A recent deep tissue massage (involving a strong elbow to an excruciating muscle found deep in the glutes) brought to light numerous questions. What is that muscle? Why is it so tight and sore? Besides being tortured by an elbow, how can I stretch it out? Is this sciatica?
To answer these questions we turn to Dr. Victor Prisk, a board certified orthopaedic surgeon, champion bodybuilder, former All-American gymnast, and professional dancer.
The muscle in question is the piriformis. It’s located behind the gluteus maximus. It attaches at the lower spine and the upper thighbone (the femur). “The piriformis can get tight from overuse, inflammation, spasm, muscle hypertrophy, scarring from injury, or direct pressure (sitting too much, rowing, biking, etc),” says Dr. Prisk. “The sciatic nerve runs directly under this short external rotator of the hip. Compression of the sciatic nerve causes gluteal pain and nerve pain that shoots down the leg.” That compression can occur under the piriformis or at the spine (from a herniated disk pushing on nerve roots).
Here are some ways to stretch the piriformis:
- Stretch: “Internal rotation, flexion and adduction of the hip (at 90 degrees at the hip in flexion, cross your leg over your body and push your knee to the floor with the opposite hand)”
- Foam Roller: “Rollers can be helpful to stretch and lengthen a tight muscle and especially alleviate muscle spasms.”
If that’s not enough, Dr. Prisk says there are many treatment options. “First is therapy to strengthen the glute medius and minimus while stretching hip flexors to offload work by the piriformis. Bad posture and prolonged sitting exacerbate anterior pelvic tilt and increase risk of spine problems and piriformis syndrome.” Other options include “injections, anti-inflammatories, muscle relaxants, TENS units, and surgery in the rarest of cases.”
Bottom line? Dr. Prisk says to “Stay active, don’t sit too much (especially on a big wallet), don’t neglect your core and posture, and ‘when in doubt, check it out’. See your doctor if you have any sciatic nerve pain.”