Three of the most common muscles in the body where we hold tension are known as the Tension Triad: Pterygoid, Psoas, and Piriformis. In Tension Triad Part II: The Psoas we discussed the Psoas Muscle. The last member of this tension triad is the Piriformis (pronounced Peer-ee-form-us) Muscle. The Piriformis is a muscle of the pelvis and hip that is one of 7 main contributers to external rotation of the hip. Think sitting in a figure 4 position. It rolls the upper leg bone (femur) outward from deep inside the rear-end. I call it the pizza muscle because it is shaped like a piece of pizza. The piriformis originates from the front of the sacrum (the wedge shaped bone just above your tailbone) levels 1-4 of the sacral foramina (holes where the nerves course through), the margin of the sciatic foramen and the front surface of the sacrotuberous ligament. This is the wide side of the pizza. The pointy part of the pizza ends up on the top of the greater trochanter (the knot on the side of the leg bone we commonly refer to as the hip) or just below where we do/did? the dance “the bump”. The middle portion of this muscle passes from in front of the sacrum and out to the lateral leg passing over the sciatic notch where the sciatic nerve courses through. The muscle is innervated by S1 and S2. It lies deep to the gluteus maximus (the booty muscle). Many times Sciatica and Low Back Pain are actually due to Piriformis Syndrome.
In my clinical experience for over 2 decades as a Physical Therapist, I’ve seen many patients who fit this exact description. They describe pain in the low back, (or not) and pain or numbness and tingling down the leg. The Sciatic nerve is the the bundle of nerves formed from the merging of the nerve roots of L4,L5, S1, S2, S3. It courses through the sciatic notch and down the leg to basically supply motor function (movement) to and sensory reception from the lower limbs. Picture a small garden hose, but someone has stepped on it. This is what it looks like in the mind of therapist. The Piriformis is the foot, blocking the vital energy, flow and function of this bundle of nerves. The sciatic nerve can refer pain all the way down to the toes or up into the back or out to the hip. As an external rotator, the piriformis gets tight, as does the psoas, in prolonged sitting. Our glutes (booty muscle) fail to fire efficiently (mostly cause we sit on them) and this causes the piriformis and other external rotators of the hips like the Gemelli Brothers (ask me), to become over worked and thicken into a partially contracted and restricted state. I explain this process fully in Tension Triad Part 1: The Pterygoids if you missed it.
If you look at people when they sit, sorry guys, but especially men, you may notice that they sit with the legs rolled out and wide but they have a reason.
Time to check in and notice how you are sitting now.
What is the position of your thighs?
If you sit with your legs straight out in front of you, which way do your toes point?
Out to the side walls? Towards the ceiling? Towards each other?
Is it likely the sitting posture of your preference that is contributing to tight a piriformis? Your Wellness Self Check has revealed a tight piriformis if your toes are pointing out and if trying to bring them in causes pulling, or pain in your seat, low back, or inner thighs. If it takes some extra effort to keep your toes towards the ceiling, then you can thank your tight piriformis!! Another way to check in on it is to sit in a figure 4. I show it lying down for therapeutic and easy viewing purposes.
Start your Wellness Self Check by lying down flat on a mat. Bend both knees and bring your feet towards your bottom about 12 inches to 20 inches or as you are able to do so comfortably. If it does NOT cause knee or hip strain, cross your ankle at the opposite knee making a figure 4 with your legs. If the hip is very tight, then try straightening the bottom leg some as shown in the photo above. This position alone is often enough of a check in and a stretch for people with extremely tightened and thickened piriformis’. If you feel safe and do not feel your body bracing or tightening, then you may progress to the last phase of this Self Check In. Add a 4 inch yellow MFR vinyl ball between the waist line and the crease in your hip, but in the fleshy part of your behind, see photo above. The Self Check In may reveal a hard, tender, or hot feeling in that area if your piriformis is tight. To continue, remain in this position for 5 minutes and allow your backside to soften over the ball like taffy stretching or silly putty softening. Breathe slowly and relax. When the 5 minutes are up, check in with the other side. Each side will be different based on your preferences when sitting.
Be mindful that an over inflated vinyl 4″ ball, a lacrosse ball, or a tennis ball is NOT what I recommend for this Wellness to Work. If we force with hard balls or hard foam rollers that cause our bodies to brace with more pain, WE ARE NOT RELEASING ANYTHING! Instead we may be adding to the restrictions that occur because of contracted muscles and reinforcing bracing patterns! If you notice any increase in pain, or numbness or tingling anywhere or any time during the check in with your self, remove the ball and enlist the help of a skilled therapist. If you feel any sensations come up anywhere else in the body this is the fascial voice and may be an area that your awareness has brought to your attention. Knowing ourselves and what is normal for each of us begins with being aware of what is happening in our bodies. A good wellness plan incorporates AWARENESS as key component of overall health. John F. Barnes says, “Without Awareness there is no choice.”
John F. Barnes’ Myofascial Release Approach is safe, gentle and effective!
If you are unsuccessful with the modifications listed above, you may require the assistance of a skilled MFR Therapist to help you with your Wellness Check. You can contact me at www.mfr360.com/contact/ and I would be happy to help you with a Wellness Plan. If you do not live in the South Louisiana area, you can find a therapist near you by searching:
***If you are uncomfortable stretching yourself, have significant pain, do not understand the instructions for the wellness self check, or have a case of Sciatica, Low Back Pain, Piriformis Syndrome or other pathology of the Low Back/Hip that has been diagnosed by a Physician or Chiropractor, then an assessment or a screening by a Myofascial Release (MFR) Therapist in your area may help. This information is provided for educational purposes only to increase body awareness and is not meant to diagnose or treat any condition.
Checking in with our bodies is a VITAL part of maintaining our overall Wellness. It is how we become aware of what is happening inside before our bodies scream at us in pain or break down on us. When we ignore muscle tension, unexpressed emotion, or any other imbalance that is allowed to continue over time without release, we are setting our systems up for failure. Please take care of yourself, stretch, go for a walk, meditate, dance, listen to music you enjoy, journal, paint, draw or create in any safe way that is unique to you. Wellness involves all aspects of our being: physical, emotional, mental and spiritual.