Does the piriforims need to be stretched?

The piriformis is an external rotator of the hip that attaches proximally to the anterior surface of the sacrum and 

inserts onto the superior aspect of the greater trochanter. The near horizontal alignment of the muscle which is primary rotator. Also, the insertion at the top of the greatnction of the piriformis. Certainly, it is an external rotator and hip abductor in the anatomic position of 0⁰ of hip extension; 0⁰ of hip flexion; 0⁰ of adduction; 0⁰ of abduction; 0⁰ of internal rotation and 0⁰ of external rotation .

 However, the researchers said ,neutral is very rare in the real world. As the hip moves, the function of the hip muscles change. When the hip is at about 45⁰ of flexion (see the image), the line of pull of the piriformis now makes it act as a purely coronal plane muscle (abduction) with little to no transverse plane influence .

 As the squat depth increases(see right side image), the line of pull of the piriformis continues to change. Past 90⁰ the piriformis becomes an internal rotator of the hip . the function of the piriformis, is consider the position of the knees during the overhead squat assessment.

When the knees demonstrating valgus during a squat assessment indicates that the piriformis isn’t holding up the femur in alignment. Since the muscle acts as an abductor at these angles, if the knees are adducting then the muscle is lengthening.

Remember the more they are pulled, the tighter they get. Therefore, if a patient knees demonstrate the valgus position, the piriformis does NOT need to be stretched. However, if a client demonstrates knee varus , then the piriformis may be short and stretching may required.

 let us consider the muscles opposite the piriformis. While there may be several, a key       muscle group is the adductors. Thus, the client with knee valgus  may have short and       overactive adductors that internally rotate which pull the femur and subsequently             pull on the piriformis.
    Remember it is only a primary external rotator at neutral, and then, as    the hip begins to flex, it serves more of an abduction role,until greater  than  90°, then becomes an internal rotator. [restrict] %MCEPASTEBIN%Thus, to perform a great piriformis stretch, the hip needs to be flexed to about a 45-65⁰ degree angle and adducted

I frequently have friends who perform the stretch which we describe above  and quickly hear from patient that they don’t feel any stretch. Do not scratch your head because  they DON’T need to stretch it. The muscle is likely long, not short.

Lets see, What is Piriformis Syndrome and what can we do about it?

piriformis  syndrome is when the sciatic nerve is not compressed by the spine but by the piriformis. This is much more of a muscular issue that may be influenced by soft-tissue work. In most individuals, the sciatic nerve runs directly through, under, or over the piriformis muscle . No matter the direction, the sciatic could get compressed and become irritated.

If the problem is in fact caused by the muscle being too long then stretching would not be indicated—it is already too long. But, foam rolling would be a great way to get the muscle to calm down on a neurological level without specifically trying to add length to it.

*In most cases the piriformis is too long, not too short. Therefore, start with foam rolling and DO NOT stretch the muscle unless indicated by the movement assessment. *

How to correct piriformis syndrome?

Step 1: Does the client demonstrate knee valgus ?

Inhibit : Piriformis   
For the knee valgus client, use the foam roller to reduce feelings of tightness in the hip and to help mobilize all the tissues.
Adductors: Hold tender spots for 30-45 seconds.

Activate :

Integrated exercise:

Lateral tube walking: 10-15 reps each side

References

1. Neumann, D.A. (2010). Kinesiology of the musculoskeletal system: Foundations for rehabilitation. (2ndEd.). St. Louis, MO: Mosby Elsevier.
2. Clark, M., Lucett, S., & Sutton, B. (2012). NASM essentials of corrective exercise training. Burlington, MA: Jones & Bartlett Learning.
3. Reynolds, L.W., & Schrattenholzer, T.F. (2007). Piriformis syndrome. Pain Management, 2(834-836.
4. Chaitow, L., & DeLany, J. (2008). Clinical application of neuromuscular techniques: The lower body. Vol 2. Philadelphia, PA: Elsevier.
5. Koes, B.W., van Tulder, M.W., & Peul, W.C. (2007). Diagnosis and treatment of sciatica. BMJ, 334(7607), 1313-1317.
6. golfloopy.com image courtesy

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