As someone who has suffered terribly from a crippling case of sciatica in the recent past I felt compelled to get to know the culprit in order to better understand the crime. The piriformis muscle is the most powerful player in external rotation of the leg, particularly in classical ballet. In addition, the piriformis is responsible for abducting the femur (lifting the leg away from the midline) while the hip is in flexion, an important function to transfer one’s weight into the opposite leg while walking. It lies beneath the gluteus maximus, nestled in with its counterparts in external rotation known as the “deep six.” The shape of the piriformis resembles a pyramid, its namesake.
The piriformis is one of the "deep six" external rotator muscles in the hip.
What sets the piriformis apart from its fellow external rotators is that it lives above the sciatic nerve, the largest nerve in the body, instead of beneath it. In the event that the muscle becomes inflamed, goes into spasm, or is chronically shortened, undue pressure is put upon the sciatic nerve that can result in what is commonly thought to be sciatica but is actually piriformis syndrome. To make matters worse, in approximately 15-30% of the population the sciatic nerve actually passes through the piriformis, dividing it into two parts and increasing the chance of piriformis syndrome. Women are also believed to be at a greater risk, due to the steeper degree at which the femurs angle in to the midline from the acetabulum in female hips.
According to Gabe Mirkin, M.D., in his article aptly titled Pain in the Butt: Piriformis Syndrome: “You probably shouldn’t do any exercise that causes you to bend at the hip while keeping your knees straight, because this will stretch the sciatic nerve.” Ah-hem, Uttanasana 108 times a day, anyone? Runners and cyclists are also good candidates for this condition due to the repetitive contraction and release of the piriformis muscles while propelling them forward through space. Sitting at a desk or in a car with the legs apart and externally rotated are also situations that would cause contraction in the piriformis for extended periods of time, irritating to most of us as well as the sciatic nerve.
In my research on the piriformis I came across an amazing and moving article that shed a lot of light on my conundrum. In How To Get Rid of That Pain In Your Butt by Dr. Clay Hyght, he discusses how common it is to associate symptoms of sciatica with disc herniation, but that it may not be the primary cause at all. Apparently about 50% of people over 30 have herniated disks but don’t know it, so an MRI is likely to find one. The shots, the surgery, the money, the possible addiction to powerful pain pills, and time it takes to recover, still might not take care of the problem if it is, in fact, the pesky piriformis muscle. Needless to say I’m glad I trusted my instincts on that one, Wahe Guru!
Before even considering surgery or other invasive treatments for prolonged sciatica, get on a steady regimen of deep, therapeutic massage and physical therapy with a body worker familiar with the elusive piriformis syndrome. Strengthening exercises for the abdominals, hip-flexors, and pelvic floor are also recommended for this condition as they might help to take some of the workload off the poor piriformis. An old fashioned dose of R & R wouldn’t hurt either. Using these self-care techniques can help others, like myself, to finally establish peace in the piriformis.
This is remarkable information. If more people knew that a deep external rotator could be the crux of their chronic pain which is readily treatable with YTU massage balls and corrective exercise, it could save people thousands of dollars. And who knew that some of us have a piriformis superior and inferior! Amazing.
How incredible, Kate! As a fellow former “bun-head” (yes, ballet junkie), I can absolutely relate to the intense awareness of the external rotation of the leg and the beautiful (err, painful) awareness it brings to the piriformis. It’s been your outstanding adjustments in twisted standing poses – e.g. Twisting Half Moon (Parivrtta Ardha Chandrasana) – that have brought awareness to the tightness in the piriformis, which limits internal rotation of the thigh. Thanks for shining a spotlight on this issue!
Great article, Kate! I am just learning about the piriformis and its relationship to the sciatic nerve. I found it so interesting that the sciatic nerve runs behind the piriformis making it possible for inflamation of the piriformis to compress the sciatic nerve (and cause pain!). As I am both a runner and a cyclist, I am glad that you mentioned that both of these activities contract and release the piriformis. Thanks for your suggestions of self-care techniques.
Great blog Kate, I did not know that I could blame my piriformis for my “pain in the butt”after long car rides and now I also know what I can do to cure or avoid it (besides rolling on these balls
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so interesting. i had never heard of the piriformis before our YTU weekend, but now i think about it whenever i do uttanasa or find my legs exterally rotated when i sit in front of my computer.
This is certainly knowledge everyone should have but few people do. After suffering from sciatic a handful of times, I assumed the paint hat began bothering for me last year was the same one. I was fortunate that someone was able to explain piriformis syndrome to me after seeing me self massage. Time to study my muscles!
I love this article – chock full o’ great facts. Thank you so much, I am definately going to reference it as a teaching tool for my students. I found the statistic on disc herniation especially interesting…..%50! Lets lower those numbers
Thanks for the article. YTU balls are a god-send!
What is so frustrating for me is that so many clients are told they have sciatica but use it as a crutch to avoid exercises when if only they stretched their piriformis they’d be much more comfortable.
Yes, I totally agree Christine! They tend to avoid stretching the piriformis too, because it hurts…
it makes sense to be really cautious when working out tightness in the external rotators of the hip. as anyone with an injury to this area can tell you, excessive rotation is felt immediately as pain in the knees. it seems like tightness in the adductors can also undermine attempts to release the deep external rotators in poses like supta baddha konasana. if problems with the piriformis or other rotators stems from some kind of bone injury, odds are the muscles all around the hip will have to be worked in concert before any one of them will fully release, since the attachment points cluster so tightly around the sacrum, ischium, pubis, and proximal femur.
