A Better Way to Stretch the Piriformis and Relieve Sciatica

In this article, Im going to add to my list of Stretching Don’ts and show another widely popular stretching and warm up exercise that is based on nothing but nonsense, and should be eliminated from your program.

The scary thing is that because of the vast popularity of this exercises, it's very likely that you're practicing it or that it has been recommended to you by a chiropractor, physical therapist, yoga intructor or personal trainer.

As I have done in my previous stretching donts article, I'm going to provide you with a whole bunch of science and a solid rationale for why the stretching exercise listed below both fails to promote proper movement patterns, and, based on recent research, may actually lead to dysfunction.

Stretching Don't: The Lying Piriformis Stretch and/or Standing Leg Cradle

The leg cradle is used by many sports coaches to develop mobility in the hip rotators by mainly stretching the piriformis. It's basically a standing variation of the traditional supine piriformis stretch.

This is another one of those movements that I haven't used much because I've never really liked it. I feel that it's a hard movement to coach and thought that it created unnecessary torque on the knee joint. Regardless, I kept giving the leg cradle a chance and used it on occasion. Finally, however, I decided to eliminate it entirely from our program while attending a physical therapy workshop. It was called Diagnosis of Mechanical Dysfunction and Stability Retraining of the Hip, and taught by Mark Comerford.

During the workshop, Comerford thoroughly explained why stretching the piriformis from any position (standing, sitting, supine, etc.) with the hip externally rotated and abducted (as in the leg cradle) will actually do more to stretch the posterior lateral hip capsule than the piriformis muscle.

According to Comerford, consistently stretching the hip capsule in most cases is a bad thing because it can develop uncontrolled motion (i.e. instability). This type of instability can eventually lead to a number of hip dysfunctions such as hip impingement syndrome.

Hip impingement occurs when the head of the femur (thigh bone) butts up against the acetabulum (hip socket). In the process, the labrum (cartilage around the rim of the socket) gets pinched.

It was at that point that I realized something very important. I realized that both the leg cradle and traditional supine piriformis stretch placed the hip in virtually the same position as when sitting cross-legged.

What Comerford was teaching us went along with what physical therapists have been saying for years about limiting cross legged sitting as it can lead to hip dysfunction. Until then I had just never made the connection. It was fairly obvious to me at that point that the leg cradle was a stretching Don't. Just to put the final nail in the leg cradle's coffin, I found a research article on hip impingement by Dr. John C. Clohisy that said something pretty amazing.

"Improved MRI technology has made it possible to study this problem more closely. As a result, we now know that many people who have no symptoms have femoroacetabular impingement." (John Clohisy, Clinical Orthopedics and Related Research Journal September 2007. Vol. 462 Pp. 115-121.)

This is very important to understand because it means that someone can actually have hip impingement and not even know it. What's just as important to understand is that the first thing any qualified physical therapist instructs a patient with hip impingement to do is avoid cross-legged sitting because it enhances the problem.

So, by performing the leg cradle or the traditional piriformis stretch (which imposes the same forces as cross legged sitting) you could very well be promoting a dysfunction. It should be clear to you now that the leg cradle and the traditional supine piriformis stretch are both poorly designed movements that should be eliminated from your program.

The question now becomes, "Can I stretch the piriformis muscle without possibly causing hip dysfunction?" Lucky for you, I have the answer. Yes, you can, and I'm going to show you how it's done.

To help you better appreciate the rationale behind the stretching protocol I'm about to show you, you need to understand some basic biomechanics of the piriformis muscle.

"In the neutral hip position the force vectors of piriformis action contribute to hip abduction, extension and lateral (external) rotation. It might be assumed that the hip must flex, adduct and medially rotate to stretch piriformis, but this isn't the case. As the hip flexes, the rotation moment of piriformis changes such that by full hip flexion it becomes a medial (internal) rotator." (Travell & Simons, 1992)

"The transition point for this change in action is considered to occur at about 60 degrees of hip flexion." (Kapandji 1970, Lee 1989)

Because the piriformis, like all muscles, functions in all three planes of motion, it must be stretched in all three planes of motion in order to be lengthened effectively. If we look at the leg cradle we can clearly see that the hip being stretched is in flexion, external rotation, and abduction.

As explained above, the piriformis contributes to hip abduction and therefore is shortened in that position. This is the reason why the leg cradle does not stretch the piriformis effectively.

In order to effectively stretch the piriformis as an internal rotator (above 60 degrees of hip flexion) we need to place the hip into flexion, external rotation and adduction. You will see this occur in the protocol below.

Note: the below sequence displays how to stretch the right hip. Reverse for the left hip.

Step 1: Assume a quadrupedal (all fours) position with your right ankle crossed over the back of your left knee.

Step 2: Place your right hand out to the side.

Step 3: Shift your hips and shoulders toward the right until you feel the stretch.

<a onClick="javascript:pageTracker._trackPageview('/outgoing/article_exit_link');" href=" http://www.performanceu.net/article02.html">Click here</a> to see pictures of this stretch

Be sure to move your pelvis and shoulders together in rhythm while avoiding any lateral flexion or rotation at the pelvis and/or trunk. This helps you prevent any substitution patterns (such as lumbar flexion which is commonly seen in the supine version) and build some awareness of spinal stability.

This stretch can be performed dynamically by moving the hips back and forth every one or two seconds, or it can become a static stretch by holding the position for 20 to 60 seconds or more.

We use this hip stretch as a level one progression in which we have developed two other, more advanced variations. In my Warm Up Progressions DVD series, we display the entire progression spectrum for this stretch and give you many ideas for safer, more functional alternatives to the Warm up and stretching don'ts listed in this and my other articles.

Conclusion

I'm going to close by sharing something I've been pondering about this whole piriformis thing:

Given that the piriformis changes its function from an internal rotator to and external rotator relative to the degree of hip flexion, is it possible that in order to better improve its function, we might need to stretch it in two different ways using two different hip positions? It's definitely something to think about. And like I said, I'm the thinking man's coach.