Exercises and Stretches for Sciatica and Piriformis Syndrome

Exercises and Stretches to Help Alleviate and Prevent Lower Back and Hip Pain from Sciatica and Piriformis Syndrome

In a survey conducted in 2019, 39% of adults in The United States stated they had experienced back pain in the past three months.  There are many different types and causes of lower back pain.  The National Institute of Health lists 20 potential causes of low back pain in five different categories. There are also many different risk factors for developing low back pain.  Some genetic causes can’t be prevented but many risk factors, like fitness level and smoking, can be modified to decrease your risk of pain. 

It isn’t always easy to determine what is causing your pain.   For example, sometimes low back pain comes from the back, other times hip issues might be causing the back pain.  Then in other instances your hip pain may be a result of something in your back.  Numerous parts of the hip and back can be injured or wear out, and many issues in this area can display the exact same symptoms.    

If your low back pain goes down into the back of your leg, it may be sciatica.  According to the Mayo Clinic, “sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg”.  Usually if you experience this pain, it will only affect one side of your body.  The way sciatica pain feels can vary greatly.  You might feel the pain all the way from your lower back to your thigh or even all the way down to your calf.  The pain level varies, from mild to excruciating.  Sometimes it can be an achy feeling or numbness or a tingling sensation and other times it can feel like a jolt or electric shock.  Anything that causes inflammation or irritation of the sciatic nerve can cause sciatic pain.  This could come from injuries or muscle spasms, a herniated disc, as well as pressure from bones in the region.  Sciatic pain usually goes away on its own.  Stretches, movement and strengthening the core muscles can help.   

Very often, muscles in the hip that get tight or strained can cause compression on the sciatic nerve, which can lead to sciatica or a different type of low back pain.  One muscle that can irritate the sciatic nerve is the piriformis muscle.  The sciatic nerve runs right by the piriformis, either above it, under it or through it depending on your individual anatomy.  The piriformis muscle connects the lowermost vertebrae with the upper part of the leg.   Its job is to help externally rotate the hip when walking or running and to help abduct the thigh in a seated position.  When the sciatic nerve is irritated or compressed by the piriformis muscle, it is called piriformis syndrome.  Estimates suggest that about 5% of cases of sciatica are due to piriformis syndrome and experts think it is much more than that.   Piriformis syndrome can have many symptoms that can mimic other common conditions which involve the low back, pelvis, hips, and legs.  In general, piriformis syndrome symptoms may include acute tenderness in the buttocks, increased pain when sitting and sciatic-like pain down the back of the leg.   

A few things to help prevent or lessen lower back or hip pain 

Exercise regularly.  To keep your back strong and pain free, pay special attention to your core muscles – the muscles that are essential for proper posture and alignment.  Strong abdominal, gluteal, and hip muscles can keep you in proper alignment as well as take pressure off your low back and support your spine.   

Have good posture and don’t sit too long.  When seated, have good lower back support, keep your shoulders back and down, maintain the normal curve in your lower back and keep your knees and hips level.  Try not to sit for long periods at a time.  Take breaks and stand often (at least once every 30 minutes) to reduce tightness in your hip flexors and back.   

Don’t smoke.  Smoking reduces blood flow which can contribute to disc degeneration, and it increases the risk of osteoporosis.   

Exercises 

Strengthening your core will help prevent many injuries, aches, and pains, including low back and hip pain.  Your core consists of all the muscles that move, support, and stabilize your spine.   This includes your abdominals, obliques, pelvic floor muscles, back muscles, and glutes.  It also includes your hip muscles (including the piriformis muscle).  The following exercises are just a few examples of ways to strengthen your core.   

If you have an injury and/or pain in your back, talk to your healthcare provider or physical therapist about which exercises will best help you and how to do them correctly and safely. 

Forearm Plank – Extend your body on the floor, face down with only your forearms and toes on the floor.  Engage your abs, drawing your navel toward your spine.  Your head is relaxed, in line with your spine and eyes should be looking at the floor.  Your elbows should be directly under your shoulders and forearms facing forward.  Keep your torso straight and rigid, your body in a straight line from your ears to your heels with no sagging or bending.  Hold this position for 10 seconds.  Over time work up to 30, 45 or 60 seconds.   

Side Plank – Lie on your right side with your legs straight and feet stacked on top of each other.  Place your right elbow under your right shoulder with your forearm pointing away from you.  Engage your abs, drawing your navel toward your spine and lift your hips off the floor so that you are supporting your weight on your elbow and the side of your foot.  Your body should be in a straight line from your ankles to your head.  Keep your hips stacked and facing forward.  If this is too difficult, lower the knee of your bottom leg to the floor but keep your hips lifted and top leg straight.  Hold this position for 10 seconds.  Over time work up to 30, 45 or 60 seconds.  Repeat on the left side.   

Resistance Band or Cable Abduction -- Stand sideways near a door or cable tower. Secure elastic tubing or ankle cuff around the ankle. If using tubing, knot the other end of the tubing and close the knot in the door near the floor.   Pull the tubing or cable out to the side, keeping your leg straight. Return to the starting position. Do 2 sets of 15 on each side. For more resistance, move farther away from the door or cable tower. 

Hip Extension -- On all fours, bend your knee and lift your leg keeping your foot flexed, moving it skywards.  Keep your navel pulled up toward your spine and glute squeezed. Come back to starting position with knees side by side.  Do 2 sets of 10-15 repetitions on each side.   

Clam Exercise -- Lie on your side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your hips stacked and heels touching each other. Hold for 2 seconds and lower slowly. Do 2 sets of 15 repetitions on each side. 

Stretches 

Gentle low back stretches can help reduce tension and pressure on the nerves in our back.   Incorporating hamstring and glute stretches can also help ease sciatica and other types of pain.  Stretching the piriformis can help alleviate pressure on the sciatic nerve as well as help to prevent pain caused by piriformis syndrome.  These are just a few examples of stretches and they are best done when your muscles are warm.  So, doing them after a workout or a quick walk is best.  Hold each stretch for 15-45 seconds and repeat 2 -3 times. 

Standing Hamstring Stretch – Stand up straight with one heel resting on a small stack of books or step.  Reach your arms up and bend forward slightly from your hips until you feel a stretch in your hamstring (the back of your thigh).  Switch legs and repeat with the other leg.   

Seated Figure Four (Piriformis) Stretch -- Begin sitting upright in a chair. Cross one leg over the other so that your ankle is resting on top of your opposite thigh. Gently pull your bent knee across your body toward your opposite shoulder. You should feel a stretch through the back of your hip and buttocks. Try to not to arch your back or lean to one side as you stretch.  

Lying Figure Four (Piriformis) Stretch -- Lie on your back, with your knees bent and feet lying flat on the floor.  Place your ankle on your opposite knee.  Grip your thigh and gently try to pull in towards your chest, till you feel a stretch in your buttock.   

Please check with your physician with any chronic back pain issues before starting a new exercise routine.  Some situations will require medical interventions and your doctor can help determine the root cause of your pain.  Luckily most issues can be resolved through medications designed to relieve pain and inflammation along with lifestyle modifications including not smoking, eating healthfully, and exercising.   

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