One of my chiropractors thought I was suffering from the piriformis syndrome. Now that arthritis is the primary culprit, I fine regular massage work invaluable. I am looking forward to using the Tune Up Balls in the morning and making space in my body.
I read Kate’s article for 2 reasons: 1) I love Kate! She is my inspiration for embarking upon the yoga teacher training journey and 2) in 2003 I, too, suffered from a crippling case of sciatica from both piriformis aggravation and a herniated L5-S1 disc.
I had never heard of piriformis syndrome before! Very good to know.
This explains why Parsvottanasana relieves my pain every time.
Interesting. This is helpful preventative information.
So interesting!! I feel like this may be what is causing me pain in the upper leg whenever I do Trikonasana on the right side. I am going to try some of these techniques and see if it helps. Thanks!!
Amazing article,thank you.I have shared this info with one of my student few months ago who suffers with sciatic pain for many years and she has truly found massaging into her piriformis to be a very easy and accesible solution to aleviate the pain on day-to day basis.
This really hits a nerve with me, well, potentially! After practicing ballet until the age of 15 i went on to pursue martial arts and other more rebellious past times. However, the tight external rotators stayed with me. I’m duck -footed! I had become resigned to the fact that this is just the way MY hips are. I did not imagine that my yoga practice was affected. After all, i could stand with feet parallel in tadasana in comfort. It was not until delving into YTU that i realized the imbalance this represents and the potential injury waiting to happen with an unstable SI joint. I had my epiphany today doing half happy baby at the wall. We have been doing this pose all week and i have been tempted to reach for the outer edge of the foot. However, i reached for the instep as instructed because by now i have realized Jill leaves no detail out. As she corrected the supination of my foot it dawned on me – i wanted to create a close chain in the movement so i would not have to do the work of pronating my foot with my weak outer ankle. I bear weight unevenly into the outer edge of my foot and this originates from the hip of course. I now feel empowered to conquer my long-standing turn out and take back my hips! Thank you Jill for your indelible instruction and Kate for this inspiring article.
As a cyclist I know too well the pain experienced when my piriformis gets tight – ouch. But I have also learned a few years ago the importance of massage and self massage with the Yoga Tune Up balls. I stretch, and then massage as many muscles as I can after each ride to ensure an enjoyable day after my ride. This article is a great reminder of the importance of looking after our muscles after we have exercised.
Thank goodness for YTU therapy balls! I know this discomfort all to well and see it in many of my students that spend their days seated at desks. Often the pain is preventing us from working on strengthening the back, core and hip flexors, but YTU exercises and deep massage relieve the pain and bring so much needed release to chronic piriformis syndrome
Wonderful article, Luckily I do not have any of the pain that propelled you to investigate. But I listen to people who are working at correcting these pains in the but. Your article outlineing the deep six was helpfull to me. What struck me was your description of activities that could trigger or aggrivate the sciatic nerve and this piriformis syndrome – most of those activities are done all the time by just about anybody, I mean who doesn’t catch themselfs in bad posture even when reading blogs about posture he he. Not to meaniton just regular active people who enjoy cycling, running for sport or even with family ect… it’s good to know about these issues as we care for our selfs, families, and other yoga students or people who go to the gym with us! Tonight in Yoga Class our instructor had us use the ytu balls on our piriformis and you could hear different reactions all around the room there were people who sooo needed that. I consider your blog informative and helpfull as I interact with people with these two different ‘problems’.
The Sciatic nerve can take differing routes at the Piriformis muscle. I was surprised to learn from Grant’s Anatomy that in 12% of their dissections the peroneal division of the nerve passed through the muscle and it one case (out of 210 dissections) the peroneal division of the nerve passed above the Piriformis. With a tight muscle and a nerve passing through it, the situation could become quite painful. Careful work with the YTU balls makes a lot of sense to start releasing the muscle. At 12%, one person out of each eight in class could have a branch of the nerve that passes through the muscle! Variations are discussed here: (http://www.anatomyatlases.org/AnatomicVariants/NervousSystem/Text/SciaticNerve.shtml). I’ve certainly been more sensitive to variations in my students since tuning up with YTU!
Reading about sciatica always hits close to home for me. My mother has intense sciatic pain due to herniated lumbar vertebrae, which is enough to create a huge “pain in the butt” for anyone, but your article makes me wonder how her piriformis may or may not be contributing to her constant discomfort. The next time I see her, I’m translating and sharing this information because I’m not sure that how much her doctor’s have made this information available to her, and the more she knows her own body, the more angles she’ll have to tackle her pain. Thank you for sharing this info.
I’ve frequently heard people refer to their sciatica but have never known to what that term actually referred. This blog illuminates on and gives a name to some of the experiences I have had in the past as a runner. Knowing that it is a common symptom that can be easily prevented with some self-care is a relief and will help me in helping students who run.
Thank you for clarifying on an important issue to be aware of when advising students. Hip work is difficult in the beginning, but we can be encouraging that much can be reversed with yoga therapy
Last night at Kate’s YTU class, we rolled out our glutes and piriformis muscle using YTU balls. Wow! My piriformis is sensitive and I think my classmates were as well given all the groaning going on. Even though rolling out the piriformis can be painful (in a good way), I can really feel the difference in my hips afterwards.
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I had a brief stint with sciatic pain and often feel a little nerve sensation when sitting too long on a plane. Exercise has relieved a lot of my symptoms. After learning in my anatomy clas with Sarah and in Kate’ss restorative yoga class, I take the Yoga Tune-Up balls and suggest to everyone I know this is a miracle worker and money saver on massages, on the piriformis and IT bands.