I really hate labelling exercises as the "best" as there really is a big variance from person to person, it is impossible to say that 100% of the time this is the best way to go. But this question is asked of me almost every day, and especially for piriformis syndrome. So while I stand by my statement of saying there is no one size fits all exercise that helps everyone, I have found over the past 15 years working with literally hundreds of different cases in our rehabilitation program, a few trends and common factors that can help narrow down the major cause and also the corrective strategies. A very difficult injury to work with for often the real solution is also the same thing can really aggravate the problem! In this article, I am going to share what I have found to be the 4 most common corrective strategies. These tips have been formulated from many of the case studies and successful outcomes of programs we had never tried before. We made a note of these and this helps us with future cases and also was the catalyst for reinventing our assessment procedure. Make sure you check out these case studies by going to our testimonials page. Okay onto the article.

What Is Piriformis Syndrome?

Before getting into the top four exercises it is important to really understand what Piriformis Syndrome actually is. 

As mentioned in the beginning this such a tricky condition to work with as there is so many compensatory patterns and muscles at work it is hard to find the “real cause” of the problem. The piriformis muscle lies deep within the buttocks, covered by the massive gluteal muscles (your butt). It’s job is to externally rotate the hip when it is extended, and abduct the hip when it is flexed. If you have trouble stabilizing your leg in a single leg stance there is likelihood that the Piriformis muscle will become overworked, short and tight.

This muscle is located right near the sciatic nerve, and when it overworks it begins to thicken and shorten, developing trigger points but even worse it may compress the large sciatic nerve. The compression feels like a deep aching pain in the butt or a radiating sharp nerve pain that extends along the middle of the rear thigh. Occasionally numbness and tingling can continue to the calf and toes. These symptoms can be accompanied by low back pain and worsen after prolonged sitting.

You must be careful not to confuse this with other injuries and a correct diagnosis from a health practitioner is essential. Sciatica symptoms that appear to be the same as piriformis syndrome could in fact be related to a herniated disc, and vice versa. You must seek out correct diagnosis from a qualified therapist before you attempt to make any exercise corrections. Read this article to see more on this - How do you know if you have piriformis syndrome or a bulging disc?

A weak core and more to the point weak gluteal muscles are often the problem, but here lies the paradox. We need to have exercises to strengthen this area but these same movements and exercises are also the ones likely to aggravate the condition or even make it worse!

Now you can see why this is such a tricky problem to work with!

Getting Rid Of The Pain

The first time I usually hear from someone for help with piriformis pain, is usually after they have already seen a doctor or therapist, and the treatment prescribed either did not work or even made it worse! Now this is not the case for all people. Some people will respond well to the traditional treatment strategy which will usually consist of anti inflammatory medication to reduce the inflammation and a stretching or massage treatment administered. In some cases this will help the pain straight away as the release of tight areas might be enough to restore function to the area and remove the pain. But by no means are they out of the woods yet, more on that shortly.

However in many cases the stretching and massage although working for some will actually exacerbate the problems for others! Why? For the real problem is not in the tight overworking muscles needing to be stretched, but from correcting instability of joints around the hip and ankle along with strengthening lazy and extremely weak muscles. And on top of this a series of compensatory movements will also need to be addressed for they will now be causing a chain reaction of problems to avoid pain. The solution for this person will be in using stability and strength exercises while at the same time correcting faulty movement patterns.

Watch the 2 videos below for more detail on this.

The person who has no pain from the traditional treatment will also need to do this to ensure the problem does not return. Just because there is no pain, does not mean the problem is "fixed". Can you see now why I say this is so hard to treat. The good news is it can be corrected, and you can in fact get rid of it permanently. We have almost 100% success rate in improving this condition when the client remains consistent with their exercise program, does not rush things and finds the trigger of the problem and gets rid of it. Use of what we label a KEY EXERCISE is critical in their ongoing management of the problem. This is where I am going to share the 4 Exercises I have found to be most people's key to fixing their problem for good!

