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If you suffer from lower back ache or feel a deep set pain within your glutes that runs down the back of the leg you could be suffering from piriformis syndrome.
This painful condition, which should be diagnosed by a physical therapist, can arise in several ways ranging from sitting for long periods of time through to overuse and trauma.
In this article, we’ll take a look at 6 piriformis syndrome exercises to avoid plus some suitable strengthening exercises to target the hip flexors.
What Is Piriformis Syndrome?
Piriformis syndrome is compression of the sciatic nerve caused by an inflamed or tight piriformis muscle.
The piriformis is a small muscle located deep within the gluteal muscles and helps with external rotation of the hip joint.
As the piriformis muscle passes directly over the sciatic nerve, when it becomes inflamed, tight or irritated it may compress this nerve resulting in sciatic pain.
Whilst it’s important to seek an official prognosis from a healthcare provider, there are a few indicators of piriformis syndrome and these include the following:
- Discomfort to the gluteal region when sitting for a long time.
- Deep set pain to the buttock region.
- Isolated tenderness to the sciatic notch.
- Piriformis pain.
Diagnosis of piriformis syndrome is quite difficult and is instead being referred to as deep gluteal syndrome (DGS).
Recommended Reading – 7 Effective Gluteus Medius Exercises To Strengthen Glutes
DGS results in the same symptoms of sciatic nerve pain, low back pain along with discomfort down the back of your leg but without pinpointing it to just the piriformis muscle.
Instead, DGS is much broader with symptoms arising from all structures of the glutes including the muscles, tendons and nerves.
It also encompasses a range of conditions including piriformis syndrome pain, disc herniation and tendinopathy to the hamstring muscles.
6 Piriformis Syndrome Exercises To Avoid
Most of us know the benefits of exercise, especially in terms of health and recovery, but can you workout if you suffer from piriformis syndrome symptoms?
The answer is yes, you can.
However, there are certain types of exercises that should be avoided to prevent aggravating the condition.
Squatting is a technical compound movement that requires excellent form to prevent injury.
During deep squatting you’ll likely place excessive stress on the gluteal muscles and hip joint, which could worsen sciatica symptoms.
Depending on the severity of your condition, bodyweight squatting to just above parallel may be OK.
However, it’s a good idea to avoid squatting below parallel or using heavy weights which may strain the gluteal region.
The traditional lunge exercise, especially those with a deep forward or sideways lunge, may stress the gluteal muscles in the same way as squats potentially making symptoms worse.
You should consider modifying this movement by performing it with a smaller range of motion or opting for alternative exercises that target the same muscle groups.
The leg press machine is popular as part of many people’s strength training program. But, when performing a leg press, it can place significant pressure on the glute muscles and hip area, potentially aggravating sciatica-like pain.
It’s recommended to avoid leg pressing, especially with heavy weight, and ensure the seat and foot positioning won’t cause discomfort or pain.
As with the lunge exercise, you can decrease your range of motion with the aim of keeping tension to just the quadriceps, calves, and hamstrings.
Deep Hip Flexor Stretches
Stretching plays an important role in workouts and helps to warm up and cool down muscles to prevent injury and delayed onset muscle soreness.
That being said, deep stretches specifically targeting the hip flexors may put unnecessary strain on the deep gluteal region and exacerbate symptoms.
Be sure to focus on gentler hip stretches that do not put excessive stress on the affected area and remember to perform them slowly and listen to your body. If anything feels uncomfortable or painful, then stop.
Exercising that involves repetitive high-impact movements, such as long distance running on a hard surface or high interval training (HIIT), can increase irritation of the sciatic nerve and place more stress on the hip muscles.
There are several great options for low-impact exercises including swimming, cycling, or using an elliptical machine which will minimize stress on the affected area.
Heavy Weight Resistance Training
Lifts or exercises that involve heavy weights, such as barbell deadlifts and squats, will place a huge amount of stress on the muscles and joints.
