Around thirteen years ago, after recovering from a fractured radius (a long story involving a moped and cobblestone Key West roads), I somehow managed to injure my left hip. Shooting, burning sensations lanced down the back of my left thigh, and finding a comfortable position to do anything was well-nigh impossible. After a visit to my chiropractor, I learned that the piriformis muscle was the culprit. I had been taking yoga classes for several years at this point, but I had never heard of this muscle, and it was making its presence known.
The piriformis is one of the deep-six lateral rotators of the hip joint (along with the superior and inferior gemelli, obturators internus and externus, and quadratus femoris). All of these lateral rotators come in pairs, and for hip health, it is important that they be balanced side to side in both strength and flexibility. To give a bit of anatomical orientation, the piriformis is a pear-shaped muscle that lies underneath the gluteus maximus and is located between the gluteus medius and the superior gemellus. Because it attaches to the front of the sacrum (inside the pelvic bowl) and runs along to the greater trochanter on the outside of the femur, this little muscle overlies the sciatic nerve. In some folks, the sciatic nerve actually runs through the muscle fibers. If one piriformis becomes overtightened (in my case, on the left side), it can pull the sacrum out of alignment and compress the sciatic nerve, mimicking the symptoms of sciatica—a sensation I experienced firsthand.
This little muscle also has other functions besides laterally rotating the hip–it also assists in hip abduction and in medial rotation of the thigh when the thigh is flexed more than 60 degrees (see Joseph Muscolino’s Muscular System Manual, p. 516—many thanks to Laurel Beversdorf to pointing me to this reference). Thus, it is always working behind the scenes whenever we move our hips and thighs.
Because so many of us in Western culture have the habit of externally rotating one or both hips (duck-foot syndrome), the piriformis will often be locked short and be both tight and weak. And this muscle doesn’t work in isolation—through connective tissue and movement relationships up the torso and down the lower limb, an unhappy piriformis can affect not just your hips, but also your pelvic floor, your knees, and your low back. Check back on Friday for a great stretch that can bring hip pain relief and make your piriformis your friend again!
Read “Keep Your Hips Healthy With A Happy Piriformis”
Totally going to read the next article for release! Similar injury from a fall from horse.
Great article Dawn, Thanks for so beautifully highlighting the importance of this untalked-about muscle. I’ve heard of so many people having a sciatica like pain run along the back of the leg and when checked , the piriformis was the culprit. This really shows the lack of attention towards this significant muscle. We can now to start to befriend this muscle and eager to read the other article about keeping the hips happy with this muscle.
Oh my goodness, I was so excited when I read why my sacrum could be coming out of position, I screamed with joy. Wow, no one has ever said this to me, I have had sciatic, knee, hip and lower back pain for a very long time . Now I will be more informed when I go to my appointments. I am hoping I can find your next blog to find out a method to help relieve this pain and balance my piriformis.
Thank you so much,
Linda
Thank you for the clarity on where the piriformis is located. I had a light bulb moment when reading on how externally rotated hips (duck feet:)) can shorten the piriformis, because I have an on and off hip pain and have duck feet.
What a great educational blog in laymens terms to help explain piriformis. This little bugger definitely can be misinterpreted. Great overview as to how the weak/tight piriformis can through off our gait in respects to overcompensating on one side. Helpful to know and feel through working with the tune up balls the connection between the greater trocanter and anterior sacrum. THank you so much!!
What I’d like to know is how a doctor or bodyworker can isolate that pain is specifically a piriformis issue versus any of the other “deep 6” rotators? I have a bit of pain that can arise in my right hip when it externally rotates into a very specific angle. It is a much sharper pain when I slip and my leg has to react to catch me to prevent me from falling. The sharp pain will peak initially and then dull itself but stick around for 15 seconds whenever that happens before it feels normal again… Sounds like it could be kind of piriformisy? What might be my next steps in determining where this come from?
Very useful description of the piriformis and the lateral rotators. So many have trouble with this muscle! Thanks
Thank you for this article on the role of the piriformis and the issues it can cause.
Very clear articulation of the tightening/weakening of the piriformis and the gait tendencies! I try to sit on the floor more often since I know that sitting in chairs has been exacerbating my prirformis issues, but wonder if sitting in a cross legged position has a similar impact as external rotation while walking?
I have definitely noticed Piriformis tends to be chronically short in those who walk with external rotation or duck feet. Thanks for the article!
