Piriformis Syndrome Elusive Obvious

Simplicity works! One of my favorite sayings and a way of living I aspire to follow. Too often we overcomplicate the hell out of everything, especially in the pain game. “It can’t be that simple man!’ Well, it can and often is. Keep in mind, simple does not mean easy. If it was, more people would be doing it. You gotta use your noggin’ and look for relationships. And as you know, relationships can be dysfunctional 🙂

Take the pain in the ass (literally) Piriformis Syndrome. An extremely painful and tough condition to get rid of where the piriformis muscle chokes down on the sciatic nerve causing pain down your leg. I’ve had it and it’s awful. My life was completely turned upside down from pain. What does the piriformis muscle do?

A few things…

  • It’s part of the ‘Deep 6’ lateral (external) rotators of the hip.
  • Also works to functionally extend the hip

The piriformis originates on the anterior surface of of the sacrum and inserts on the superior border of the greater trochanter of the femur.

The question to ask is WHY is the Piriformis muscle choking down on the sciatic nerve? What is causing it to go crazy?

Remember there are TWO piriformis muscles, one on each side of the body. They MUST play nice together and maintain balance. What happens if one piriformis is not efficient? Inhibited (not engaging at the right time)? The other might become overactive (facilitated). When it becomes overactive, it may choke down the sciatic nerve.

The simple relationship to assess is one piriformis to the other. Are they balanced? Is there a Yin to a Yang?

Let’s take a look at see. Here are a few suggestions.

  1. Palpate one and then the other? Is there a difference? Atrophy? Hypotonicity?
  2. Watch movement. Stand with feet together and rotate to the right as far as you can. Shoulders should reach 90 degrees and hips half that distance 45 degrees. Don’t extend backwards in the spine, rotate! If you extend, that’s cheating. When you rotate to the right, the right hip should rotate internally and the left hip rotates externally. Rotate left and the hip motion switches. Range of motion should still be the same 90 and 45.
  3. Muscle test the piriformis muscles. Lie prone and bring one knee up in flexion to 90 degrees. Place one hand on the medial side of the ankle. Resist rotation of the ankle towards the opposite knee. That’s external rotation of the hip. Should be strong and locked. Is there a weakness, inhibition or pain? Does one test strong and the other weak/inhibited?

Possible Scenario:

Client presents with right sided piriformis syndrome and many sessions of releases have been done to the right piriformis. Problem still exists. So lets’ check the right one AND the left one in relationship to each other.

  1. You palpate the right side and it’s painful and hypertonic. The left side feels mushy and hypotonic.
  2. You have client rotate to the right and the hips don’t reach 45 degrees. Why? Perhaps the right hip will not internally rotate because the facilitated right piriformis is keeping it externally rotated. It will no relax to let the hip move into internal rotation. The left hip will not externally rotate efficiently if the left piriformis is inhibited. The left internal rotators may be over active. Classic functional opposite relationship. (synergist/antagonist)
  3. Right piriformis muscle test strong. Left side gives way. Can’t hold. Inhibited. What happens if the right piriformis tests weak or inhibited even though it’s tight and painful? Then another muscle will be overworking. It could very well be the opposite piriformis. Remember, relationships can change. However, in this case scenario, let’s assume the right is strong and left is inhibited.

Now you have a relationship to address.


By using the RAIL reset system I teach in Primal Movement Chains course.

Release. Activate. Integrate. Locomotion.

  • Release the right piriformis anyway you want (hand, ball, roller, etc.) for 30 seconds.
  • Activate the left piriformis by doing external rotation of the left hip. Unloaded on the ground. Leg straight and leg then bent. Do 10 reps each one.
  • Integrate by bending both knees and feet flat lying on your back. Let the legs fall to the left towards the floor controlling the motion. Mimics standing rotation lumbopelvic motion but in a safer environment. Bring back to center and repeat 4 times.
  • Locomotion. Lie on back and flex right leg and left arm in the air and press left heel and right arm into the ground. Keep right leg straight. Just like a gait pattern. Hold for 4 seconds. Stand up and walk.

Now go back and recheck the standing rotation assessment. Is it better? Do the hips move more? Do muscle test on the left piriformis. Is it stronger? If so, you are on the right track and repeat the procedure daily as needed.

What if the left piriformis was not an issue based on your assessment? Then it’s not the relationship you need to fix. Find another one. One possible relationship is inhibited internal hip rotators on the right. Could you have both? Sure can. There is always a relationship. The piriformis does not exist by itself.


  • Assess both piriformis muscles. One is often working too much for the other and thus it hurts. The linchpin is to activate the inhibited one.
  • Because it attaches to the sacrum, it’s a power stabilizer of the pelvis
  • Don’t chase pain. Treat it, but don’t chase it.
  • Remember it’s always a neuromechanical combination. Can’t have one without the other. The best way to assess neural? Movement.

HAVE FUN! Thank you for reading and I hope this inspires you to have hope in getting better. Feel free to share and inspire others. That’s where the MOJO lives.


Until next time…live and inspire with MOJO!