Pain in the Glute: Yoga Rehab for Piriformis Syndrome

Don’t let piriformis syndrome and sciatica kick your ass. Learn the anatomy of the hip, symptoms of injury, and techniques for treatment and prevention.

If you have ever noticed an annoying pain in the side of your hip, gluteal region, or down the back of your leg while practicing yoga, you may have experienced piriformis (pair-rhee-for-miss) muscle pain. Often we ask our body to do more than is capable without allotting the proper rest required for healing—and this can be a real pain in the glute. To become stronger and more resilient, we must allow time for restoration after yoga, as with any activity where muscles are used in a repetitive manner. Recovery time is vastly different from person to person, but it can be accelerated with proper treatment and maintenance.

Piriformis syndrome and sciatica

Piriformis syndrome is caused by chronic tightening or shortening of the piriformis muscle from repetitive activity. Sciatica and piriformis syndrome are directly related, as the sciatic nerve runs beneath the piriformis muscles. When the piriformis muscle tightens, the sciatic nerve is compressed, resulting in nerve irritation, inflammation, and excessive pain. This can affect performance, limit mobility, and cause extreme discomfort.

Anatomy of the piriformis

The piriformis muscle is located deep within the gluteal region of the pelvis. It’s attached from the inner sacrum and medial base of the spine to the outer edge of the hipbone, called the greater trochantor (troh-can-tore).

This muscle has several basic functions, and produces movement in the hip by coordinating with the gluteals and additional external rotation muscles: obturator internis/externis, gemellus superior/inferior, and quadratus femoris.

In yoga practice, the piriformis is responsible for the following movements.

• External rotation of the hip and leg, as well as abduction when the hip is flexed.
  This takes place in Bound Angle pose (Baddha Konasana), Extended Hand-to-Big-Toe pose (Padagustasana B), and Warrior 2 (Virabhadrasana II).
• Stabilization of the sacroiliac joint during single leg balances.
  In Tree pose (Vrksasana), the piriformis of the balancing leg stabilizes the hip, while the piriformis on the opposite side actively contracts to open the hip away from the midline.
• Stability of the entire posterior pelvic region. As the hips externally rotate outward in Yoga Squat (Malasana), the pelvis becomes stable enough for the inner hip joint to open. The stretch is then introduced into the internal rotation and adductor muscle groups.

When the body speaks up, listen

Repetitive stress injury (RSI) is quite common in active individuals and occurs as a result of pushing muscles beyond their limits. Muscle tightness and increased tension in the muscle-tendon junction, or tendon to bone attachment, is a typical response from the body’s natural protection mechanism.

Muscle guarding

If the muscle’s sensory receptors detect a possibly injury, the brain sends an immediate response for the muscle to hyper-contract and protect—a process known as muscle guarding. This tightness can produce several symptoms that suggest injury or strain.

Athletes who perform repetitive movements, such as yogis, runners, cyclists, and Crossfitters, may experience, at one time or another, piriformis or sciatic pain and possible stress injury. In this case, the piriformis is typically placed under great demand and, without proper rest and stretching, tends to become overworked, resulting in increased tightness in the muscle fibers.

As the muscles tighten from overuse, blood supply decreases and they become dehydrated. This places the muscles at high risk for strain injuries or muscle tears, and inhibits the ability to recover at a rapid rate. It is imperative to reintroduce fresh, oxygen-rich blood and hydration back into these tissues through proper recovery techniques and treatment.

Pain and inflammation

When a muscle is injured or overstressed, the body signals an immune response to release the chemicals needed for tissue repair. This, in turn, elicits an inflammatory and pain response to the site of the injury. Pain, warmth, and tenderness surrounding the outer hipbone are typically the first signs of a possible micro-injury to the piriformis muscle. A loss or decrease in mobility may be present as well, due to the increased fluid surrounding the area and the muscle guarding response. As the muscular and connective tissues create excess tension on the hip joint, bursitis (inflammation of the fluid-filled sac in and around the joint) and tendonitis (inflammation of the tendon) may also manifest.

Sciatic neuralgia

Neuralgia (newr-al-juh) describes the distribution of pain along a nerve or set of nerves. Due to its location under the piriformis, muscular compression “strangles” the sciatic nerve and causes the following types of pain:

• Burning, stabbing, or shooting pain sensations
• Tingling and numbness down the back of the leg and into the foot
• Muscular weakness or loss of control of the leg

Piriformis syndrome and sciatica go hand-in-hand; however, the causes of each condition differ. While the former stems from a chronically tight or overused piriformis muscle; sciatica manifests as a result of a bulging or herniated disc, or a bone spur that compresses the part of the nerve originating in the lumbosacral area of the spine.

Give your body a rest

It’s very important to allow a strained or injured muscle time to rest. The first 24 to 72 hours are most crucial, as the body enters the protection and inflammation phase of healing. Proper nutrition and hydration are imperative during this time. Make sure to nourish the body with nutrients that aid in healing and avoid pro-inflammatory foods.

Massage

Massaging this area regularly, especially if you are experiencing chronic pain, is also recommended. Massage promotes blood flow and hydration to the tissues, and allows them to realign and heal. You can even practice self-massage using a tennis ball.

• Place a tennis ball under the gluteal area between the sacrum and the hip joint.
• Gently lower yourself onto the ball and slowly roll from side to side, drawing awareness to any areas of tenderness . Trigger points may be present and the pain elicited may be very intense, as the body is ridding itself of the toxins and lactic acid built up from overuse.
• Find a tender area and allow the ball to rest there for 20 to 30 seconds, or as long as you can tolerate. Five minutes of massage at a time is usually sufficient.

Cryotherapy

Icing the affected area three to four times a day, for 15 to 20 minutes at a time, will decrease inflammation and pain. Cryotherapy is especially useful after intense exercise or anytime an area of the body feels sore. Always remember to keep a barrier between the ice and your skin—a pillow case works great!

Stretching

Do not stretch until the acute pain has diminished and the muscle has rested for at least 24 to 72 hours. Reintroducing space and gentle movement in the piriformis will mobilize the tissue to relieve nerve and muscle pain, but only after an adequate amount of rest.

Yoga therapy

Practicing the following yoga poses, which require the thigh to cross the midline, will also encourage the release of piriformis tissues.

• Pigeon pose (Eka Pada Rajakapotasana)
• Cow Face pose (Gomukhasana)
• Seated Spinal Twist (Matsyendrasana)
• Supine Spinal Twist (Supta Matsyendrasana)
• Supine “Figure 4” Stretch
• Standing “Figure 4” Stretch (Standing Rajakapotasana)
• Seated “Figure 4” Stretch (Seated Rajakapotasana)

In yoga, we are taught about ahimsa, which in Sanskrit means non-injury and non-violence. Too often we disregard what our body tells us, and this is where the trouble lies. Pushing your body past its limits while lacking rest and proper self-care can be a recipe for disaster. Over time, consistent micro-traumas and violence to the body result in injuries with longer healing times and increased amounts of pain. Practice ahimsa and be kind to your body—it’s all you have!

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