What are the recommended stretches for piriformis syndrome?

From the Guidelines

For piriformis syndrome, I strongly recommend performing static stretches for the major muscle tendon units, including the piriformis, 2–3 times a week, holding each stretch for 15–30 seconds, and repeating 2–4 times per stretch. When it comes to specific stretches, several options can be beneficial. The seated piriformis stretch is one such example: sit in a chair, cross the affected leg over the opposite knee, and gently lean forward while keeping your back straight until you feel a stretch in your buttock. Other effective stretches include the figure-four stretch, performed lying on your back by crossing one ankle over the opposite knee and pulling the uncrossed leg toward your chest, and the pigeon pose from yoga, which involves bringing one knee forward between your hands while extending the other leg behind you from a hands-and-knees position. Additionally, the supine piriformis stretch, where you lie on your back and pull your knee across your body toward the opposite shoulder, can also be helpful. It's essential to hold each stretch for 20–30 seconds and perform 3–5 stretches per key muscle group, 3–5 days a week, as suggested by the American Heart Association 1. These stretches work by lengthening the piriformis muscle, which can become tight and compress the sciatic nerve, leading to pain and discomfort. Combining stretching with gentle strengthening exercises and avoiding prolonged sitting can maximize improvement. If pain persists after 2-3 weeks of consistent stretching, it's crucial to consult a healthcare provider for further evaluation. Key points to remember include:

• Stretching frequency: 2–3 times a week
• Stretch duration: 15–30 seconds per stretch
• Number of repetitions: 2–4 per stretch
• Importance of combining stretching with strengthening exercises and lifestyle modifications to alleviate piriformis syndrome symptoms.

From the Research

Piriformis Stretches

• The recommended stretches for piriformis syndrome are not explicitly mentioned in the provided studies, but some studies suggest that stretching and physical therapy modalities are commonly used treatments for piriformis syndrome 2, 3.
• However, one study suggests that the traditional approach of stretching the piriformis muscle may not be effective, and instead proposes a hip muscle strengthening program with movement reeducation as an alternative treatment approach 2.
• Other studies mention the use of various treatment modalities, including physical therapy, steroid injections, botulinum toxin injections, and dry needling, but do not specifically focus on stretches for piriformis syndrome 4, 5, 6, 3.

Treatment Options

• The treatment options for piriformis syndrome include:
  • Physical therapy and stretching exercises 2, 3
  • Steroid injections 4, 5, 3
  • Botulinum toxin injections 5, 3
  • Dry needling 5, 6
  • Surgical options, such as endoscopic release of the piriformis muscle 5
• The choice of treatment depends on the severity of the symptoms and the patient's response to conservative management 5.