Today’s post is a guet post from Dr. Sarah Duvall. If you’ve seen some of her previous posts, you know she always crushes it and this post is no exception. Enjoy.
The piriformis is one of those fun muscles that likes to let you know in a dramatic way when it’s feeling tight. Not only does it cause pain in your backside on road trips, but it can pinch your sciatic nerve which is no fun for anyone.
So why does the piriformis muscle tighten down? Muscles generally get angry from overuse, and the piriformis is no exception. Now I’m not talking overuse from intense workouts. I’m talking about overuse in daily life which happens when the piriformis is having to do more than its fair share to help you move.
The first thing to understand is that this is not the fault of your piriformis. It is just getting overused. So as we stretch it and beat it to death with a ball and foam roller, I want you to keep in mind that it’s just the victim and you’re not addressing the cause of the issue. Foam rolling or stretching a piriformis rarely creates a long-term solution. This is why you may find you need to stretch it every day just to keep the pain at bay.
What does stretching really do? Stretching helps to dampen the nervous system which can work to calm a tight muscle down and make it feel more flexible for a short time. But oftentimes the stretching doesn’t hold, and the muscle goes right back to being tight. To me, stretching never seems like a fix, it seems like more of a Band-Aid without solving the problem. But, sometimes stretching can be a good idea to pair with addressing the cause of the issue to help calm the muscle down and encourage change! So, stretching isn’t all bad, it just needs to be done as part of a plan and not the whole plan.
So what is really causing the piriformis to overwork, and how can we fix it?
The first thing we have to figure out is what the piriformis is compensating for, because you have to fix the compensation patterns to help the piriformis let go on its own. So essentially, find the weakness and strengthen it. The piriformis can compensate for many things, so let’s dive into that list and see if we can figure out what yours is compensating for. This process can get a little bit complicated but if you have a little patience, you can really get to the bottom of it.
One major pattern I’ve found is hamstring dominance. This is someone whose hamstring tends to fire before their glute or takes over for the glute for movement at the hip. If the hamstring fires before the glute, then it will pull the femur forward in the socket. (Thanks so Shirley Sarhman for this concept.) When the femur (leg bone) goes forward in the socket, it sets up a nice environment for the piriformis to want to grip. It can also set you up for tight hamstrings and hamstring strains, which then makes you feel like you have a whole side that is tight when in reality, you just have a side where the assisters have turned into the prime movers and the prime movers have taken a vacation. So the first thing to check is whether your glute is firing before your hamstring.
Check out this short video to find out if your glute is firing before your hamstring.
Problem number two that can lead to the piriformis overcompensating is excessive paraspinal activity.
You can think about tight paraspinals as a seesaw. When something pulls on one part of your spine, it also affects the other part. So if you have tight muscles pulling on the top of your spine, what ends up happening to the bottom of your spine where the piriformis attaches?
Another way is to think about your piriformis as your anchor for the bottom of your spine, so if something is putting a huge force up higher (like the paraspinals) then the poor piriformis is going to be hanging on to help counter that pull.
Overactive paraspinals can also contribute to a butt wink. In someone who has overactive paraspinals, they will initiate their squat with these muscles by arching their back instead of lengthening their glutes and piriformis. The squat should be initiated by eccentric loading of the glutes, piriformis and other deep hip rotators, not by the paraspinals arching.
This pattern will often show itself during a squat. This is when the glutes and other deep hip rotators don’t want to eccentrically lengthen and so your bottom tucks under.
You can also feel it when you try to go down into a full squat on the ground. If you’re tight in the paraspinals, glutes and piriformis, you’ll fall over backwards unless you squat on your toes.
So how do we get those paraspinal to loosen up? We look at breathing and abdominal control. The paraspinals will take over for weak abdominals and a poor breathing pattern. This is especially true with someone who is a shallow breather or a belly breather.
Take a look at this video to find out how breathing can help loosen your paraspinals and activate your abs. #1. Assess breathing – does it go up or down? #2. Can you breathe into your back?
I find a tight psoas can also cause the femur to move forward in the socket.
What causes a tight psoas? That also usually comes from weak abdominals and a poor breathing pattern, as well as glute strength and hip strength, and okay, the whole body just not working together well. Stress can also play a role in the system since the psoas is so tied in with the diaphragm and our nervous system. (The stress comment here is not an afterthought, it’s actually a major piece to consider!!)
