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.

Posterior Hip Muscles, including the PiriformisAnatomy 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.

(Photo by Wikimedia Commons / CC BY)

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.

TennisBallCrop

  1. Place a tennis ball under the gluteal area between the sacrum and the hip joint.
  2. 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.
  3. 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.

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!

Teach Your Students How to Rock Warrior II

New practitioners and seasoned yogis alike have all struggled, at one point or another, with Virabhadrasana II, known by most as Warrior II. This dynamic pose challenges multiple body systems; and it requires muscular endurance and strength, balance and stability, proper alignment, and mindful awareness to get the greatest benefit and prevent injury. On the flip side, it cultivates a sense of solidarity, confidence, and courage to be the badass warrior we are inside.

There are three major areas of anatomical focus that are of the utmost importance in Warrior II.

Feet

The base of support (BOS) is key to building any yoga posture. Without a solid foundation, the pose loses its integrity, and the practitioner’s focus fades into a struggle to find stability and stillness. The feet are the most important component to any standing yoga pose. Proper cueing of the feet enables the practitioner to feel deeply grounded and connected with the floor, offering a direct sense of stability before they move further into the actual pose.

Cueing the feet:

  • As you stand, begin to feel the sensation of your body weight sinking into both feet.
  • Feel equal, balanced pressure along the pads of the forefeet, outer edges of the feet, and center of the heels.
  • Press the feet down while lifting the arches, and feel a deep connection into the earth through the mounds of the big toe, little toe, and center of the heel.
  • Lift the toes, spread them apart, and then root them down into the mat one at a time—from baby toe to big toe.

Hips and pelvis

Most yogis will agree the hips are the most problematic area of the body during asana (physical posture) practice. Muscular tightness and limited range of motion (ROM) in the joints inhibit the depth a practitioner can reach in each pose. Many struggle to externally rotate the femur, open the hip, and deepen the lunge to stack the knee (i.e., femur over tibia) without feeling pressure in the joint or a sensation of falling forward.

Preparatory poses to open the hips are immensely helpful, as they encourage an “unlocking” of the muscles and supportive structures surrounding the joint. This increases external rotation by allowing the ball-and-socket joint to roll and glide smoothly. The practitioner can then place the foot and ankle in a safer position while deepening the lunge. The combination of muscle actions in the gluteals, hamstring group of the front leg, and iliopsoas connection of the back leg will allow a deeper, supported opening in the pelvis, while improving stability in the Warrior II stance.

Preparatory hip-opening poses:

  • Bound Angle pose (Baddha Konasana) – This pose encourages relaxation of the adductor muscles that run along the inner border of the thighs—a chronic area of tightness that limits a deeper opening of the hips.
  • Extended Triangle (Utthita Trikonasana) – From a biomechanical perspective, Extended Triangle creates a smooth transition into Warrior II, as a result of the forward positioning of the pelvis. The pose gradually deepens external rotation and flexion in the hip, as the knee begins to flex and position into a supporting lunge for Warrior II.
  • Tree pose (Vrksasana) – Tree pose builds and balances neuromuscular connections from the brain to the muscles, providing a greater sense of stability as you ground down through a single leg. Placing the free foot onto the inner thigh of the standing leg deepens the opening of the inner hip joint and adductor muscle group. It also strengthens the external rotator and hip flexor muscle groups in a non-weight-bearing position. This allows the hips to develop greater joint stability and strength in the standing leg, as well as greater joint play and exploration in the lifted leg.

Chest and shoulders

Opening the chest and shoulders with ease is another problematic task for many yoga practitioners. Our modern, sedentary lifestyle can promote poor posture and rounded shoulders, which cause the chest cavity to collapse and shift forward. The common ways we position our bodies—while driving, eating, or working at a desk—wreak havoc on the spine and its supporting structures. It consequently takes greater effort to balance these effects through the practice of yoga.

Warrior II opens the entire thoracic cavity by unweighting the shoulders, drawing the arms away from the body, and releasing the pectoral and intercostal muscle groups. This creates space within the chest cavity for a fuller breath, while strengthening the mid-back musculature to support the upper torso.

As we inhale in this posture, we activate the accessory muscles of breathing. The sternocleidomastoid (SCM) muscle, located along each anterior side of the throat, activates and elevates the sternum, as your gaze draws forward over your front hand. The scalene group and pectoralis minor also activate to lift the upper ribs.

