I'm going to have to add a Scott Sonnon section....

 Original Post on Scott's blog

Due to the repetitive strain caused by cyclical exercises such as walking, jogging, biking and spinning, as well as due to the unnatural act of long duration sitting, many people suffer piriformis syndrome. As a coach, my athletes often complain of a nagging ache under the glutes and even pins and needles associated with sciatica.

The piriformis originates in the sacral spine and attaches to the greater trochanter – that large boney “can-opener” where your femur attaches to your pelvis on your hip. The sciatic nerve runs underneath it, though in 15% of the population it runs through the piriformis. So, when you strain the piriformis, you can impinge the sciatic nerve. A strained piriformis muscle can irritate the sciatic nerve. This causes pain underneath the glute often refers down the back of the thigh and/or into the lower back, called sciatica. Athletes generally complain of pain deep under the glute, which they exacerbate by the cyclical activities I wrote above, including sitting. The piriformis muscle assists in the abduction and laterally rotation of the thigh. For example, you can experience the action of the right piriformis muscle, by balancing on the left foot, and moving the right leg directly sideways away from the body, then rotating the right leg so that the toes point towards the ceiling. Strain causes a “turn-out” of the foot so that the toes no longer point forward directly in front of the heel, which is one of the tell-tale signs that I look for in my poise analysis of new athletes.

The conventional gluteal stretch often only addresses superficial tension, and athletes never get deep enough to contract-relax the piriformis muscle. I have found that using ½ Spinal Twisting Pose perfect for inhibiting the glute from action so that we can actually get deep enough to release the piriformis.

½ Spinal Twisting Pose (left side, example):

1. Bring your left knee crossing your right leg, outstretched.

2. Lower your left knee until you can keep your left sits-bone on the mat.

3. Clasping your fingers pull your left knee to your right arm-pit as high as you can keep your left sits-bone on the mat (or you’re out of the pose!)

4. Start twisting around to the left to move your navel towards the inside of your left thigh, so that you’re twisting at the waist and not merely with your neck in the pose.

5. If you can get your belly-button to the middle of your thigh, then try hugging your knee with your right forearm to go deeper.

6. If you’re experienced in this pose, then you can practice bringing your right heel up to your left hip. But if you can’t keep your left sits-bone on the mat, then extend that right leg back out. It’s not your yoga today. Yoga’s never linear, so don’t get frustrated. Some days we get to go deeper than others. Just respect where you are and don’t try to accomplish the appearance of the pose. Be the actual structure of the pose so you can experience your true depth for today.

7. You can stay here and get 100% benefit out of the pose, or to go deeper, you can inhale your right arm up overhead; and exhale it across your left thigh, so that your right tricep is on the outside of your left thigh. Place your right palm flat on the mat, and if you can’t and can only place your fingers on the mat, go back to hugging. This step isn’t your yoga today. If you can place your hand flat, then you can stay there or grab your shin if possible, or all the way up to grabbing your knee if you can.

8. Inhale to lengthen your spine as you look over your right shoulder. And start to move your left hand behind you toward your centerline from behind. Go as far back as you can keep your palm flat on the mat, so if you’re on your fingertips, then go shallower until you’re flat. You’ll need the leverage for the twist. (Later, as you find yourself able to move your left arm back past your centerline with your palm flat, you can wrap your left arm all the way around your back, and grasp your right thigh from behind.) 

9. Exhale through the mouth and look over your left shoulder as you practice the counter-points of the pose:

10. Sit your left sits-bone down.

11. Pull or drive your left knee across towards your right arm-pit.

12. Twist at the waist to move your navel father towards your left thigh, and pull your navel towards your spine to create more room for the twist.

13. Go as far and long as you can avoid holding your breath. When you find that you’re struggling with your breath, back off slightly in depth and hold right there exhaling through it, experiencing that tightness under your left glute start to melt. It takes about 20 seconds.

14. Unwind back to center. Inhale through the nose looking off your right shoulder to lengthen your spine again crown towards the sky.

15. Exhale and go deeper this time cycling through the 3 counter-points: left sits-bone down, left knee across, twist at the waist. Be strong. Yoga isn’t about stretching, but strengthening in the opposite direction and surrendering the superfluous tension to the strength.

16. Unwind back to center. Inhale through the nose looking off your right shoulder to lengthen your spine crown to sky.

17. Exhale through the mouth and go for it. Turn it on. Your lower back and hips are ready to handle it now. Twist at the waist and try and move your right ribs across and over the top of your left thigh. Exhale off the top 20% of your lungs in little huffs.

18. Release, unwind, relax and extend your right leg if it’s not already, and move your left leg out to meet it.

19. Take a moment to hit a seated “reset button”: crown up, chin down, drive your shoulders towards the mat, and find that triangle of balance between your two sits bones and your tailbone. Now bring your right leg across your left and repeat in the opposite direction.

CONTRAINDICATIONS: Women approaching and past 1^st trimester in their pregnancy should avoid this pose. Athletes suffering from peptic ulcers, hernias or hyperthyroidisms should approve this pose specifically by their physician. And if you’re suffering sciatica or a slipped disc though may benefit from this pose, you should still get it confirmed by your physician since there may be other factors involved which could contraindicate its use. Even if you’re sure it’s okay, just ask your doc first!

In the next installment, I’ll discuss the impact of a strained piriformis on its antagonistic relationship across the SI joint with the psoas; and psoas insufficiency contributes to a different syndrome; and what you can do to prevent and alleviate it.

 
Distinguished Master of Sport

RMAX International