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 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.

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.

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.

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.

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!

Pain in your butt can be far more serious than a simple idiom.

Piriformis syndrome can severely limit one’s range of motion, can create permanent damage, and can be downright painful.

Yoga poses specifically for stretching and strengthening the piriformis region greatly reduces the likelihood of developing an injury but does not completely remove the risk.

If a student files a claim against you for injury, you want to ensure you have professional liability coverage within your yoga insurance policy.