The quadratus lumborum—located between the posterior aspect of the floating ribs and the posterior border of the pelvis—draws the lower posterior ribcage down toward the tailbone, lifting the front of the chest. The abdominals simultaneously draw the front ribs downward to reduce hyperextension of the middle and lower spine. In drawing the shoulders blades slightly together and pressing them down toward the tailbone, we contract the rhomboids and lower trapezius to further open the chest and stabilize the mid-thoracic spine.

Teaching cues

1. Press through the heel of your front foot while grounding through the outer edge of your back foot.

Encourage your students to feel connected and grounded to the mat, promoting a solid foundation to build the posture from. Grounding down strengthens the arches of the feet and peroneals, and stabilizes the ankles. Pressing through the heel of the front leg co-activates the gluteal muscles, hamstrings, and quadriceps to create a bandha (bind) of the femur, and stabilizes the knee and hip.

2. Spiral your front thigh outward and press through your back heel.

As yoga teachers, we want to ensure our students move at the most mobile joint first to prevent injury. We may prompt them to move at the shoulders or hips, for example, as both joints have greater ROM than the elbows or knees. This cue draws awareness to the hip, allowing it to open and be supported by the external rotator muscle group—specifically, the piriformis. Pressing through the back heel stabilizes the back hip and promotes a deeper opening of the pelvic space.

3. Draw your tailbone down and sweep your inner pelvis in and up.

Encourage your students to place the lower spine in a neutral, safe position while improving overall balance and postural stability. Stabilizing and strengthening the pelvic floor has numerous benefits on the spine and pelvic organs.

4. Lift your ribcage up, away from the hips, and reach through the fingertips while lifting your arms.

This activates the transverse abdominus (corset muscles) and accessory muscles of breathing to open the chest, allowing for a full diaphragmatic breath to enter and expand into the deepest spaces of the lungs. The shoulders become stable and strong, promoting a deep sense of readiness and power.

5. Press your palms toward the floor and send your gaze out over your front hand.

By pressing the palms down, we activate the latissimus dorsi muscles—located beneath the armpits and wrapping along the sides and back of the ribcage—to further open the chest and stabilize the shoulder joints and scapulae. Pectoralis minor is simultaneously activated to lift heart center (sternum) upward. This relaxes the shoulders away from the ears to create space and ease tension in the neck.

To make sure the shoulders are positioned correctly, turn the palms to face up and notice how the shoulder blades relax down the back. Then flip the palms over solely at the wrist level. This externally rotates the shoulder joints to draw the shoulder blades down while maintaining the integrity of the pose.

Move It or Lose It: 5 Desk Yoga Poses for Corporate Crusaders

Every newscast on the current health of the American public seems to report the same thing: We are becoming increasingly sedentary due to an overall decrease in physical activity and a rise in jobs that require little activity, such as office work. The problem is: We sit too long! Not to say that sitting is detrimental to our health; however, the effects of prolonged sitting adversely affect our spinal health, decrease overall postural strength, and promote unnecessary weight gain.

Stand up for your spine

The axial skeleton comprises the skull, spinal column, sacrum, coccyx (tail bone), and pelvis; while the appendicular skeleton comprises the upper and lower extremities. When we stand, with proper postural support, we allow the entire axial skeleton or torso to “float” over the legs, decreasing the amount of compression on the spine from gravity.

On the contrary, when we sit, the amount of pressure and compression on the spine increases; as the sitting bones (ischial tuberosities) become the main base of support, offering little distribution of the compressive forces placed on the spinal column.

The main shock absorbers for the spine are the intervertebral discs, which consist of a gel-like material called the nucleus pulposus (similar to the consistency of toothpaste) encased by a thick cartilaginous membrane, or layer. The discs are crucial to spinal health, as they absorb and evenly distribute compressive forces and shock throughout the spine. The discs take the greatest “beating” while sitting.

