Do you experience an unwelcome tingling ache down your leg after prolonged sitting?
What is the piriformis? As with most muscles, there is more than meets the eye when it comes to the function of the piriformis. Yes, it is an external rotator and hip abductor. The piriformis muscle is located deep in the buttock, running from your sacrum to your thigh bone, and in close proximity to the sciatic nerve. It's difficult to reach and when the muscle begins to push against your sciatic nerve, often due to too much sitting, it can cause excruciating pain. The term sciatica is often used and understood in reference to pain caused by the piriformis muscle, however a tight or inflamed piriformis is what is known as piriformis syndrome
Can you tell me more about piriformis syndrome? This happens when the sciatic nerve is not compressed by the spine but by the piriformis. This is much more of a muscular issue that may be influenced by soft-tissue work. In most individuals, the sciatic nerve runs directly through, under, or over the piriformis muscle. No matter the direction, when the piriformis muscle spasms or becomes tight and/or inflamed, the sciatic nerve can get compressed, causing irritation. This irritation leads to describe acute tenderness in the buttock and sciatica-like pain, tingling, and numbness that runs from the buttock, down the leg and sometimes into the foot.
Have you ever felt this? Typical piriformis syndrome symptoms may include:
a dull ache in the buttock;
pain down the back of the thigh, calf and foot (sciatica);
pain when walking up stairs or inclines;
increased pain after prolonged sitting; and
reduced range of motion of the hip joint.
Piriformis syndrome isn’t always caused by inactivity. It can occur after an accident or even after vigorous activity such as running.
Here are my favourite seven yoga poses to target the piriformis, hamstring, and hip extensor muscles that I find helpful to decrease the painful symptoms along the sciatic nerve and improve range of motion in the hips.
1. Standing Forward Fold Twist (featured image): Begin in a standing forward fold, feet hip-width apart. Place the fingertips of your right hand on the floor directly underneath your face. Deeply bend the right knee as you straighten the left leg, reaching your left fingertips up to the sky as you rotate your chest open to the left and create a lovely release for your lower back. Try to stack your shoulder blades and keep your hips squared to the front. Gently swing your hips over to the right slightly to feel a deeper stretch into your glute and piriformis muscles. Stay for a few breaths and release your left hand back to the floor on an exhalation. Repeat on the other side.
2. Eye of the Needle: One of the best ways to open the hips and prepare for Half Pigeon is through a supine modification called Eye of the Needle (sometimes called Figure Four). I teach this pose to first timers and practice it myself on a regular basis. As you move through this and the next variation, make sure that you alternate sides so that your body can unfold evenly and progressively. To begin, come onto your back with your knees bent and your thighs parallel and hip-distance apart. Next, cross your left ankle over your right thigh, making sure that your anklebone clears your thigh. Actively flex your front foot by pulling your toes back. When you do this, the centre of your foot will line up with your kneecap rather than curving into a sickle shape, which can stress the ligaments of the ankle and the knee. Maintaining this alignment, pull your right knee in toward your chest, thread your left arm through the triangle between your legs and clasp your hands around the back of your right leg. If you can hold in front of your shin without lifting your shoulders off the floor or rounding the upper back, do so; otherwise, keep your hands clasped around your hamstring or use a strap. The goal is to avoid creating tension in the neck and shoulders as you open the hips, so choose a position that keeps your upper body relaxed. As you draw your right leg in toward you (making sure to aim it toward your right shoulder and not the center of your chest), simultaneously press your left knee away from you. This combination of actions should provide ample sensation, but if you don't feel much, try releasing your pubic bone down away from your navel toward the floor. This will bring a bit more curve into your lumbar and should deepen the hip stretch.
3. Eye of the Needle Extension: From Eye of the Needle, wrap your right hand around the bottom of the left foot to grip onto the outside of the left foot. At the same time wrap your left arm around your left knee and along the left shin. Bring your right foot flat to the mat, knee remains bent. So know you are supporting your left shin in the air, bringing it parallel to the floor. The left big toe is moving towards your right ear, and the left knee toward your left ear. Experiment with simple adjustments like lifting your toes higher to the sky, and maintaining pure relaxation in the shoulders. Do not force the ankle or knee beyond a comfortable position. Hold this stretch for 30 seconds, then slowly return to the starting position. The perfect accompaniment to Eye of the Needle to delve deeper into where the piriformis muscle is hiding.