WOW! This is eye opening. I suffer from similar symptoms and have been diagnosing myself with sciatica. Yet it can easily be that my piriformis is overtightened and it can be pulling my sacrum out of alignment and compress the sciatic nerve. This proves to me that I should just visit a physio therapist who can confirm my injury and start focusing on healing it. Thank you for this information!
I can so relate to this post. I wonder now with my piriformis syndrome if always sitting in external rotation is shortening this muscle and making the situation worse. I will have to investigate.
I too had never heard of the piriformis, left alone piriformis syndrome until after a bad car accident a few years ago. It has also given me the feeling of sciatic nerve pain down my right leg. I saw many physiotherapists and massage therapist and experienced no relief until my alpha ball. 🙂 I sit on it all the time. I do find that sitting in the traditional legs forward position causes me more discomfort and that I am nearly always sitting cross legged with both legs in external rotation. I wonder if this is shortening my piriformis muscle more after reading your article. I will need to investigate further.
Tightening of the piriformis and the external rotation that accompanies is an especially common problem for runners. And this little muscle’s relation to many other local muscles and movement patterns, as you mentioned, coupled with the extremely repetitive and high-impact nature of running, makes the “chain-reaction” of piriformis lock-up effect other areas of the body even more quickly than with daily movements.
Thanks for the great description of the deep six! Currently learning at a YTU level 1 and this really helps. I have massaged the Piriformis with the tune up balls and immediately feel a difference in my hips and low back. Tomorrow we learn the compete hip sequence can’t wait. Great read thanks again.
Thank you for the diagram of the six external rotators. Having learned more about the origin, insertion and function of the piriformis, I now have a better understanding of how it affects pelvic alignment and will pay closer attention to feet orientation (e.g., duck feet) when teaching my yoga classes. I recently discovered when standing in Tadasana that my right foot is slightly externally rotated, I wonder if my right piriformis may be tight? Might this be contributing to the pain I’ve been experiencing in my right hip? Something new to explore…
While going through my 200 RYT training 7 years ago, I injured my piriformis…. I think from having to hold pigeon for lengthy periods. I’d never been to a chiropractor, but found one who helped me, not only with adjustments, but also with muscle stimulation. It took several treatments of muscle stim and stabilizing exercises to get back to “normal”. If only YTU balls had been around then. It’s amazing how you can feel such intense sensation from such a tiny ball!
The piriformis, hidden deep in the pelvis… A massage therapist introduced me to this fine tissue many years ago but nothing has helped to release the affected area like getting in there with the tune up balls. Of course getting to the piriformis also rolls out other hip muscles at the same time give the proximity of them all–this is an added benefit!
Thank you for highlighting the location and function of the piriformis. I’ve struggled with “piriformis syndrome” for nearly a decade and not matter how many times I endeavor to cross my anklse vs my legs to prevent the piriformis from becoming overtightenedon one side and puloling my sacrum out of alignment, my 8-5 desk job keeps this guy short and tight. Any specific suggestions on how to relieve this muscle and the otheres around it besides pigeon pose? Thanks much in advance.
I think my piriformis is too tight and pulls my sacrum out of alignment causing pressure on the sciatic nerve. My chiropractor always asks me what I am doing because my sacrum is out of alignment. I now roll on the therapy balls and a roller, continue to practice certain yoga poses (backbends) that literally help with the pain in my butt! Thank you for the information.
My default posture was standing with my feet externally rotated. It’s been so hard to create a new pattern. I have worked on my parallel feet constantly, during yoga practice, standing in line, while talking to friends. Thank you for the reminder.
Amazing how much discomfort the piriformis can cause if not kept healthy. When I first started doing plyometric workouts regularly and jumping rope very often I started to have a lot of issues to the point of foot tingling and didn’t know what it was. Once I nailed the trouble zone with a foam roller (life changing!) the pain was completely eradicated. Now I don’t skimp on rolling and love targeting the piriformis on my tune up balls.
@Lisa Get them loosen up with balls is definitely a great idea. Then, how about followed by supta hasta padangusthasana 1 (YTU leg stretch 1)? The “up leg” is actually doing external rotation in order to bring the leg to neutral (the natural tendency is to internally rotate). Therefore it does strengthen piriformis. Personally, I found supta hasta padangusthasana 1 very “centering.” It cultivates great sense in balancing the two hips, especially after extensive “hip openings,” which tends to put us into pushing the range. And when the ranges are different on two sides, we overtime enhance the difference.
Yup, just realized piriformis was spelled wrong so many times!
