan, or X-ray can identify its presence. It is for this reason that Stretch Therapy spent so much time and energy on inventing effective exercises – if the exercise relieves the pain that you're experiencing, then piriformis syndrome is likely. Piriformis syndrome needs to be distinguished from the kind of nerve impingement phenomena that are ordinarily associated with some kinds of disc problems. If one of the piriformis exercises helps the problem, then a diagnosis of piriformis syndrome is the more likely cause.

What are causes and risk factors for piriformis syndrome?

The major cause of piriformis syndrome is lack of suitable movement – and this describes most human beings living presently. If your job involves long periods of sitting, and you don't get up and down from your desk regularly, your risk of piriformis syndrome is increased. If you are a professional driver, like a taxi driver or a truck driver, the risk factor for piriformis syndrome is high as well. One of the real problems of piriformis syndrome is that it can masquerade as another cause of hip pain and other kinds of back pain, too. We have had patients who have been told they need a hip replacement, for example, when all they need to do were some relatively simple piriformis exercises. Because the risk factor of all the piriformis exercises is extremely low, a conservative approach suggests that trying piriformis exercises before exploring any other kind of diagnostic technology is simply sensible. These remarks apply to back pain as well.

Can you prevent piriformis syndrome?

Piriformis syndrome can definitely be prevented. Even if part of the sciatic nerve pierces your piriformis muscle, as it does in the case of your author (and probably around 40–50% of the rest of the population as well), piriformis syndrome can be completely overcome with the right movement and exercise. The other important aspect of this approach is that the exercises and the movement are extremely low–risk in comparison to any other treatment strategy. These exercises are also free on this Wiki.

How is sciatica caused by piriformis syndrome treated?

Sciatica caused by piriformis syndrome is treated exactly the same as any other instance of piriformis syndrome: by loosening the piriformis muscle with the right exercises. Our experience with piriformis syndrome suggests that even people with quite flexible hips can get this problem and the solution is to loosen piriformis well beyond what it is presently, even if you are relatively flexible, as is your author. As well, in my case, piriformis syndrome was experienced in only one hip, and the hip of my shorter leg. The anomaly here was that my right hip was much looser in ROM in the key piriformis movements than the left hip yet only the right hip had problems. I needed to loosen the right hip significantly more that it was when I found these exercises before the problem went away. 

The excellent aspect of trying the piriformis exercises as potential solutions is that, in addition to being cost-effective, it will put you in control of a problem in your body. This is literally empowering.

Where do you feel piriformis pain?

Piriformis pain can be felt just behind and deep in the hip, the leg itself (especially the outer part of the thigh and the outer part of the calf muscle), and in the foot itself as pain in the feet or toes. Numbness of part of the hip or the leg is a common accompaniment. The pain itself can vary from dull and diffuse to incredibly localised and intense, and anything in between.

What are the risks and side effects of piriformis syndrome?

The main effect of piriformis syndrome is that it can be excruciatingly painful, affecting every aspect of your life. As well, if it persists, and you cannot find a solution for it, you will seek assistance from medical professionals. One major risk is that if you have disc pathology, as about half the adult population do, the pain that you're experiencing could be attributed to it, and an operation recommended as a potential solution. Another major risk is the possibility of having your problem diagnosed as some kind of dysfunction of the hip joint itself, with the possible recommendation of a hip replacement. In our view, it is better to explore all conservative measures before going down this road.

How does the piriformis get inflamed?

It is not so much inflammation of the piriformis that causes the problem – it is a chronic shortness, or even spasm, of the muscle that causes all the problems. Research has shown that only about 20 g force is needed in compressing part of the sciatic nerve to cause all sorts of problems downstream of that impingement. A piriformis muscle in spasm is capable of generating more than that kind of force.

What is the purpose of a piriformis steroid injection?

The idea behind an injection of steroid, usually cortisone, into a muscle that has a problem is that it will relieve the inflammation in whichever muscle is causing the problem. Cortisone works by inhibiting collagen production, so should only be considered a potential short-term solution. We feel strongly that a conservative longer-term potential solution is simply the more sensible way forward, which is why we recommend exploring the piriformis exercises.

Does piriformis syndrome ever go away?

