Piriformis Muscle

The Piriformis Muscle

David Keil Anatomy, Lower Limb 13 Comments

What does piriformis mean?

The Latin name for the piriformis muscle is musculus piriformis. Piriformis translates as “pear shaped” muscle. The word piriformis comes from the Latin words pirum meaning “pear” and forma meaning “form or shape.”

Where does the piriformis muscle attach?

  • The muscle attaches to the anterior sacrum which is on the inside of the pelvic bowl.
  • The other end of the muscle attaches to the very top of the femur, which is called the greater trochanter.

The Piriformis Muscle

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What are the actions of the piriformis muscle?

This muscle externally rotates the femur and assists in abduction of the femur at the hip joint. Although we don’t abduct our leg often in a way that activates this muscle, one example of this action occurs in single-legged balancing postures when the piriformis helps stabilize the pelvis.

Piriformis and the SI joint

In addition to doing abduction of the thigh at the hip, piriformis is also an important muscle for maintaining stability and balance in our body.  Specifically, it helps allow for or restrict movement at the SI (sacro-iliac) joint. You can read my post on nutation counter-nutation if you’re curious about the movements of the SI joint.

Because the piriformis attaches on the inside of the sacrum and runs forward to attach onto the big bump at the top of the femur (greater trochanter), it creates a tensional force on the sacrum at the sacroiliac joint. This force is the opposite of the force generated by the psoas muscle. The two, therefore, create a certain balance of forces at the SI joint. You can find more on the psoas on the psoas resource page.

So, if you’re experiencing SI joint pain, one thing to assess is the tensional relationship between the psoas and the piriformis. When I say assess, I mean you could either create situations that test the flexibility/tension of these tissues, or better still, directly palpate (touch) these muscles. This of course assumes you have the skill to do that. You could also experiment with stretching both the psoas and the piriformis. Stretching the psoas requires extending the hip joint. A lunge can do the trick if the other hip flexors of the same side aren’t overly tight as well.

Postures where this muscle contracts

piriformis muscle in utthita hasta padangusthasana

The piriformis muscle contracts on the right side in standing leg raise to stabilize the pelvis relative to the femur.

Postures where this muscle is lengthened

piriformis muscle in pigeon pose

Pigeon is a classic example. The closer the front leg is to parallel with the front line of the mat, the more pressure goes into the piriformis muscle.

Common problems and additional information

Among muscles, the piriformis muscle is especially popular. I wrote an article on it titled: Sciatica, Piriformis Syndrome, and Yoga. It’s also mentioned in two other articles: one on sit bone pain and the other discussing the gluteal and psoas relationship. Let’s give it the attention it deserves right here though. The muscle is a lightning rod. Anytime anyone has pain in their buttocks it must be the piriformis, right? It could be, but it’s not necessarily the source of the pain. There are plenty of other causes of pain in the buttocks as outlined in the articles I linked to above.

Piriformis syndrome

Piriformis syndrome is probably one of the most common reasons that everyone has heard of the piriformis muscle. It’s a syndrome that can be confused with sciatica. You can read more in my post on sciatica, piriformis syndrome, and yoga. While a tight piriformis compressing the sciatic nerve is part of the description of this syndrome, it’s actually more specific than that. In fact, one of the more common causes is repetitive contraction of the muscle. Sorry runners, you’re more likely to end up with piriformis syndrome. If you have a tight piriformis and want to stretch it out, great, just don’t overdo it. While stretching can help, too much stretching can inflame it more! Although there are multiple postures that stretch this muscle, I usually recommend pigeon and its variations for this purpose.

Trigger points

Piriformis Trigger Points

Comments 13

  1. I love your newsletter!
    It seems as though you have started using more photos/pics , as opposed to written descriptions , to make your point, and that helps!

  2. I just wanted to thank you for your articles on the piriformis and also the video on Lotus prep. This cured years of chronic pain. My pelvic/hip area was so congested that it pulled my SI joint out of alignment. Thank you, thank you, thank you!

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    2. Hi. I signed up just to ask you what video has the Lotus prep in it? I have piriformis syndrome that can be totally relieved (in one session) by a competent trigger point massage therapist (he releases the piriformis and sometimes the gluts, using trigger point therapy) but it comes back. So I’d love to find out how you fixed yours.

  3. hello could this piriformis syndrome be my problem,i have pain in the tailbone,cant go into plough,aches and burns frequently and pigeon seems to help,and thank you for very interesting articles,looking forward to the next one! yours,eila hankinson

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  4. I have experienced pain, a pinching sort of pain, in this very spot for the last couple of years. It goes away when I sleep and is back as soon as I start moving around. I have scoliosis in two places and arthritis in my lower spine and one leg is shorter than the other. In the last few months, I’ve gotten mild sciatica. My doctor sent me to a physical therapist and a chiropractor, but it none of it helped. “I’ve done Hatha yoga and Kundalini yoga since last December, and I do laps in an Olympic size pool nearly every day. Both seem to help by warming the muscle. I have to sit, though, because of my job. That’s when the pain is the most severe, even when I take breaks. A couple days ago, after sitting for a long time and then walking for a half hour, my calves cramped up so badly that both legs and feet turn in. It really frightened me, but my doctor didn’t seem that concerned. My question is could the Piriformis muscle be the culprit? And if so, should I try and cure the pain in that muscle?

