Video: Stretch for piriformis related low back pain or sciatica

Most of the cases of low back pain I see are related to hip tightness. The gluteal muscles are often a source of dysfunction but less often a source of pain. That means you may rarely feel a pain in your glutes, but you will likely feel a pain in your lower back or legs that stems from the tightness in your glutes and hips. One important gluteal muscle is the piriformis muscle which crosses over the sciatic nerve. Tightness in this muscle can present in lower back pain, hip pain or gluteal pain.  In extreme cases of piriformis dysfunction you may feel pain down the back of your leg, cold feet due to poor circulation, tingling or numbness in your toes, feet, or legs.  This is referred to as pseudo sciatica or piriformis syndrome.

If you have a tight piriformis muscle, you may find it difficult to cross your legs while seated (masculine, not feminine leg crossing).  In yoga class, you may find the pigeon poses especially difficult.

A shortened piriformis muscle can be treated with acupuncture, massage or a series of stretches & exercises.  Here is a simple piriformis stretch that I like to recommend because it can easily be performed while sitting (eg. at the workplace).

Guidelines for performing the stretches:

1. Check with a health care professional before you attempt these exercises to ensure that it is safe for you.  It is especially important to rule out any disc problems before you do this exercise.
2. Do the exercises slowly and gently.  Failing to follow the instructions or consult with a health care professional could cause your symptoms to worsen.
3. Try to breathe  slowly and keep your body relaxed.  Do not tense up or hold your breath as this will invite muscle spasm.
4. You should feel a gentle stretching sensation, but you should not feel any pain during the exercises.  If you do feel pain, decrease the range of movement by stopping before you get to the point of pain. Continue the exercise within the pain free range.
5. Pay attention to the position of the lower back.  As the instructor explains, the back should be straight, not bent.  Bending at the lower back is cheating and does not stretch the piriformis muscle.  Also, if you are feeling leg pain or tingling because of true sciatica or sciatica due to a disc problem, you may cause more damage to the disc if you perform this exercise incorrectly.
6. If you cannot find a comfortable, pain free way to do these exercises, discontinue immediately and seek the advice of a health care professional.
7. Do the exercises in a set of 3 for a minimum of 3 times a day for best results.
8. Hold the stretch for 15 seconds each time.