Time for a change

Most people who work at a desk, or are in school, sit for up to eight hours a day, if not more, with very few breaks. The average office worker should get up and move or walk for at least two minutes every 20-30 minutes. If this seems unrealistic, a maximum sitting time of no more than one hour may be more reasonable. With time, the body will gradually mold into any shape in which it’s continuously placed. The repetitive sitting shape creates imbalances in the body, resulting in neck, back, and shoulder pain, digestive and circulatory issues, and spinal pathologies. Some common imbalances include:

  • Tight calves (gastrocnemius, soleus)
  • Tight hip flexors (psoas, rectus femoris)
  • Weakened abdominals
  • Overstretched spinal erector musculature (erector spinae group)
  • Tight shoulders and mid back (trapezius, rhomboids, latissimus dorsi)
  • Tight pectorals
  • Tightness in the anterior musculature of the neck (scalenes, longus capitus, longus colli)

These five yoga poses can be practiced at your desk to relieve back pain and avoid imbalances. Before attempting any of the following yogic approaches, please note:

  • You should not feel anything sharp, shooting, or burning during these exercises. If any of these sensations occur, back off or discontinue altogether.
  • The intensity of each stretch should be light to medium. Feel free to back off at any time, or modify as necessary for comfort.

1. Chair Roll Out (modified Child’s pose)

If you have a rolling chair, you can use it to your benefit to relieve low back pain. Sit toward the edge of your chair with a wide stance in your legs. Ground your hands down onto your desk, shoulder-distance apart. Using your feet, begin to slowly roll or scoot your chair back and gently lean forward through your outstretched arms until you feel a mild stretch. You should feel a light stretch in your lower and upper back, shoulders, and sides. Hold for at least five slow, deep breaths.

Benefits:

  • Releases tight muscles in the lower and mid back
  • Opens ribcage and pectorals
  • Releases hamstrings

2. Chair Side-to-Side (modified Side Child’s pose)

Similar to the exercise above, sit with a wide stance in your legs and place your hands on the desk, shoulder-distance apart. Then scoot your chair back enough to lean the body forward.  Slowly begin to walk your hands over to the right and gently lean in until you feel this stretch along your left side.  Hold for at least five slow, deep breaths. On an inhale, release the posture, slowly walk the hands over to the left, and gently lean in for the stretch—you will feel this on your right side. Make sure to keep your wrists in line with your shoulders to avoid compression in the front of the shoulder joint.

Benefits:

  • Releases tight spinal side flexors
  • Opens ribcage and shoulders

3. Chair Twist

Begin by sitting toward the edge of your chair. Place your right hand behind you, on the outer edge of the seat, for support. Place your left hand on your right knee. Inhale and sit up tall. As you exhale, gently begin to draw your torso to the right, taking your gaze over your shoulder.  Hold for five deep, slow breaths. Inhale as you return to a neutral position. Repeat on the opposite side.

Benefits:

  • Improves spinal flexibility
  • Nourishes and hydrates abdominal and spinal tissues
  • Detoxifies abdominal organs

4. Chair Cobra pose

Place your hands and forearms on your desk, shoulder-distance apart, allowing the elbows to rest off the edge of the desk. As you inhale, press your forearms and hands firmly into the desk, allowing your heart center and chin to lift upward. Hold for five deep breaths. To deepen, gently draw the shoulder blades together to open the chest further. Release on your final exhale.

Benefits:

  • Opens the chest, stretching the pectorals and breathing accessory musculature
  • Allows for deeper, fuller breath
  • Decompresses and lengthens the throat and anterior neck musculature

5. Chair Tree pose

Stand behind your chair and place your hands on the backrest for support. Set your gaze on an object in front of you. Draw your awareness down to your feet and gently begin to transfer your weight onto your right foot. Imagine pressing through the floor, as you lift up tall in the torso, and feel your right hip firming and drawing in. Place the sole of your left foot at the ankle, calf, or mid-inner thigh. Never place your foot directly on the knee joint.  Feel free to leave the hands on the chair, or draw them to prayer or another mudra of your choice.  Hold for five deep, slow breaths. Release on an exhale and repeat on the opposite side.

Benefits:

  • Activates and balances both sides of the brain and body
  • Improves mental focus
  • Activates and strengthens the core
  • Increases energy levels

Life will always be busy. Jobs are increasingly demanding, time is limited, and no one can afford to lose mobility or function. However, practicing just a few simple, mindful movements with focused breath each day can greatly benefit your body. Protect your spine to protect your body.