If you re-incorporate the right movement patterns and keep this muscle loose, piriformis syndrome can be completely overcome. When your author discovered the best of the piriformis exercises, it was on a night where he had discussed with his wife that if he was not able to solve his piriformis problem, he was going to stop teaching exercise forever. Luckily for him, that exercise was discovered and refined in that class, and we have been teaching variations on this ever since. The problem has never returned. Many other patients have reported identical experiences with these exercises.

What piriformis syndrome treatments could help me?

We can only recommend conservative exercise–based approaches. As mentioned above, all the important piriformis exercises can here on this Wiki.

As well, and this is a novel part of the Stretch Therapy system, you can target the piriformis muscle with a hard ball, and use the body’s weight to apply direct pressure to it. A lacrosse-style ball is the perfect size for most people. This RollStretch technique, together with the right stretches (we have four) can change the experience of this problem muscle completely.

How do you release tension from the piriformis muscle?

Tension is released from piriformis by remaking the brain's map of what tension should be held there – and the most effective way of doing this is using one of the Contract–Relax based stretching exercises we recommend. The use of contractions, gentle in the beginning and stronger as you become used to them, is that this muscle gets stronger – and we believe that it is the brain's awareness of the increase in strength in the muscle that is part of the process that allows it to relax more than usual. Over time, its held tension (the habitual tension we all hold, and which in a problem muscle is higher than the rest of the body) will diminish as its ROM improves, and eventually the problem will be a memory.

What is the straight leg raise test used for?

The SLRT, or straight leg raising test, is used to determine whether a patient's pain or dysfunction is being caused by direct disc impingement on the sciatic nerve. In the test, the patient lies on her back, and the practitioner slowly raises one leg away from the floor or table. If the pain is reproduced early in the range of movement, typically between zero and 40°, the straight leg raising test is classed as positive, which suggests to the practitioner that disc impingement of the sciatic nerve is the likely cause of the pain/dysfunction. The problem that is not usually spoken about is that piriformis syndrome can cause exactly the same response in testing, as can very tight hamstrings. This test, and our modifications and refinements, is explored in its own chapter in Overcome Neck & Back Pain.

In the ST approach, if a positive SLRT is found, the practitioner will immediately help the patient to do one or more of the recommended exercises, and then retest. It is often the case that a single repetition of an exercise allows the leg to be lifted into the ‘normal’ range, classed as somewhere between 65 and 90° from the floor or table. Adding one of the piriformis exercises to the SLRT has avoided a great many 'false positives' (this term describes a problematic test result which appears to trace the cause to one problem, when in fact the cause is another problem altogether).

The only way to distinguish which is the cause of the problem (disc impingement or piriformis syndrome) is to use one of the piriformis exercises we recommend. In many cases, loosening the piriformis exercise allows the leg to be lifted up into the normal range without any pain. If this is the result, then the practitioner will advise the patient that a conservative course of exercises is likely to be effective in their case.

Do squats help piriformis syndrome?

Squats do not directly help piriformis syndrome. Having said this though, sometimes squatting up and down can relieve the pain of piriformis syndrome momentarily, through a mechanism not understood.

What are the early and later symptoms and signs of piriformis syndrome?

Early symptoms of piriformis syndrome are simply milder versions of the full-blown syndrome.

Why is piriformis syndrome so painful?

Piriformis syndrome can be extremely painful because the muscle is applying pressure to the longest and thickest nerve in the body, the sciatic nerve. Any impingement to this nerve can create excruciating pain in the hip and the leg.

Is heat good for piriformis syndrome?

For the majority of the population, the application of heat is beneficial. However, heat on its own as a treatment will not fix the problem. The only long-term solution that we are aware of is to increase the range of movement of piriformis muscle in certain planes of movement, such that when the exercise is complete, the patient feels that this area in the body has relaxed substantially – and as they become aware of that relaxation process, they become aware that the pain has also diminished significantly, and possibly all together.

Does sitting make piriformis syndrome worse?

Sitting for long periods not only can make piriformis syndrome worse, it is the most common patient history of anyone who suffers this problem. Even walking around when the syndrome is in effect can help the sensations in the hip, in particular.

How do you relax your piriformis muscle?

Relaxation is a fundamental and critical part of the Stretch Therapy approach. The book Overcome Neck & Back Pain contains the script for a particular relaxation exercise which, when used together with the piriformis exercises themselves, synergistically adds to the final relaxation effect. This recording can be downloaded from the 'Audios' section of this Wiki page.

