Origin/Insertion: Anterior surface of sacrum/Upper border of greater trochanter of femur
Action: Lateral rotation & abduction of thigh
Let’s talk about the piriformis
I remember the day clearly, even though a decade has since passed. You never forget the day you turn old. And nothing makes a person feel quite so old, regardless of their true age, as a bad lower back.
I was 30 years old and in the midst of a deep love affair with mixed martial arts. The gym I trained at specialized in striking so our coach brought in a wrestling stud to help us with our grappling game. We were warming up with some basic pummeling drills when the pain first hit.
With every twist of my hips it felt like someone was stabbing me with a cattle prod right in the lower back. I tried to push past the pain, tried to tough it out, but this wasn’t simply a case of discomfort. My ability to move properly had been compromised; I couldn’t squat, couldn’t shoot in for a takedown. It was as if my body decided to go on strike. Frustrated and annoyed, I approached our guest coach more out of embarrassment than anything else.
Before I had even finished describing the situation, coach knew exactly what was up. He then sat me down and demonstrated a stretch that has since become a staple of my daily routine, as well as that of my clients.
Small muscle, big problem
The piriformis is a small pear-shaped muscle that sits deep within the glutes. That’s right, it’s one of them ass muscles. Or, more accurately, a hip muscle; the piriformis is responsible rotating the thigh laterally at the hip joint, as well as pulling the thigh away from the midline of the body.
So what’s the big deal, why such fuss over this relatively tiny muscle that doesn’t even do anything all that spectacular? The problem is, the piriformis sits close to the sciatic nerve, and when the muscle is tight or when it spasms, it irritates the nerve. This can lead to a range of issues, from mild numbness and tingling in the legs, to intense pain that radiates throughout the entire lower body and back.
Whenever someone mentions lower back pain, the first thing I have them do is perform the above illustrated stretch. More often than not, just attempting to get into this figure-four position will trigger a yelp of pain. That’s what happened when I tried to follow my wrestling coach’s lead that fateful afternoon all those years ago.
A cure for pain
Thankfully, the initial remedy for a pesky piriformis is the exact same as the assessment tool used for diagnosis. The figure-four/piriformis stretch can be performed sitting in a chair or lying flat on your back. I prefer being on my back for this one. The intensity of the pain, and your general mobility, will determine the best position for you.
To compliment this stretch, you can (nay, should!) perform some exercises that help strengthen the lower back, core and hips. Planks are ideal for this, specifically side planks and high planks with some leg abduction added in. Aim first for a 20 second plank, then work your way towards one full minute. Two or three sets will do the trick.
And of course, learning how to squat properly will help, too. Too often people focus on their knees when they squat, when what we should be thinking about is opening the hip. Remember earlier when I outlined how the piriformis functions? How it’s responsible rotating the thigh laterally at the hip joint, as well as pulling the thigh away from the midline of the body? Both of those things happen when you squat with ideal form.