I’m working to figure out whether or not a piriformis’ imbalance can affect the balance of the hips. My hips are no longer balanced – the left hip is more posterior than the right and I’m trying to find away to keep them balanced AFTER my chiropractor adjusts them and puts them back into place. I’m going to play with this idea that one piraformis may be tighter (would that be the stronger one then?) and one may be weaker – and see if this is what is causing the hips to keep pulling themselves back into this pattern. I’m familiar with ball techniques to roll out a tight piraformis, but how do you strengthen the piraformis? Adduction / Abduction exercises?
@Pam. Hmmm….I am also an ex-dancer and can see through YTU teacher training and through reading these blogs, just how my body continues to unwind and reform itself after 24 years of ballet! I hadn’t really thought about combining strengthening internal rotators, with loosening those external rotators, including piriformis. Thanks for that Pam. It’s also really helpful to feel the connection between greater trocanter and my anterior sacrum, by piriformis. It’s almost as if piriformis is both external and internal rotator at the same time; like it’s on the boundary. Thanks for the post….I’m beginning to feel it.
No one pays attention to the piriformis until it screams for attention in the form of sciatic pain. Often times, a simple gait and sitting analysis can identify some of the culprits that lead to a tight piriformis. the key is not to give up your favorite activities, but to manage the mobility issues that may accompany it, as well as being proactive in rectifying other behaviours in your everyday life that may be contributing to the overall picture.
As an ex-dancer… I am sure I have over worked my piriformis! In arabesque etc.. And it desperately needs to release, and for me to strengthen my internal rotaters of the hip. Looking forward to the stretch!
Hi Dawn, I suspect my left piriformis needs the care and attention you are speaking of. Can you reference me to the “check back on Friday,” stretch for be-friending my piriformis again? thank you.
Great article which clearly outlines the ripple effect across the body if the piriformis is not “on your good side.”
The Piriformis is an amazing muscle that is so interconnected to the other muscles in the body. It is interesting that if the piriformis is overstretched it can pull the sacrum out of alignment and compress the sciatic nerve, mimicking the symptoms of sciatica. I wonder how one would be able to decipher/diagonose a pull in piriformis and sciatica? You mentioned to check back regarding a great piriformis stretch (but did not see where to obtain this), and has these stretches helped you in your healing your left piriformis?
Great blog on educating people about the function of the piriformis , I have had much luck with the Yoga Tune Up balls to help with piriformis syndrome, by placing the YTU balls to the outside of the sits bones, then begin to bring the hip into flexion and extention, gently rolling the balls. This creates a great release for the piriformis.
In reading your blog, texts and reviewing the diagrams, I can see that the piriformis acts agonistically with other external rotator muscles. However, we tend to identify issues specifically with the piriformis. Is this because it is the muscle that actually taps us on the shoulder to say “hey, there is an issue” because of its involvement in sciatic pain?
I actually go to a massage therapist regularly to have my pelvis put back into alignment. I’m not wondering if will rolling and YTU stretching I can actually rectify this myself, as it sounds like it might just be my piriformis throwing it out of alignment.
In my yoga practice I have completely abandoned passive stretches of any sort. I think my version of performs syndrome is aggravated by years over stretching. From the awesome Andre Bernard I learned reciprocal inhibition which goes my many names now but back in college was the key to deeper stretch for me as a dancer. Now it is key to SAFE stretching.
Is it possible to have an overstretched piraformis? Or rather, does the piraformis and surrounding “deep six” muscles contribute to a loose SI Joint? I often have felt, in my own body, the sensation of separation in the SI Joint, and it is usually followed by a stuck flextion of the hip joint until I can soften the musculature and tissues enough to erect my spine. AKA: stuck in Utkatasana! Thank you for the insight!
Very informative article about different joints of the hip and how they work together. My right hip is especially tight–seems like it might be a tight piriformis muscle. The illustration is helpful in understanding how these muscles work together and how I can stretch and strengthen to relieve hip pain.
Hi again Dawn,
This has been a great article for me. I’ve learned some extremely useful information that address chronic hip pain that I’ve had for decades. I’ll bet that much of my pain is due to a tight piriformis muscle. I get a stretch that address that right hip pain when practicing the lower body part of Gomukasana with the right leg on top, while flexing from the hips with an extended spine. Rocking laterally from left to right really gets in there also. Extending the lower legs to a right angle was good, but not as good as lateral rocking. Thanks for leading me into finding something new and promising for addressing this issue.
You noted in your article that we that live in the West have gotten into the habit of externally rotating our hip or hips. Do you have know why it is so prevalent to our culture? If so any suggestions how could prevent our children from following suit and thereby preventing pain and injury?