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The piriformis muscles can be a real pain in the butt. Truly. These muscles connect your upper thigh bone to your lower spine on each side of your pelvis. They sit deep in your buttocks and work with your other hip muscles to move your thigh and provide stabilization.

But because your piriformis is so close to your sciatic nerve, it can be a source of pain. Physical therapist Robert Catanese, PT, DPT, explains why this happens — and how you can feel better.

What is piriformis syndrome?

Your sciatic nerve is a large nerve that travels from your low back, under your piriformis, to your legs. When your piriformis is tight, it can aggravate your sciatic nerve and cause piriformis syndrome. The main symptoms are numbness and pain in your buttocks that radiate down the back of your leg on one or both sides.

Dr. Catanese says piriformis syndrome is most common in people who sit for long periods. But athletes who spend a lot of time in the weight room and cyclists can also experience this painful condition.

Should you exercise with piriformis syndrome?

Absolutely. You may think you should sit down or stop moving, but rest isn’t the answer. Often, rest is what caused the problem in the first place.

Stretches and exercises are the go-to treatments for piriformis syndrome. “A consistent regimen of stretching and exercise can significantly improve symptoms,” says Dr. Catanese. “The goal is to loosen the piriformis, so it’s not irritating the sciatic nerve.”

Here are Dr. Catanese’s top moves for piriformis syndrome. Talk to your healthcare provider before starting a new exercise routine, especially if you have pain or haven’t been exercising regularly.

Seven best piriformis syndrome stretches and exercises

Stretching helps loosen tight muscles by creating length and flexibility. Exercises improve the strength and mobility of the piriformis and surrounding hip muscles. Together, they can help alleviate the radiating pain and numbness you feel with piriformis syndrome.

1. Knee-to-shoulder piriformis stretch

1. Lie flat on your back with your legs straight.
2. Lift your leg and bend your knee. With your opposite hand, pull your knee toward your opposite shoulder.
3. Hold for 30 seconds.
4. Do this on each side three times, twice a day.

2. Ankle-over-knee piriformis stretch

1. Lie flat on your back with both knees bent.
2. Cross your ankle over your opposite knee.
3. Grab the back of your thigh area behind your opposite knee.
4. Gently pull your thigh straight toward your chest.
5. Hold for 30 seconds.
6. Do this on each side three times, twice a day.

You can also do this exercise in a seated position, which is convenient if you work in an office:

1. Sit in a chair with both feet on the floor.
2. Cross your ankle over your opposite knee.
3. Let your knee fall downward, keeping your ankle in place.
4. Push your knee down gently or lean forward to feel the stretch in your buttocks.
5. Hold for 30 seconds.
6. Do this on each side three times, twice a day.

3. Bridge

1. Lie flat on your back with both knees bent.
2. Contract your core and lift your hips off the floor.
3. Squeeze your buttocks at the top of that motion.
4. Slowly lower your hips back to the floor.
5. Repeat 10 times per set.
6. Do three sets, once or twice a day.

4. Side leg lifts

1. Lie on your side with your ankles stacked on top of one another. You can rest your head on a pillow or your arm.
2. Tighten your top thigh and lift your leg slowly, keeping your knee locked.
3. Slowly lower your leg to the original position.
4. Repeat 10 times on both sides per set.
5. Do three sets, once or twice a day.

5. Clamshell

1. Lie on your side with your ankles stacked and your knees bent in an “L” shape.
2. Keeping your heels together, lift your top knee as if you were opening a clamshell.
3. Slowly lower your knee to the original position.
4. Repeat 10 times on both sides per set.
5. Do three sets, once or twice a day.
   
   Note: You can use an exercise band around your knees for extra resistance.

6. Facedown leg raises

1. Lie flat on your stomach with your legs extended.
2. Tighten your thigh muscles and lift one leg off the floor, keeping your knee locked.
3. Slowly lower your leg to the original position.
4. Repeat 10 times on both sides per set.
5. Do three sets, once or twice a day.

7. Standing small range squat

1. Stand straight with your heels shoulder-width apart.
2. Hinge your hips and push your buttocks back, squatting as low as comfortable.
3. Slowly return to a standing position.
4. Repeat 10 times per set.
5. Do three sets, once or twice a day.

Positions and exercises to avoid if you have piriformis syndrome

Try not to sit for long periods. This puts pressure on your piriformis muscle and sciatic nerve. You may also want to avoid seated exercises such as biking, which could aggravate your condition.

If you sit at work, Dr. Catanese recommends standing up briefly every half hour to ease the pressure on your piriformis. “A standing desk is also a good investment. It offers a better ergonomic design for people who work on their computer all day,” he says.

Other ways to help relieve piriformis syndrome

You can supplement the seven basic stretches and exercises with other strategies to help improve piriformis syndrome symptoms, including:

• Cardio exercises: Aerobic exercise is important for your hip muscles and overall health. The best cardio exercise for piriformis syndrome is walking or using an elliptical machine. You can also jog if it doesn’t cause pain.
• Core exercises: A strong core can help support your piriformis. Dr. Catanese includes core exercises in treatment plans for his patients with piriformis syndrome. Examples include crunches, leg lifts and planks.
• Foam roller: Some people use a foam roller or tennis ball to help with piriformis syndrome. A foam roller or ball can locate a trigger point in your piriformis muscle and release it. “Finding the trigger point can be challenging if you haven’t done it before,” says Dr. Catanese. “Ask your healthcare provider or physical therapist for hands-on instruction.”
• Yoga and Pilates: You’ll find many stretches and exercises in yoga and Pilates classes that can relieve piriformis syndrome. These classes can also help you reach other muscles that might be tight.

What if my symptoms aren’t improving?

If you’re not feeling better after about a month of consistent stretching and exercises, check in with your healthcare provider.

“Piriformis syndrome is tricky,” says Dr. Catanese. “It can mimic other conditions such as lower back problems, hamstring injuries and gluteal tendinopathy.” An evaluation by a medical professional can help you find the source of your symptoms and get you the treatment you need.