The sciatic and peroneal nerve, pictured above, is a thickest and longest nerve in the body. Sometimes both of
these nerves pass the underside of the piriformis muscle before dividing (first picture on left),and sometimes
they divide and only the sciatic nerve passes through the piriformis muscle (second picture above). Other
times they both pass through the piriformis muscle before travelling down the back of the leg, and eventually
branching off and ending in the top and the sole of the feet.(See third photo below). Compression of these
nerves, particularly in the instances of pictures 2 and 3 above, can be caused by spasm of the piriformis
Note the piriformis muscle,
lying deep to the Gluteus
Piriformis Syndrome Signs and Symptoms
Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend
down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic
nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm
pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are
not due to piriformis syndrome.
Piriformis Syndrome Diagnosis
There is no definitive test for piriformis syndrome. In many cases, there is a history of trauma to the area, repetitive,
vigorous activity such as long-distance running, or prolonged sitting. Diagnosis of piriformis syndrome is made by the
patient’s report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In
some cases, a contracted or tender piriformis muscle can be found on physical exam.
Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other
causes of sciatic nerve compression, such as a herniated disc.
How can Pilates help?
First, establish that your client has piriformis syndrome. If so, in consultation with their physical therapist, commence a
program of stretching, and then strengthening the entire gluteal region.
Which exercise should I start with?
Gentle, contract/relax stretching, with several days in between for recovery is a skillful way to start. Try the stretches
below, and see how you or your client responds. Send information to their physical therapist too, and get the OK from
them before commencing.
To enhance the stretch, lets add the contract/relax component
Try this approach for 3 to four weeks, practicing one of the stretches every second day, at least
twice on that day. Practice it for the full length of time suggested.
Gauge your progress, and relay that back to your Pilates teacher and Physical therapist.
Therapy is an evolving process. No one knows how you will respond to their treatment, we only
have the history of others as our guide. For a general guide on releasing sympathetic nervous
system tension and muscle pain, please refer to our “Five Tibetans” article