Another hip flexor muscle that tends to play tug-of-war with a piriformis is the TFL. The TFL wants to pull you forward, and the piriformis wants to pull you back, and the glute medius should really be the one that’s working instead of this tug-of-war battle because it sits smack in the middle of the piriformis and TFL. Glute medius weakness can really affect the piriformis because it’s another weakness the piriformis will pick up the slack for. If your glute medius is weak and the anterior fibers can’t fill their role as internal rotators, then the TFL has to overwork for internal rotation. (Also a cause of the IT Band being angry. Same as with the piriformis, it’s not the fault of the IT Band.)
If the posterior fibers of the glute medius are weak and the glute max is weak, then the piriformis and other deep hip rotators (many people have obturator tightness as well and don’t realize it) will pick up the slack.
The glute medius also helps to hold the hip securely in the socket, which makes the piriformis very happy. So, as you’re learning, a strong glute medius and max can make a big difference.
Now, I know what you’re thinking, how do I work my glute medius and glute max without my piriformis taking over? I’ve tried to strengthen my glutes, and I just get a tighter piriformis! That’s the technical question, and one that means you have to focus on exercise form and not just go through the motions. You have to feel, and you probably have to decrease the intensity or the weight. Stay with me and I’ll dive into more details.
So now, in theory, we have your femur sitting back in the socket a bit more because we’ve decreased hamstring dominance and strengthened glute medius and glute max, and we have your breathing improved and abdominals stronger so your paraspinals are letting go, so what next?
Let’s take a look at your posture. You can have a tight piriformis with both an anterior pelvic tilt or posterior pelvic tilt.
When you’re in a posterior pelvic tilt, meaning your bottom tucks under a bit too much, that’s usually a sign of holding constant tension in the piriformis muscle. Unclenching or letting go of those hip muscles can really help with releasing the tension that causes chronic tightness.
When you’re in an anterior pelvic tilt, this is when your pelvis spills forward, it changes the line of pull of the glute medius and piriformis. I’ve found if I can decrease someone’s anterior pelvic tilt, I can change this line of pull and decrease the strain. The glute medius and max start working more naturally, and the piriformis has less demand on it.
I also find strong adductors pair well with the glute medius. I like to think about them as anchors on the inside and outside of the pelvis. Pretty fun, right? The body just loves balance.
A simple glute vs piriformis strength test is to see if your glute holds your weight when you go into a single leg bridge or if your weight shifts into your TFL and piriformis. Give this test a try!
Once we fix the underlying weaknesses and movement patterns, it’s time to move on to teaching your piriformis how to lengthen under load. Nothing like a bit of eccentric work to make a muscle feel safe enough to let go.
With this in mind, claims are one of my least favorite exercises for helping piriformis problems. The muscle is already overworking and tight, why would we want to work it more? Just say no to external rotation!
Add an adductor squeeze to your bridge for a very simple piriformis relief exercise.
Toe down single leg squats. Come down with one, up with two so you focus on the lengthening.
Seated pullbacks. Trying to open that butt cheek and create space.
All of these exercises help to lengthen and discourage the piriformis from overworking.
Teaching a muscle how to lengthen under load can help rewire the muscle so it doesn’t want to hang on so tightly. This is an important step as you work on fixing all the causes that I mentioned above. Then you can give those other muscles more of a role with balancing out the body and you’ll have a happy piriformis.
So instead of being mad at your piriformis being tight, give it a little slack. Did you know that I consider the piriformis a pelvic floor muscle? It’s in our pelvic bowl, playing an important role in supporting our pelvic organs. Learning more about the way the core and pelvic floor work together to support our entire body is vital if you write workout programming.
Come dive into the PCES course with me to learn a bit about pregnancy and postpartum, but most importantly, how it all works together and how to unravel the pieces to solve complex issues. This material isn’t just for moms, it’s for all bodies! The early bird enrollment starts today, May 21st, and goes through May 26th, so if you want to get more info on post-partum training and recovery, SI joint pain issues, breathing/posture considerations, exercise nutrition for pregnancy, plus a whack of guest interviews, now is the time to get in on it.