Q: I am a Pilates instructor in Australia and seem to be suffering from Piriformis Syndrome. I taught 6 classes last week, 2 more than usual and am wondering if too much side leg series work, bridges etc could cause this? I’ve been doing the usual stretches and rolling to relieve it but wondering if you have any other tips. A few of my clients are also interested as some of them also suffer with this. Thanks, keep up the great work I love your site. Kim.

A: Hi Kim!

First of all, thank you very much for your question. I’m sure it will help a lot of people that could be suffering from the same or similar disorder.

To start, let’s take a closer look at the piriformis muscle and this mysterious syndrome.

Your piriformis muscle originates mostly from your sacrum (base of spine) and inserts on the greater trochanter of the femur (thigh bone). In other words it passes very deeply through your buttock. In the standing position it is a lateral hip rotator muscle, but it changes to a medial hip rotator in hip flexion due to its orientation. Besides that, it can also assist the hip abduction. This enables us to walk, shift our weight from one foot to another, and maintain balance.

When the piriformis muscle spasms and causes buttock pain, it’s referred to as Piriformis Syndrome. It can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot. That’s why sometimes this condition is called ‘pseudo sciatica’, as it is often confused with pain in the nerve resulting from a low back disc bulge.

Your side leg series and bridges could only cause the piriformis spasm if you are overusing this muscle to perform these motions. It’s more likely that Piriformis syndrome is caused by the piriformis overwork. The main reasons for it to overwork is due to protection or dysfunction of the adjacent SI or hip joints, weakness of your deep hip stability muscles or even overpronating feet.

As there is not a specific test for piriformis syndrome, it is very hard to diagnose. In many cases, there is a history of trauma to the area or repetitive and vigorous activity such as long-distance running or prolonged sitting. Diagnosis of piriformis syndrome is usually made by a report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted or tender piriformis muscle can be found with a physical exam.

After you are sure that it really is piriformis syndrome, my first recommendation would be to rest from offending activities that could trigger this muscle.

As you said, lengthening this muscle is always good to help rebalance it. The piriformis muscle is legthened with flexion, adduction, and internal rotation of the hip adductors and the knee while lying in supine. Just be careful not to overstretch this muscle. Although the piriformis is commonly considered to be short when this syndrome is present, in my clinical experience and in the scientific literature I have seen symptoms of this syndrome in people who has a lengthened piriformis muscle. So, we must carefully examine the length of the muscle before planning intervention for the syndrome.

Lengthening hip flexors, ITB and hamstrings will also help to create balance within the lumbo-pelvic junction. Besides that, strengthening the core is also a good idea. Start with static exercises such as bridging and quadruped arm/leg reach and progress to dynamic exercises such as bridging with leg arc and side lying hip circles.

Don’t forget to strengthen the upper body, specially the “weak links” like rhomboids and lower traps. Moreover, strengthening gluteus medius and minimus is also very important to stabilize the frontal plane. This can be done with body weight side step lunges and progress adding theraband around the hip proximally.

Here are some exercises that I would say would be my “go to” exercises for piriformis syndrome:

Mat work:

  • Supine pelvic rotation
  • Side lying clamshell
  • Side lying hip abduction
  • Neutral shoulder bridge and side bridge
  • Side kick
  • Rond de jambe

Reformer:

  • Supine hamstring lengthening with adduction (single leg is in strap)
  • Frog
  • Bicycle
  • Developpé
  • Lunge
  • Side splits

I hope it helped to clarify a little bit this enigmatic syndrome, Kim!

Remember your anatomy and biomechanics and you and your clients will have a nice and safe Pilates restorative session.

Barbara Lopes De Silva
Born in Brazil, Barbara’s trained as a Physiotherapist and Pilates instructor. She’s worked with a variety of athletes, pre- and post-surgical clients, rehabilitation, pre- and post-natal clients, and people of all fitness levels.
“When I’m working with a client, my focus is on contemporary, intelligent, biomechanically-efficient exercises that provide maximum results through precise alignment and controlled movements.”
Barbara is currently a Pilates Teacher at both Body Harmonics Dupont and Eglinton locations.