Piriformis tightness is a common problem with many of our clients. Not only does it limit range of motion while squatting or lunging, a short, stiff piriformis can create compensatory changes down the entire kinetic chain. In this edition of FITNESS INSIDER, we will look at the causes of this common condition as well as outline a corrective strategy for dealing with a chronic tight posterior hip.

Why does the piriformis get so tight and problematic? To better understand the causes, let's take a brief look at its' function.

The piriformis attaches from the anterior portion of the sacrum to the greater trochanter of the femur. With the hip in a neutral or semi-flexed position, the piriformis is an external rotator of the hip. As the hip approximates 90° of flexion, the piriformis changes its' role to an internal rotator and horizontal abductor of the femur. However that is really only part of the story because the piriformis' functions are much greater when the foot is in contact with the ground.  A few of these functional roles will be highlighted below. The piriformis:

  • assists the gluteus maximus in controlling internal rotation of the hip during the loading or pronation phase of gait;
  • assists external rotation of the ilium on the femoral head;
  • assists the posterior oblique chain in stabilizing the sacroiliac joint;
  • assists stabilization the femoro-pelvic joint (hip joint);
  • through it's fascial attachments on the anterior sacrum, likely assists the pelvic floor in stabilizing the floor of the thoracopelvic canister.

A stiff and/or short piriformis has significant ramifications on function. It can lead to;

  • limitations in internal hip rotation which can create a compensatory increased internal rotation at the knee during the gait cycle;
  • fixation and limitation in the sacroiliac joint leading to both sacroiliac pain and compensatory changes through the low back;
  • stiffness in the hip joint making it difficult to centrate the femur within the acetabulum which causes problems during gait, squatting, lunging, and other lower extremity patterns;
  • sciatica-like symptoms by compressing the sciatic nerve as it leaves the gluteal region.

There are two simple ways to determine if your client has a short, stiff piriformis. In the supine position, you can passively check your client's internal rotation by grasping the ankle and rotating each leg. Compare side-to-side noting the side of greater resistance and restriction. You can also check range of motion in the 90° hip flexion - 90° knee flexion position, However this time you will evaluate external rotation range of motion since the piriformis becomes an internal rotator once the hip hits 90° of flexion. Again, note the side of greater restriction or resistance to movement.

The first goal to solving piriformis problems is to release the myofascial component so that we can get our client's femoral head to sit back in the acetabulum during their corrective and functional patterns. There are several methods of accomplishing this including but not limited to;

  • manual release;
  • myofascial release using a foam roll, ball, or similar device;
  • quadruped weight shifts with focus on relaxing through the posterior hip region;
  • waiter's bow focusing on releasing through the posterior hip region;
  • pigeon stretch and/or figure 4 stretch as performed in yoga;
  • PNF contract-relax techniques.

While you are likely very familiar with using the foam roller to release the piriformis, I've demonstrated several of the latter techniques in the video below.

CONCLUSION

The piriformis is an important muscle during functional activities including walking, squatting, and lunging. It can restrict your client's ability to centrate their hip in the socket which can lead to a decrease in performance and potential injuries to the low back, sacroiliac joint, knees, and/or feet. The first goal to solving the chronic tight piriformis is to get your client to release the myofascial restrictions so that they can glide their femoral head posterior in the hip socket and centrate the hip. In the next edition of FITNESS INSIDER we will look at centration of the hip joint to help your client access the stabilization as well as dynamic function of the piriformis muscle.

Helping You Think Bigger of Your Role as a Fitness Professional,

Dr. Evan Osar