4. Seated Eye of the Needle: Come back to the initial position in Eye of the Needle - lying down and crossing your left ankle over your right thigh. Tuck you chin in and lift up onto your elbows and then up onto your hands, as you begin to hinge forward at the hips into a seated position. Walk your right heel closer towards the buttock as you guide your left knee away, continuing to open the hips. Aim to bring the weight out of your hands, and use the abdominal muscles to support you in this seated pose. On every exhalation, move your chest closer towards the left shin to deepen the stretch. When ready to release, come out of the pose exactly the same way you came into the pose. Make sure to repeat Eye of the Needle, Eye of the Needle Extension, and Seated Eye of the Needle on both sides.
5. Supine Twist: Lie on your back, and hug the left knee into the chest, right leg is flat. Leaving your right hand on the left knee, extend your left arm out to the side in line with the left shoulder. Inhale to prepare, and exhale to guide your left knee over to the right as you gaze to the left if your neck will allow. Use your right hand to encourage the right knee down towards the ground as you melt your left shoulder lower to the floor in unison. Perhaps you will feel a sensational release in your lower back and along the spine to the scapula. When ready, inhale to bring your head back to centre first, followed by the rest of the body. Repeat on the other side.
6. Supine Hamstring and Twist with strap: Hug both knees into your chest on your back. Bring your yoga strap, or rolled up towel, around the ball of your right foot, and lengthen the left leg flat to the mat. Bringing one end of the strap into each hand, take the sole of your right foot up to the sky, as you kick you right heel, and begin to guide your toes up and overhead. Keep a slight bend in the right knee if you feel any sensation behind the knee joint. The more you extend through the knee, the more powerful the pose, and the more your hamstring will respond. Maintaining this position, bring both ends of the strap into your left hand, and take your right arm out wide to the side in line with your right shoulder. Inhale to prepare, and exhale to guide your right leg over to the left, as you gaze towards your right thumb. Only take the leg over so far until the glutes and piriformis start to talk to you, known as the "sweet spot" down the outside and back of the right leg. This could mean that your leg stays at a 45 degree angle, or moves closer to the ground, perhaps even connecting with the earth. Everyone will come into a different expression of the pose, depending on what works best for their bodies. Maintain foot flexion to experience the full power of this pose. Kicking away through the heel, and straightening the right knee slightly, without bringing sensation behind the knee joint. Inhale to bring your head back to centre, followed by the right leg. Hug both knees back into the chest and repeat on the left.
7. Half Pigeon Pose: Start on all fours, placing your hands directly below your shoulders, and your knees below your hips. Bring your right knee forward until it touches your right wrist, keeping your right thigh parallel to the sides of your mat. Slowly inch your right shin and foot (hereafter referred to as your "front leg") toward the midline of your body until your foot is directly below your left hip. Now straighten your left leg (hereafter referred to as your "back" leg) toward the back of your mat. Instead of leaning forward, walk your hands back and lower both sides of your pelvis toward the floor. As your pelvis releases, be sure your hips don't lean to the right. You'll know this is happening if your left hip lifts higher than your right. You need to keep your hips as level as possible to get the full effects of the pose and to keep your lower back safely aligned. If you're not able to lower the hips evenly (join the club!), sit on a folded blanket or a block before starting the pose. As your hips continue to settle, press your fingertips firmly into the floor and lengthen the sides of your waist to help keep your lower back long and free from strain. Using your arms this way allows you to modify the intensity of the stretch. Walk your hands forward, inhale deeply as you lengthen your torso, and exhale as you fold forward, lowering your elbows to the floor. Again, use your arms to adjust the weight you release into your hips. It's important to refine your alignment to ensure that you're peeling away layers of tension rather than stressing any of your joints. Start by making sure your hips are level. If you were meticulous about this in the first stage, you are probably in good shape. If not, then any imbalance will increase as you come forward. So if necessary, place a folded blanket under your right buttock so your pelvis isn't off kilter. Look at your front thigh. Make sure it's parallel to the sides of the mat and that your front foot is directly beneath your back hip. Breathe into the sensations rumbling in your hips. Relax your eyes, jaw, and throat. Continue to breathe into your hips and allow your belly to melt toward the floor. After 5 to 10 breaths in the forward bend, inhale to come back up. Press down through your fingertips as you lift your hips away from the floor and transition all the way to Downward Dog. Take five deep breaths and observe how your hips feel—lighter? clearer? achy? Switch to the second side.
Walking with a tight piriformis puts extra strain on the inside and outside of your knee joint, making the outside too tight and the inside weak, which creates an unstable joint. Let me know if these piriformis yoga poses also help to ease knee and ankle pain.
Like with any type of exercise, you should stop doing it if it hurts. Don’t try to work through the pain. Those pain receptors are there for a reason.
Louise FitzRoy is the Principal of Activ Life, a leading health and wellness company based in the Cayman Islands. If you enjoyed this article you may also like: 5 yoga moves with your chair and Anti-aging yoga secrets.