The piriformis is a cone-shaped muscle in the hip and is responsible for lateral rotation of the femur. It also acts as a stabilizer muscle during movement. The sciatic nerve runs through, or very close to, the piriformis and tension in the piriformis can aggravate that nerve--causing lower back and buttock pain, shooting pain down the back of the leg.
Determining if the Piriformis is Tight
The most obvious way to tell is by touch. When feeling the area, the piriformis will feel tense, even hard. The piriformis is responsible for external rotation of the leg, so another way to determine if the piriformis is tight is to sit on the floor, relaxed, with the legs extended. If the knees rotate outward, the most likely cause is a tight piriformis.
The Piriformis Stretch
From a supine position, bring the knee of the affected leg up to the chest and pull it across to the opposite shoulder. Grab the area just above the ankle on the raised leg and pull the foot toward that opposite shoulder. The key to this stretch is to do it slowly and only pull until the piriformis muscle starts to stretch. Some people may feel the stretch the moment they bring the knee up to the chest. Hold the stretch for 20 seconds then release. Don't force the stretch because that may cause the piriformis muscle to tighten, irritating the sciatic nerve that runs through the muscle.
Trigger Point Pressure
Trigger point pressure in the area of the piriformis and sciatic nerve, helps to release the tightness and quiets the nerve. Simple pressing on the trigger spot, with the thumb or fingers, is effective but often fatigues the hands. Using a ball is more effective because it allows the patient to apply pressure longer. From a supine position, bend one knee, resting the foot on the floor. Feel around on the buttock for tender spots in the area of the piriformis muscle. Place a tennis or racquet ball on one of those spots and gently allow the bent knee to drift or fall outward. Hold this position for up to one minute. Move the ball to another tender spot and repeat. If the piriformis is really tight, the ball may be uncomfortable and slightly painful. If there is severe pain, remove the ball immediately.
Muscle Balance
Piriformis tightness is often a result of imbalances in other areas of the back, thighs and pelvic girdle. When the body is in motion, the piriformis works to maintain balance and keep the hips properly aligned. If the other stabilizer muscles in the core are not doing their job, the piriformis has to work harder, leading to tightness and irritation. Core exercises, like Pilates, strengthen all the core muscles so that they can all work together to keep the pelvis stable. Balance exercises, like standing yoga exercises, also help by training the body to stay over the center of balance and maintain proper posture.
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