If you suffer from piriformis syndrome, not only could heavy lifting worsen pain, but it’s likely to have a detrimental effect on your form making injury more likely.
During resistance training stick to body weight exercises or drastically lower the weight load.
This will ensure you focus on maintaining proper form and technique to avoid exacerbating symptoms.
Recommended Reading – 8 Best Glute Exercises At Home With Resistance Bands
Piriformis Exercises to Strengthen Hip Muscles & Relieve Sciatica Pain
Now that you know what not to do, let’s look at some of the best exercises you can perform to help strengthen the hip flexors and relieve pain.
Seated Ankle Over Knee Stretch
- Start in a seated position with your back supported.
- Your ankles should be directly under your knees.
- Take your left foot and rest it across your right knee.
- Gently lean forward so that your feel a stretch to your buttock muscles.
- Hold this position for around 30 seconds and then repeat 3 times on both sides.
Prone Leg Raise
- Lie on the ground face down, preferably on an exercise mat.
- Rest your head on your arms and keep your legs outstretched. This is your starting position.
- Squeezing your quad muscles slowly raise one leg off the floor.
- Keep your knee locked out and pause briefly at the top.
- Complete 10 repetitions on each leg.
Hip External Rotation Stretch
- Start by lying on your back with both knees bent.
- Place your ankle on the opposite knee.
- Place both hands around the thigh of the resting leg.
- From here, gently pull the knee towards your chest until you feel a stretch in the buttock region.
- Hold this stretch for around 20-30 seconds and repeat 2-3 times on each side.
- Begin by lying on your side and one leg positioned on top of the other.
- Rest your head on your arm for stability.
- Bring your feet towards your glutes by bending at the knees. This is your starting point.
- Slowly raise the knee of the top leg towards the ceiling but keep your ankles together.
- Perform 10 repetitions 3 times on either side.
- Start in a side lying position with one leg stacked on top the other and your upper body resting on your forearm.
- Take the hand of your free arm and place it flat on the ground in front of you for support.
- Raise your hips away from the ground.
- Your body should be forming a straight line from your head to your ankles.
- Hold this position for 30 seconds and then repeat on the opposite side.
Side-Lying Hip Abduction
- Lie down on one side with your legs straight and stacked.
- Keeping your top leg straight, raise it as high as you comfortably can.
- Pause briefly and then lower it back down.
- Perform 10-15 repetitions on each side.
Foam Rolling Exercise
- Take a foam roller and place it on the ground.
- Take a seat on the foam roller ensuring the most tender part of your glutes is resting on it.
- Keep both knees bent with feet and hands flat on the ground.
- Simply rest in the position to relieve tightness or, if you prefer, gently roll backwards and forwards to the lower part of the glute to apply a little more pressure and cover more area
Whilst there are several treatment options to help with piriformis syndrome, if you’re undertaking specific exercises as part of a physical therapy program, it’s important to seek the advice from a qualified professional before committing to any new forms of exercise.
Understanding which piriformis syndrome exercises to avoid is important if you suffer from glute pain and discomfort.
By steering clear of certain movements that could worsen symptoms and put excessive strain on the piriformis muscle you have a much better chance of promoting healing, lowering pain, and preventing further problems.
Instead, you should look to incorporate exercises that encourage flexibility and strengthen the surrounding muscles, which should go some way to providing pain relief and limiting symptoms of sciatica.
Stretching out the piriformis muscle, performing hip-strengthening exercises, and even building a strong core are beneficial strategies for managing the condition.
It’s important to remember that everyone is different and everyone’s experience with piriformis syndrome may vary.
Therefore, it’s recommended to consult with a healthcare professional, such as an osteopathic physician for personalized guidance.
They can assess your medical condition, provide an accurate diagnosis, and create an individualized exercise plan that best suits your needs and helps to promote recovery.
With proper care, patience, and a targeted exercise regime, you can overcome the challenges of piriformis syndrome and return to an active, healthy lifestyle.