Piriformis Syndrome - Home Stretches & Exercises

What's going on everyone, Tom Walters here from Rehab Science back with a rehab video this week. This week we're going to look at a common cause of hip especially buttock related pain and even nerve pain, sciatica type pain. It's often referred to as piriformis syndrome in the research and by some clinicians. As the research is changing we're seeing that name is sort of outdated and not really appropriate anymore so now it's referred to as deep gluteal pain syndrome which is basically a big mouthful that just means irritation of the sciatic nerve by some of the structures in the pelvic region. It could be the piriformis muscle, it could be some of the other small muscles underneath the glutes, even the upper part of the hamstring in some cases can irritate the sciatic nerve and cause pain that's in the buttock region, goes down the back of the thigh, maybe even past the knee into the shin and foot. So this is basically a sciatica that is not associated with the low back. Our sciatic nerve and its branches start in the low back so some people with disc herniations or spinal stenosis can have sciatica. That would be a sciatica that again stems from the low back. This is different, it's a sciatica that comes from the pelvis, from the pelvic region and usually associated with some of the muscles deep in the backside of the hip underneath the glute muscles. So we're going to cover four exercises, four sciatica that really comes from that buttock region. So if you've got that kind of pain, check out these four exercises. If you have any questions, leave them in the comments and I will try to answer everyone. Alright, here we go. So for the first exercise, we're going to do a lumbar rotation stretch. Again, this sciatica is more related to the hip but because those nerves start in the low back, we're going to do a stretch that stretches the low back and the hip a bit. I'm going to, in all of these videos, pretend like I have the pain on my right side. So you can do this on both sides, all these exercises you can do on both sides, but I will do them on my right side so you can see what you do if you've got pain just on one side. So if my right side has this piriformis syndrome or deep gluteal pain syndrome, I'm going to lay on my back, I'm going to bring that right leg up, grab it with my left hand and stretch over to the side. This is a stretch a lot of people are familiar with. We often use it to kind of pop our low back. So it's the same kind of stretch, but I'm going to get a stretch of my low back and of this lateral side of my right leg and even a little bit back into my glutes and some of those deep rotator muscles. So just hanging out here, you can perform this three to five times. What I'll usually do is perform on one side, hold for 15 to 20 seconds and then come back to your normal position and then rotate and the same thing on the other side. So just a good way to stretch your spine into right and left rotation and the hips. So that's our first exercise, a spinal rotation and hip combination stretch. For exercise two, we're going to do another stretch. This one will be more specific in terms of targeting our glute muscles and our deep rotator muscles, including the piriformis muscles. So again, my symptoms are on my right side. I'm going to bend my left knee and cross my right leg over my left and then I'm going to grab up by my knee with my hands and pull that knee towards my opposite shoulder, which should create a stretch in your buttock region on the right side in this case. So I'm going to pull across there until I feel a decent stretch and then I'm going to hold for 15 to 30 seconds and I'm going to perform two to four repetitions of this. Again, if you only have pain on one side, it doesn't hurt to do the other side. Just stretch both sides. If you're short on time, just do the side that has pain. So this is our piriformis deep hip rotator stretch. You should feel it in the buttock region. For the third exercise, we are going to do a nerve mobilization. So this is going to target the sciatic nerve and its branches all the way up into the low back. So for this, again, my pain is on my right side. I'm going to reach behind into my hamstring region here, the back of my thigh. Use my arms to hold my leg, basically my femur in a vertical angle up straight towards the ceiling. And then I'm going to straighten my knee until I feel a stretch in the back of my leg or pain, whatever comes first. And then from there, I'm going to pump my ankle up and down just gently. Be careful because when you pull your foot down, it tensions the nerve and may create some discomfort and pain. So just move gently. You're just going to pump your ankle up and down like this, just a standard ankle pump. But doing this pulls on the sciatic nerve and helps to mobilize it. These mobilizations have been shown to help improve blood flow to the nerve, which can help speed up the healing process. So this is our third exercise, a sciatic nerve mobilization. You're going to perform this, this ankle pump 15 to 20 times, and then rest. And you can perform two to three sets of this throughout the day to help improve nerve health. For the last exercise, we are going to activate and strengthen gluteus medius and gluteus minimus, which are these glute muscles up in the top back corner of our hip. Working these muscles often helps relieve buttock, hip, and low back related pain, sciatica type pain. So this is going to be our last one. We've done some mobility exercises, now we'll have a strength one. So you're going to lay with your painful side up. So my right side is the painful side. I'm going to put my hand here on my pelvis. I'm going to roll forward. So right now I'm laying with my hip pointed up towards the ceiling. I'm going to roll forward slightly. And then my top leg is going to lift up and back to the corner, and with my toes turned slightly down. That's called hip internal rotation. So I've got a combination of hip internal rotation, abduction, which is going away from my body, and extension, which is back to the corner. Those three movements together really help target gluteus medius and gluteus minimus, and will help to build strength there. So I'm just going to go up and down, nice slow controlled movement through the full range of motion. I'm going to shoot for three sets of eight to twelve repetitions, just basically until I feel some fatigue in this upper part of my glute. So do a set, and then rest for 30 seconds to one minute, and then another set, and you'll go for three sets total. Again, you can do this on both sides. It'll probably help your other side too, but if you're short on time just stick with the painful side. So that is the last exercise of the four, side-lying hip abduction.