Piriformis Syndrome Followup: Four Ways To Release The Lower Back
April 20, 2010 by Dr. Mark Wiley
Last week’s article on piriformis syndrome, Your Lower Back Pain Or Sciatica Might Actually Be Piriformis Syndrome, created quite a bit of interest from readers wanting to know more. Indeed, it seems many people who think they are suffering sciatica or other lower back pain ailments are actually feeling the side effects of a tightened piriformis muscle. And while many physicians are quick to throw drugs and surgery at such problems, many times the answer is as simple as releasing lower back muscular constriction, which is in large part due to piriformis syndrome.
Today’s article is a response to the many queries we received on this syndrome and exercises that will help. Below I would like to share with you four sets of therapeutic corrective exercises you can do on your own.
If you can manage to perform these three times per day, in just a few days you will begin to feel lasting relief. After just a few weeks the body will self-correct and imbalances in posture due to muscular-skeletal issues related to piriformis syndrome should be corrected. Let’s look at each exercise now.
1. Pelvic Tilting
The purpose of this exercise is to warm up the area of the lower back by bringing heat and blood into the lumbar and sacral areas. Begin by sitting on a firm chair, toward the front with feet planted firmly on the ground (fig. 1). Allow your body to slouch slowly by titling your pelvis forward. Allow around three seconds to tilt to full slouch then hold that position for three seconds (fig. 2). Next, tilt your pelvis backward, swaying your low back to lift your upper body upward. Allow three seconds to reach full height then hold that position for three seconds (fig. 3). Repeat this slouch-and-sway movement set continuously for a total of 30 repetitions.
2. Piriformis & Hip Flexor Stretches
This next set of stretches works on releasing tightness in the piriformis and gluteus muscles in an effort to release compression on the sciatic nerve. Begin by sitting on a firm chair, toward the front with feet planted firmly on the ground (fig. 4). Place the ankle of your right foot over the knee of your left foot. Many of you will have very tight hips and using your hands to hold the leg in place will help here (fig. 5). Allow your hips to relax in this position for 10 seconds before pulling your knee toward your chest with both hands (fig. 6). Hold this stretch position for 10 seconds then release the knee slowly to its former position. Next, press your right hand down on your right knee, holding for a count of 10 seconds (fig. 7). Release and relax for 10 seconds, then press again this time counter-pressing your right knee into your right palm for 10 seconds (fig. 8). Release the contraction and relax in position for 10 seconds. Lastly, rest your forearms on the thighs of their respective sides and bed forward from the waist (fig. 9). Hold the forward position for 10 seconds then slowly return to the starting position (fig. 4). Perform this sequence, slowly and steadily, for a total of three repetitions.
Remember to repeat with the opposite leg.
3. Balanced Squats
Now that the previous exercises have warmed up the body and loosened the hips, we can continue with these squats. Stand up straight with feet a shoulder’s-width apart, toes pointing forward and holding onto a steady chair or counter for balance (fig. 10). Slowly and steadily bend your knees and flex your hips to lower your buttocks toward the floor (fig. 11). It is important to keep your knees behind your toes while lowering for balance and also to avoid straining the knees (fig. 12). Hold the lowest position to can maintain without using the chair as a crutch (it is for balance, not resting on). Hold this lower position for five to 10 seconds (fig. 13), then slowly and steadily rise to the starting position (fig. 10). Relax in the upright position for 10 seconds then repeat the squat for a total of three to six times, as your ability allows.
4. Gravity Leg Hanging
Now that the muscles and tendons are looser and blood is moving we can move on to the final “stretch” exercise in this series. Begin by lying on your left side close to the edge of the sofa, with a pillow under your head for support (fig. 14). Create an X-shape by reaching back with your right hand to grab the cushions (or bed sheets) for balance. Slowly slide your right leg off the sofa, stretching the quadratus lumboratum (fig. 15). Allow the leg to drop as it will—do not strain—and allow gravity to work. Because this is a “passive” stretch, the muscles in the lower back will release quickly as your body will sense little threat to the position. Hold for one minute before slowly returning to the starting posture. Next, lie with your back facing out, grabbing a cushion (or sheets) for balance (fig. 16). Slowly allow your right leg to slide backward off the sofa, stretching the psoas muscles to balance the frontal stretch (fig. 17). Again, allow gravity to do its things as you relax in this position for one minute. Do this only once then change sides and repeat with the left leg.
As a rule, even though pain is felt in a specific area or a diagnosis for something has been given; other areas are also responsible for the imbalance. With regard to sciatica and lower back pain, piriformis syndrome is often the likely candidate.
However, stretching only the piriformis muscles will not in itself be the answer to the problem. Other muscles like the tensor fascia latte, quadratus lumboratum, gluteus medius and maximus and the psoas also play a role in creating imbalances. While it is the piriformis muscle that compresses the sciatic nerve, it does not become tight or in spasm on its own. The other muscles must also be released from spasm and returned to normal resting position to allow the piriformis to also relax. By taking 10-15 minutes to do the above simple stretches at least once, but ideally three times per day, you will feel relief in no time; without drugs and without surgery.
— Dr. Mark Wiley