An interesting aspect of being human is that when the whole body's muscle tension reduces (by whatever mechanism is being used), the experience in the body is relaxation – and if there has been any anxiety associated with the hip or leg pain, that also diminishes. But a muscle that is in spasm only reduces roughly the same amount of tension as the rest of the body when whole body relaxation is pursued – so we still need to do the right exercises for that muscle group to reduce its tension back to the level of the rest of the body for a full cure to be effected.

Which doctors, specialists, or healthcare professionals treat piriformis syndrome?

Most doctors are not well versed in prescribing or practising exercises, nor does their best practice recommendation (ten patients an hour) allow the kind of lengthy interventions that are needed to teach and practise the necessary exercises. Doctors usually refer piriformis syndrome patients to physiotherapists or exercise physiologists. We have trained many hundreds of massage therapists around the world, and most of them will list Stretch Therapy among their modalities if they have done our training. There is also a list of teachers and practitioners available here on our site. Having said this though, I believe that anyone can learn to do the right exercises from watching a video, and all of our important exercises are available free on this Wiki page. If you do suspect piriformis syndrome, consider following this option.

Is foam roller good for piriformis syndrome?

Foam rollers, by their very shape, cannot target piriformis directly – they are simply too large. As mentioned above, however, a lacrosse-style ball is the perfect size for getting into this area. Many people have found rolling or simply lying or sitting on one of these balls has been very helpful for their problem. When combined with the exercises, the best results are achieved.

How should I sleep with piriformis muscle pain?

Piriformis syndrome patients are frequently woken up by the pain in one or both hips. It can be very difficult to find a comfortable position where the pain is reduced. My recommendation, if you are woken by piriformis pain, is to lie on your back, and gently bring the affected hip's thigh across the body to the opposite shoulder, or as close as you can get to it. You will find a particular position which will directly affect the area. Hold the position, and try to relax that part of the body to some extent.

Piriformis Syndrome Articles

ST Founder Kit Laughlin's own experience with piriformis syndrome began after a relatively minor accident in the gym, where his training partner was not quite quick enough to catch him when he failed in a maximum back squat attempt. About two weeks later, he was sitting at the computer rewriting Overcome Neck & Back Pain (oh the irony!) and he noticed a tingling sensation down his right leg. Immediately his mind went back to the maximum squat accident, and he suspected that he might have injured one of his lower back intervertebral discs. The next six months turned out to be a massive research project, and this is how we learned all the things we now know about something called "piriformis syndrome". The frightening aspect of this common problem is that it can mimic full-blown disc extrusion – and the conventional treatment offered by medicine is surgery. It may not be necessary, and it certainly wasn't in Kit's case. Please forward these to family and friends.

From the Fit Executive in the Financial Times 
by Charles Wallace

Remedies for back pain that help avoid the surgeon's knife

Our unsymmetrical bodies are the issue, not disc deformity

Financial Times The Fit Executive

Yet, having gone ahead with the procedure, it has so far done little to relieve the pain. I was reminded of this when I spoke to Kit Laughlin, an Australian expert in physiology and the causes of back ache. He noted that a 1994 study in the New England Journal of Medicine found that MRIs of 97 people with no back pain showed that a majority nonetheless had visible disc problems, such as a protrusion or a bulge, and 38 per cent had these problems in more than one disc.

The study concluded that “the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental”. In other words, it is often not the discs that are causing the pain, even though they may look terrible. To which Mr Laughlin adds: “Diagnostic technology can’t see soft structures like muscles, nerves or fascia and that’s why so many back operations are so spectacularly unsuccessful.”

To counter this, he has produced a new version of his book Overcome Neck and Back Pain, to which I have referred before in a column about joint flexibility. The book outlines a conservative approach to back pain management that sufferers could consider before trying a surgical solution, such as the fusion of vertebrae.

Mr Laughlin’s view is that only about 1 per cent of back pain sufferers have spinal deformities that require surgical intervention. One way to tell is if you have good days when back pain diminishes, alongside bad days when pain is relatively intense. Such situational pain often means the cause is something other than discs.

One of the things I admire about Mr Laughlin is that at 63 he is not afraid to admit that he too suffers from aches and pains, including bouts of backache, such as when he recently threw his back into spasm stepping off an 8cm kerb in a car park. The trick is knowing how to fix the problem.

