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How to relieve the piriformis muscle

The buttocks pain from piriformis syndrome may be calmed with Thai massage techniques that target the piriformis muscle.

Description

Do you ever feel dull, achy, throbbing, or searing buttock pain? The piriformis may be contributing to this bad posture.

Your piriformis is a small muscle beneath your glutes that helps rotate and stabilize your hips. When the piriformis muscle spasms, it causes pain throughout the buttocks. It can also pressure your sciatic nerve and cause piriformis syndrome, symptoms of which include pain, numbness, or tingling along the back of the leg or foot.

Piriformis syndrome is frequently responsible for lower back pain or sciatica. It tends to be more common in women and middle-aged adults. Common symptoms of piriformis syndrome include:

  • numbness or tingling in your buttocks and the back of your leg
  • burning or shooting pain in your buttocks and the back of your leg
  • pain that gets worse with physical activity
  • pain that gets worse during prolonged sitting

While medications like pain relievers, muscle relaxants, and anti-inflammatories can help, Traditional Thai massage, stretching and exercise are the most recommended treatments for this painful affliction. 

Function

The piriformis is a flat and the most superficial muscle of the deep gluteal muscles. This muscle assists in rotating the hip and turning the leg and foot outward. It has a pyramidal shape and is almost parallel to the posterior margin of the gluteus medius. This muscle is part of the lateral rotators of the hip that helps rotate and stabilize your hips. It starts at the lower spine and runs diagonally to connect to the upper surface of each femur.

You can locate the sciatic nerve from the piriformis muscle. This nerve enters the gluteal region inferiorly to the piriformis. In most people, the sciatic nerve runs vertically directly beneath the piriformis, but in some people, the nerve runs through the muscle.

Assessment

Place the recipient in the side-lying position with the hip you wish to test on top. Passively move the patient’s lower extremity into flexion (90 degrees), adduction, and internal rotation. Stabilize the hip and apply downward pressure to the knee to internally rotate and adduct the hip. The adduction will place the piriformis in a stretch that compresses the sciatic nerve.

The test is positive if the recipient has pain in the sciatic/gluteal area. This position may also produce pain in the anterior thigh due to femoral acetabular impingement, so asking the recipient where they feel the pain is essential.

Treatment

Here is a three-step Thai massage sequence in the supine position that targets the piriformis muscle.

Piriformis Stretch

Half kneel facing the recipient’s head with your inside knee beside the recipient’s knee. Hold the recipient’s heel with your hand so that your forearm extends over their toes, and place your outside hand on the recipient’s thigh. Lunge forward and bend the recipient’s foot with your inside forearm. Press three points on the recipient’s thigh, starting above the knee and moving to the groin and back.

Twist Body

Lift the recipient’s bent leg over their straight leg so their foot is beside their knee. Step across their body with your lower foot and gently hold the foot of their bent leg. Place your lower hand on the inside of the recipient’s knee and your upper hand on the shoulder closest to you. Press and hold the recipient’s shoulder. Push their knee away from you into a twisting stretch. Repeat three times.

Chorus Line

Step over the recipient’s body into a half lunge with your inner knee by the recipient’s thigh. Place the Achilles tendon of the stretched leg just below your outside lower knee. Stretch the recipient’s leg by stepping forward slightly and then rocking your body weight. Be sure to hold the upper thigh of the recipient’s stretched leg to stop the body from rolling up.

Self-Stretching

Regularly stretching your piriformis may help loosen up the muscle and reduce your sciatica symptoms. Start slowly and be gentle. Pushing too far or too intensely could worsen your symptoms. As your symptoms start to ease, you can gently deepen the stretches. If you feel a sudden worsening of your symptoms, stop immediately.

Sitting Piriformis Stretch

Sit in a chair with both feet flat on the ground. Lift the right ankle and place it over the left knee. Next, flex the right foot by bringing the toes toward the shin and sit up tall and straight. Keep the spine straight, and bend the chest forward toward the knees. Bend far enough forward to feel the stretch but no discomfort, and hold it for 5 seconds. Repeat with the other leg.

Knee to Opposite Shoulder Stretch

Lie on your back with your legs straight. Lift your left leg and bend your knee. Reach across your body with your right hand and gently pull your knee toward your right shoulder. Hold the stretch for at least 20 seconds and repeat on the other side.

Knees to the Side

Lie on the back with the knees bent and feet flat on the floor. Stretch the arms out straight on the floor at shoulder level. Place the right foot on the left knee. Drop both knees to the left side. Hold. Gently return to neutral and repeat on the other side.

Supine Piriformis Stretch

Lie on your back on a mat or soft surface and cross your left ankle over your right thigh. Grab the back of your thigh area behind your opposite knee. Gently pull your thigh straight toward your chest. Hold for at least 20 seconds and repeat on the other side.

Alternate Supine Piriformis Stretch

Lie on your back with your knees bent and feet flat. Grasp the left leg with both hands. Pull the leg toward your chest and bring your foot to the right hip bone. Repeat on the other side.

Pigeon Pose

Begin on hands and knees. Lift and bend the hip, bringing the left leg forward, bending at the knee, and resting the outside of the lower leg and foot on the floor. ​​The knee should be in line with the hip joint. Place both hands on the floor in front of the bent left leg. Extend the right leg back until it is straight out behind. If this is not possible, keep the back leg bent. Lower the upper body until the weight is on the forearms and the stretch can be felt in the hips. Hold and repeat on the other side.

Exercises

Bridge

Lie flat on your back with both knees bent. Contract your core and lift your hips off the floor. Squeeze your buttocks at the top of that motion. Slowly lower your hips back to the floor. Repeat at least ten times.

Lower Abdominal Strengthening

Lie on your back with your knees bent and your feet flat on the floor. Tighten your belly muscles by pulling your belly button toward your spine. Lift both feet off the floor and bring your knees toward your chest so your knees are straight above your hip and your lower legs are parallel to the floor. Lower one leg at a time to the starting position. Keep your abdominal muscles tight and your back still, and lower one leg at a time to the starting position. Keep alternating legs until you have lifted each leg 8 to 12 times.

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