4 Piriformis Exercises you’ve never tried

If you get a tight and achy sensation deep in the side of your hip then your piriformis muscle likely needs some work.

This means stretching but it also means strengthening.

Stretching is only one piece of the puzzle. Muscles that feel tight are often limited in other ways too, like a lack of strength and stability.

In this article, I’ll share 4 exercises that will help you lengthen and strengthen your piriformis.

Do you need Specialized Piriformis Syndrome Exercises? 

Many people reading this article may have a diagnosis of piriformis syndrome. I want to bring up this point early in the article so you understand that you don’t have to do anything differently if you have this condition.

Piriformis syndrome is a controversial diagnosis that causes sciatica, leg or buttock pain. The theory is that the piriformis muscle compresses the sciatic nerve which causes pain and discomfort in the surrounding region. [Parziale et al. 1996].

Piriformis syndrome is not much different than hip impingement, hip labral tears or other controversial diagnoses for chronic hip pain. It gives you a reason for your chronic hip pain which can be reassuring.

But oftentimes, getting a diagnosis can push you further away from feeling better.

The main assessment for diagnosing piriformis syndrome is the FAIR test. If pain occurs in this position then a diagnosis of piriformis syndrome is given.

The FAIR test assesses the hip in flexion, adduction and internal rotation (FAIR). If pain occurs in this position then a diagnosis of piriformis syndrome is given. [Fishman et al. 2002].

But this position is difficult for many individuals. Not just those with piriformis issues. Thinking of myself 10 years ago when I suffered from chronic hip pain, this position would’ve made me cry.

But that doesn’t mean I had piriformis syndrome. It just meant that I did not have enough hip function to enter this position pain-free.

I would never perform this test on someone that is already struggling with discomfort in the piriformis. It will likely just exacerbate the achiness they already feel.

Instead, I would test the three components of the test separately to see where the weak links are. For example, I’d first see how a person moves through hip flexion.

Then we’d look at hip internal rotation and adduction. By testing each movement individually, you will have a better understanding of where the weaknesses are and focus on them in training.

The goal should be to focus on your movement limitations rather than to fix some arbitrary diagnosis like piriformis syndrome.

Do you have a tight piriformis muscle? 

The Piriformis muscle is one of six deep glute muscles that are known as the deep 6.  Although the piriformis gets the most attention, all 6 of these muscles are equally important to proper function.

It’s possible your piriformis is tight but it’s also possible that the obturator externus is tight. I don’t think many people out there have the body awareness to feel one of the deep 6 muscles over another. I know I don’t.

Another issue is that a sensation of “tightness” can mean many different things. For example, I work with many clients who describe certain muscles as tight but when we do some tests, we discover that the muscle is actually weak.

My recommendation is to remain curious about the sensations you’re experiencing. Many of us judge sensations as tight and then spend years stretching when what we really need is more strength work. 

How to Stretch the Piriformis

The side of my hip always feels stiff when I don’t move my body for a while.

After years of troubleshooting and experimenting with many exercises, I eventually discovered the hip twist stretch. To date, it is my go to stretch when this area of my body is feeling off.

The key intention with this stretch is to pull your hip away from your pelvis. When the pelvis and hips are stagnant for too long, the joints stiffen up and lose the ability to move independently.

They get kinda stuck together. Joints need movement in order to function properly. If they remain immobilized and don’t get the lubrication they need, they will feel stiff and achy.

You can honestly stick with the above exercise for years. I certainly have. But if you want an additional challenge, you can experiment with the seated glute stretch.

In a seated position, your hips are required to flex more so it may be difficult to get as much range in the stretch. When you lay down, you are able to remove this variable.

Stretching is all about listening to your body and finding what works best for you. If you feel the stretch in the right place, trust you are doing it right. If you don’t, then try another position.

How to strengthen the piriformis muscle

Tight muscles are weak muscles. Only stretching weak muscles is kind of like taking a multivitamin but only eating fast food.

It might help but you’re missing the forest for the trees. The way to reduce discomfort in your piriformis is to build strength in this area of your body.

The first exercise to experiment with is the glute conversation and it will activate those deep 6 gluteal muscles we discussed earlier.

I love this exercise because it eliminates possibilities for compensation. Your body is in a neutral position and all the work is done with the target muscle group - the piriformis and other lateral hip muscles.

The second exercise I recommend you try is the clamshell on wall. You may have tried clamshells before but I find that most people don’t get much out of it unless they use the wall as feedback.

When you use the wall like this, you remove possible compensations in the ankle and knee. It forces the rotation to come from the hips, which is what we want.

Most exercise advice out there operates under the assumption that the piriformis will respond the way it's supposed to in a certain exercise.

I believe we need to start with the opposite assumption - that the piriformis will be initially stubborn in our efforts to wake it up and therefore, we need to be thoughtful about exercise selection.

Closing Thoughts

Our bodies are smart and there is a reason it sends us signals of tightness and discomfort. We can listen to these sensations without getting lost in them.

Just because something feels tight does not mean we need to go poke and prod an already sensitive and aggravated area.

Instead, I recommend zooming out and taking a more global approach. What are the piriformis and surrounding muscles supposed to be able to do? Can you do them?

When we start investigating how the hips and pelvis function more holistically, that's when we start seeing the results we want. My advice is to chase movement function, not symptoms.