June 27, 2016

A member of my family came to me recently with the distressing news that they were about to undergo a surgical procedure to relieve back pain. The doctor, he assured me, had showed him the images of an MRI scan that clearly indicated degeneration of spinal discs and said that this was the cause of his discomfort.


His big insight is that people think their bodies are symmetrical, but frequently they are not. One side is usually tighter or more flexible than the other. This applies not just to the upper body, which might be expected from using one hand more than the other, but also to the lower body. In fact, he notes that almost 50 per cent of the population has one leg physically longer than the other, which can easily be fixed with a heel insert.

Mr Laughlin says golfers often suffer from back pains related to the fact that their sport requires them to swing their bodies around the axis of rotation in only one direction many times a year and they become unbalanced. Similarly, boat crews move one shoulder in a wider arc than the other when rowing.

The answer to many of these muscle problems, which he demonstrates in his book and videos, is to gently stretch muscles until they relax on the overly tight side and to build up with exercise muscles that are too loose on the correspondingly weak side.

He adds that you should only stretch when your body is warm, preferably before the evening meal, and only twice a week, to allow the body to heal.

Stretch Therapy Overcome Back Pain
Course – Now Available Online!

Despite being a competitive athlete, I suffered from chronic back pain.

For months I had to crawl to the bathroom every morning because I just couldn't get on my feet. This personal experience and the desire to help others led to the creation of the Stretch Therapy Method.

It teaches you how to use specific stretching and relaxation exercises to address the underlying causes of your back pain, which will not only provide relief to your pain, but will help you feel younger, more agile and more in tune with your body than ever before.

Stretch Therapy and Piriformis Syndrome

With the first publication of Overcome Neck & Back Pain (1995), Stretch Therapy put piriformis on physical therapists' problem muscles radar. As well, over the 30-odd years that Stretch Therapy has been in business, we have invented the world's best piriformis exercises and our teaching work around the world has popularised this approach to dealing with piriformis syndrome.

If you do a search on piriformis exercises you will find that the vast majority of them stretch the femur end of this muscle, by some variation of bringing one thigh up to the opposite shoulder. We have found that moving the other end of piriformis (the part that attaches to the sacrum) to be far more powerful and far more effective in remapping what the brain thinks is the right length–tension relationship for this muscle. We have a number of variations of this exercise that are suitable for everyone.

Here’s how we do it:

1. Sign up for the Stretch Therapy Overcome Back Pain course
2. Follow the instructions and do the online video lessons
3. You will gain a new understanding of your own body, be able to move much better and without pain.

Kit Laughlin literally wrote the best-selling book Overcome Neck & Back Pain, which is widely considered to be the definitive book on using stretching to alleviate back pain. Overcome Neck & Back Pain was the first exercise-based, self-help approach to neck and back pain, now considered orthodox treatment – it is hard to understand the impact that this book had when it was first released. It has been rewritten three times since then, too. ONBP (as we call it) is the result of years of investigation and experimentation with tens of thousands of students at the Australian National University, as well as describing the process that helped him overcome his own chronic back pain.

So, click here to sign up for our Overcome Back Pain Course. And in the meantime, download a free copy of Kit's ebook The Hidden Causes of Back Pain.

This way you can stop being captive to your hip/back pain and instead feel younger, more agile and pain free than you have in years.

Discover the Book That Started a Back Pain Revolution

Overcome Neck & Back Pain

4th Edition

Considered by many to be the world's definitive resource on how to best utilise stretching, relaxation, and strengthening exercises to relieve chronic back pain.

The book Overcome Neck & Back Pain, now in its 4th edition, presents a comprehensive self-help exercise-based approach to treating these problems.

This is the book that started a revolution in treating neck, middle and lower back problems—and a method that explicitly recognises the necessity of the patient being actively involved in the treatment.

The book has been glowingly reviewed in all the peak medical journals as well as massage, shiatsu, chiropractic and complementary medical journals.


Piriformis Videos

The Stretch Therapy Method teaches you how to use specific stretching and relaxation exercises to address the underlying causes of your piriformis pain.

Relaxation Audios

For over 35 years Kit Laughlin and Olivia Allnutt have been researching, investigating, teaching and perfecting the world's most complete stretching method.

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