  5. I try to give out the information of how easy it is to diagnose whether the piriformis is causing a pain problem. Most MDs have never heard of it, and of course there are those who say it doesn’t exist. People go through MRIs and cat scans and all kinds of other tests and don’t find anything out.
    However, if it *IS* the piriformis at fault, it can be easily diagnosed by engaging a competent trigger point massage therapist, and have him/her use trigger point therapy to release the piriformis muscle along its entire length, and also any other tense muscles in the affected buttock. If it is a tense piriformis causing the problem, this will astonishingly relieve the pain. Cause will likely still have to be addressed, but one does not have to continue with excruciating pain while the cause is sought. If this does not have an significant effect, you may be looking in the wrong place for the source of your pain.

    1. I wanted to relate how I 100% solved my problem. This was pain that on the usual scale of 1 to 10, I classified as 500,000. The only position that was bearable was standing up. Sitting or lying down caused the pain level to rise and rise, and I could not attempt to sleep for more than 90 minutes, because a) the pain woke me up, and then, when I stood up, I would start to black out and my bowels would let loose. I would rock from foot to foot, standing up and clenching my teeth, until the pirifomis muscle let go enough that I could walk. Then I would shuffle/walk for 30-45 minutes until the muscle had relaxed enough that I could go back to bed and attempt to sleep for another 90 minutes. This went on for several months and I was considering suicide. No medical or non-medical professional I contacted was able to solve the problem, and the massage therapist’s efforts were becoming less and less effective, with the problem not relieved entirely plus coming back full force within about two days.

      So I had to figure it out myself. I am now 67. When I was 19 I discovered a pea-sized hard lump in my rear adjacent to the sacrum on the left. I was advised to have it removed but was not in a financial position to do so. Years later it was larger, I had it looked at again, was assured it was not cancer, and basically treated like a dumb blonde upset over nothing. I grew accustomed to the discomfort of sitting on it and just ignored it. In June of 2016, I took a four week long road trip driving my large truck and hauling my travel trailer. The day before I arrived home, the sciatica was starting to bother me again, and it hit full time within a day after reaching home. No way I could have driven in that condition, and I have to thank Divine Providence for waiting for me to get home. Then ensued three months of the above described level of pain. I was unable to even drive to the grocery without unbelievable pain after even five minutes sitting in the car. I’d have to walk the aisles for 30 minutes before I attempted to drive home again.

      What I finally figured out as cause and fix came from info from more than one source; my chiropractor told me that every time I went, my legs were not the same length. Every time he fixed it, but if I went back even two days later, it was off again. He commented that that must just be the way my body was. A physical therapist told me that the sacrum was rotated, which I had not known to associated with the difference in leg length that the chiropractor spoke of, but made the connection. An MD told me that the lump was a cyst and was now the size of a ping pong ball, and offered opiate pain killers, which I refused.

      I am a retired engineer. I decided that the cyst was impinging on the piriformis and possibly also the sacrum, keeping them out of line, causing the piriformis to clench onto the sciatic nerve (I never had any “back pain.” It was butt pain, radiating all the way down into my ankle.) So, I scheduled the cyst to be removed under local anesthesia, noted that the condition was improved but not fixed, waited two weeks for it to heal enough to be messed with, and then scheduled first the massage therapist to release the piriformis (which he was VERY good at) followed immediately by having the chiropractor adjust my “leg length” thereby straightening the sacrum.

      It took just a few days for things to settle out; that was last September sometime (and it is now May.) I have had zero, and I do mean zero, problem ever since. This was basically a case of “wallet sciatica” wherein the “wallet” was the hard cyst that existed in my own body. I don’t think any one medical person would have figured this out because of the narrow vision they have on their own specialty. I went to an osteopath, an acupuncturist, a physical therapist, an MD, sometimes multiples of those, and the excellent massage therapist who was the only one who had a clue as to what the pain was about.

      I hope this information is helpful to someone.

      1. I forgot to say, I went to my chiropractor a couple weeks ago because I had not seen him since the last fix a few months ago. He said my leg length was fine, not out like it used to be, meaning my sacrum was not rotated. So….more than just my own input that this problem was fixed.

        1. This is an amazing story and gives me hope that my spots can be corrected. I have had two areas bothering me for over a year, neck and lower back (on same side) which feel like they have knots. I would say pain is about 6 on scale of 10 and and I have been kind of sucking it up to getting older, 47. It has not really stopped me from engaging in the activities I enjoy (tennis) but it is becoming more unpleasant and I keep thinking maybe I should quit playing.

          I have “hoped” that I could fix it myself with my yoga but to no avail and it just seems like I should be able to rid of this annoying sharp pain going down my leg and when I turn my head. I did try a chiropractor…inconsistently, and more recently, a very good massage therapist who I really liked. So far though, it hasn’t really improved much. I know some people get relief almost immediately from the right chiropractor or massage therapist. I don’t expect miracles after one session but what is realistic? I wish I could get a whole body scan and see what the heck it looks like below the surface. I envy my mother who NEVER ached until her 70’s and she has done a lot of hard labor in her time. I feel like I shouldn’t have these issues at my age.

  6. Pingback: Piriformis: Learn Your Muscles - Custom Pilates and Yoga

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