The Piriformis Release

Todd Sabol, MS, AT

Have you ever felt a nagging pain near the top or middle of your glute that either feels extremely tight or painful? Have you ever felt a burning, numbness or tingling sensation down the entirety of your leg from butt to calf? These are two extremely common symptoms of piriformis syndrome and complaints I hear from athletes I work with, powerlifters, bodybuilders or even recreational gym goers. Obviously, it is difficult to give an exact diagnosis of an injury without a complete evaluation, but my goal for writing this article is to give you an overview of why this may be occurring and offer a release technique you can employ each day.

First off, the piriformis muscle is a deep external rotator of the femoroacetabular joint or hip joint. It is considered a deep external rotator because it lies deep to the gluteus maximus and inferior to the gluteus medius and minimus. It resides at this inferior position where it attaches from the anterior surface of the sacrum to the top of the greater trochanter of the femur (if you rotate your leg you can feel this on the side of your hip). Secondly, and just as important, the sciatic nerve runs directly beneath the piriformis muscle. Additionally, in some individuals (10-12%), the sciatic nerve runs directly through the piriformis muscle, which we saw quite commonly in the anatomy lab I assisted in.

The cause of piriformis pain commonly stems from chronic overuse. When this overuse occurs over long periods of time two things can happen: hypertrophy (increase in muscle size) or inflammation of the piriformis muscle cause a decrease in the space surrounding the sciatic nerve. This can cause spasm of the piriformis muscle or sciatic pain from the compression itself. If the sciatic nerve is not compromised, pain will mainly present in the gluteal area and distribution of the piriformis muscle. If the sciatic nerve is compromised, neurologic symptoms will most likely present along the distribution of the nerve. This nerve does not only run along the posterior thigh, it branches just superior to the back of the knee into tibial and common fibula branches that supply the lower leg and have additional branches into the foot (Shown by the black arrows in the bottom image). Depending on the severity of the nerve compression and the duration in which it has occurred, symptoms can occur at any point along this distribution. So the question is, how can we either prevent this from occurring, or if symptoms are already occurring, how can they be resolved?

The recent “technique daily” with Max Effort Muscle that showed two methods of piriformis release is a great place to begin, and although they can be aggressive, they can help relieve that tension in the piriformis muscle. When you have a partner, you can perform the first release technique. This is performed by having the individual in pain lay prone on the floor. Then with your elbow, find the point of tenderness along the piriformis muscle. Once you find it, apply a generous amount of pressure and grab their ankle on the same side and begin to slowly internally and externally rotate the leg. Do this 15 times for 2-3 separate sets. This rotation of the leg takes the piriformis through its full lengthening (eccentric) and shortening (concentric) cycle. While the muscle is passively eccentrically and concentrically contracting under the pressure of the elbow, it allows for the tension inside the piriformis tissue to release and allow for an alleviation of of the spasm in the muscle or the compression of the sciatic nerve.

The other release technique that was shown was a self-release that you only need a lacrosse ball or tennis ball for. All of the same concepts are applied from the first release method. From a seated position you find the tender spot on the piriformis tissue with the ball, then simply internally and externally rotate the leg again for 15 reps, 2-3 sets. It is important to remember, the majority of the time there are not “quick fixes” for musculoskeletal issues, but if consistent care is taken over days, weeks and months, alleviation of symptoms can be achieved. Check out the piriformis release video below from Instagram @maxeffortmuscle and always remember to #HealByMoving.

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