Use This Checklist To Help You Put Your Program Together

If you want to have a simple sheet to remind you of what to do we created a checklist for you to stick up on your wall. I find these simple tools very useful for reminding my clients of the importance of daily activities. This cheat sheet will provide you with the steps you need to follow in order to help you on your way to overcoming endless pain and expensive medicine bills. Download this right now and stick it up on your wall. It is FREE with no strings attached! 

What Are The 4 Key Exercises?

As I stated earlier the following list of exercises vary from person to person.

You need to find what works for you and stick to it for a long time. Another question I am often asked is, "how long do I need to do this for before moving to the next stage?" Many people try to progress too quickly, only to do more harm, end up in pain and go back to the start. It is always wise to allow a lot of time for the body to adapt to the changes. The longer you have had the problem the longer it will take to change. With these following exercises you might find these will need to be done for almost the rest of the life. They are very much preventative as much as corrective for the person who identifies where their problem lies.

A good article to read about knowing when to progress is here, "How Do You Know When To Progress Your Rehabilitation Program"

Okay let's get started. These are in an order of easiest to hardest, but in some cases the hardest one ended up being the one that worked best. Again you need to be careful with your assessment, listen to your body and choose the right method.

Key Exercise #1: Foam Roller & Hip Quad Release

The first one I will start with is actually 2 exercises together. This is also the method closest to the traditional treatment you would receive from a therapist and is logically the first place to start. Where people go wrong is relying only on the therapist to "fix them" in the 20-30 minute appointment. Even if they had 3 appointments within a week it is still not enough. If you are the person who responds well to the release of the tight hips and piriformis trigger point you need to do corrective work EVERY DAY! The muscle will reset to it's faulty overworking dominant self very quickly and will need constant release to weaken it's neural message getting through.

Avoiding sitting, and movements that can aggravate this is crucial. I have had many clients where this ended up being their medicine. Usually this was the case with very active people, either sports or occupations that were involved a lot of manual labour. These people tended to have great strength already, just they lacked mobility and flexibility to move correctly. Once we restored flexibility the weak muscles began firing again, all we needed to do next was improve movements patterns like bending, squatting and lunging. Read our article about How To Restore Functional Movement Patterns to see more on this.

Below are 2 videos showing you how to do use the foam roller to release the trigger point and some great hip stretches to follow up after the roller. Hold the stretches for at least 30 seconds.

Key Exercise #2: Clamshell Exercise For Glute Medius

I really don't like this exercise all that much. I find there is many better exercises for the glutes than this but, I must admit it tends to have a great effect with people suffering from piriformis syndrome.

Why?

It simplifies one movement of the hip extremely well and takes away the hamstrings and quads from trying to assist. If done correctly it can begin to encourage the weak glutes, and not the piriformis muscle to do the work of abducting the hip. This prepares you to do movements and exercises in a standing position without pain. However, it can at times also greatly aggravate the condition, so you must be careful of your selection here. I have had many cases where it really flared up the pain when we first tried it, but later on after working on the stability and flexibility phase for a bit longer it had a great effect, so much in fact, that it then became the key home maintenance exercise!

Great article to read about to read for more detail on this is is here - How good is the clamshell exercise for glute medius?

Below is the video of how to do the clamshell exercise and I show you several regressions I might prefer to the standard exercise seen in the picture below. I would recommend doing 2-3 sets of 15-25 reps using the micro band on the legs for added resistance. 

Key Exercise #3: Toe Touch Drill

Now this exercise is really cool! I absolutely love this exercise and use this extensively in our rehab program for people with walking impairments and disability. See our article 6 Ways To Walk Better for more information on this. This is not a strength exercise but more of a stability and coordination exercise for the brain to remember how to move, using weight shifting and maintaining optimal stability and alignment of the leg for walking. Again for some people, even though this exercise is very easy to do it became their key movement strategy to remind the brain how to move correctly. Using a mirror to provide feedback and with enough repetition they were able to keep their problem in check.

Below is the video of how to do it. I recommend doing 2-3 sets of 3-5 circles each day with a real emphasis on quality movement. On the right is a progression I like to use later on where foot stability is considered as a potential factor.

Key Exercise #4: Romanian Deadlifts (RDL)

This last exercise is obviously a strength exercise, and for many of the people with piriformis syndrome and also back pain, it can be very hard to get to this stage and take a very long time. But for some people it was the best thing we ever did! For once this was introduced and the person developed the stability, technique, skills and strength to handle great loads, all of their tension, pain and compensation almost disappeared before their eyes! I will say it again though, you must find what works and gradually work through the process for you to know for certain if this is what your body needs. For there was some cases where this made it worse! The people this usually works well with is the person who has no real flexibility or mobility problems.

Their problem is lack of stability and strength to hold the joints in place.

The simple low load stability exercises like the toe touch drill were not enough to create strength of the joint, only once we exposed the load did the weak inhibited muscles bother to do anything, and it is when this happened that everything started to resolve itself. Every person must get to this stage eventually for this pattern of movement known as bending is an everyday activity we use all the time. If you continue to use poor patterns of movement you will not get very far with your rehabilitation efforts.

People who have bounced from therapist to therapist are also ones who often benefit from this very well for it is the only thing they have not yet tried and is the exact opposite of what they have been doing.

Good article to read with a ton of detail about the deadlift is in this article - Why the Romanian Deadlift is the key for treating hip and back injuries

Below is a great video to watch where I show you several examples of the RDL starting with the simple version and progressing to the more difficult single leg stance. The video to the right shows a slight variation of the traditional deadlift called the "Uneven Deadlift" and this is to enhance the core function with the muscles of the hip during the movement. I use this type of exercise a lot when working with people who have piriformis syndrome.

Comprehensive Online Program

Due to the complexity of this condition it is impossible to have a one size fits all program that works every time. You need to assess your condition and then use the results of those tests to determine what is needed for your body. This article I provided some of those tests, and basically the process of working through this injury but understand to keep the article to a reasonable size I have left a lot of exercises and stretches out.

You can get all the tests, exercises and stretches in a detailed video and book format below. Without a doubt the most detailed of all of our programs, as it is so difficult to work with. We had to document over 200 programs and real life case studies in order to put this program together. Included is over 60 different exercises along with 25 different assessments to identify where to start. This has been simplified down so that a person who has no gym background or equipment can still execute this program effectively. Most of the people who completed this program were everyday people, not gym junkies or athletes, although there were many runners and a few dancers who helped us put this program together.

My advice to you is to read this article and then go straight to our online shop and get your copy of the full program because this article cannot explain exactly what you need to do. I just don't have enough room on the page to explain it, and it is easier in video to show you than with text. For more information about what is inside this click here on the images below.

Conclusion

I hope you have found this article to be useful and if you are suffering with pain right now, hopefully it gives you some answers to getting rid of your problem. As I have said several times during this article there is no one magical way that will cure every person. There is so many variables and we are all so unique, even though our symptoms may be the same the cause is often different. I have given you just some examples of how this is the case. For example if your major issue is flexibility and a loss of range of movement the stretches and loosening techniques will work well for you. If however your flexibility is fine, you might find the strength and stability option does much more for you! The only way to be certain is to test it, but please be careful and take your time. Always start with the easy options first and work through the options in a process of elimination.

Again I highly suggest getting a copy of our Piriformis video and ebook as this gives you all of this process in step by step instructions so you can get to the root cause of your problems.

If you live in Melbourne and would like to book in for a Free Postural and Movement assessment click the image below to schedule a time.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Movement - By Gray Cook
• Corrective Exercise Solutions for the Hip & Shoulder - by Evan Osar
• The Psoas Solution - by Evan Osar
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Stuart McGill
• Knee Injuries In Athletes - by Sports Injury Bulletin
• The ACL Solution - by Robert G Marx
• Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek
• Twist Conditioning Sports Strength - By Peter Twist
• Twist Conditioning Sports Movement - By Peter Twist
• Twist Conditioning Sports Balance - By Peter Twist