6 Ways to Ease Piriformis Syndrome Pain with Self-Massage and Stretches

Your piriformis is a small muscle situated beneath your gluteal muscles that assists with rotating and stabilizing the hip. When this muscle becomes tight, overworked, or inflamed, it can press on the sciatic nerve and lead to a condition called piriformis syndrome.

Working on your piriformis with massage or stretching can help reduce tension in the muscle and alleviate symptoms associated with piriformis syndrome.

This article describes several ways to self-massage your piriformis at home using a foam roller or a ball, and it also outlines a number of stretches you can perform to help relieve piriformis syndrome symptoms.

What is piriformis syndrome?

Piriformis syndrome occurs when the piriformis muscle compresses the sciatic nerve. The sciatic nerve is the largest nerve in the body, traveling from the spine through the hip and down the back of the leg.

Compression from the piriformis can produce symptoms commonly associated with sciatica.

Typical signs of sciatica include:

• numbness or tingling in the buttock and along the back of the leg
• a burning or sharp pain in the buttock and the back of the leg
• pain that intensifies with activity
• pain that worsens with prolonged sitting 

Piriformis syndrome is thought to account for about 0.3 to 6 percent  of cases of lower back pain or sciatica. It is more frequently seen in women and middle-aged adults.

Overuse, injury, or tightness of the piriformis are common contributors to piriformis syndrome. Differences in leg length, such as having one leg longer than the other , may also play a role.

Self-massage for piriformis syndrome

Targeted massage of the piriformis can reduce tightness and soreness in the muscle, which may, in turn, lessen pain caused by piriformis syndrome.

You can perform self-massage at home using a foam roller or a ball approximately the size of a tennis ball. A softer ball offers a milder massage, while a firmer ball delivers a deeper, more intense pressure.

The sensation during the massage should be slightly uncomfortable but not excruciating. If you experience sharp pain, reduce the pressure by adjusting your bodyweight or switching to a softer object.

It’s safer to err on the side of gentleness rather than applying too much force. Excessive pressure can aggravate the muscle and make symptoms worse.

If your piriformis symptoms worsen while massaging, stop right away.

Below are three straightforward self-massage methods you can use to help relax your piriformis muscle.

1. Foam roller massage

If you’re new to massaging the piriformis, beginning with a foam roller is a good way to gauge how your body responds.

A smooth foam roller has a wider surface area and therefore delivers a relatively gentle massage compared with a ball.

Rollers with textured patterns usually give a deeper, more focused massage than smooth rollers.

How to do the massage:

1. Sit on a foam roller with the roller’s length running away from your sides. Place your feet flat on the floor in front of you and support your weight with your hands behind you.
2. Cross one ankle over the opposite knee and lean toward the side of the crossed leg so most of your weight rests on that hip.
3. Rock back and forth on the roller until the discomfort eases.
4. Continue for up to 60 seconds, then switch sides and repeat.

2. Tennis ball (or similar ball) massage

A tennis ball or a similarly sized ball concentrates pressure more precisely than a foam roller. Its compact size lets you target the piriformis rather than the surrounding tissues.

Begin with a softer ball like a tennis ball before progressing to a firmer option such as a lacrosse ball.

How to do the massage:

1. Sit on the floor and position the ball under the side of your left hip. Support your upper body with your hands behind you.
2. Cross your left ankle over the opposite knee.
3. Roll slightly until you locate a tender spot. Stay on that spot and roll gently for up to a minute or until the discomfort lessens.
4. Switch sides and repeat the process.

3. Sitting on a ball

Sitting on a ball under your hip offers a subtler form of massage because you can more easily regulate the pressure.

How to do the massage:

1. Place a tennis ball or a comparable-sized ball beneath your hip while sitting, either on the floor or in a chair.
2. You may keep your legs extended or bend the leg on the side with the ball so the sole of that foot rests against your opposite thigh.
3. Gently press down until you feel some discomfort, then return to the starting position. Repeat on the same side until the tenderness eases.
4. Perform the same sequence on the opposite side.

Stretches for piriformis syndrome

Alongside self-massage, regular stretching of the piriformis can also help relax the muscle and reduce sciatica-related symptoms.

Begin cautiously and use gentle movements. Overstretching or forcing a stretch can aggravate symptoms. As your discomfort diminishes, you may gradually deepen the stretches.

If you experience a sudden increase in symptoms, discontinue the stretch immediately.

1. Pretzel stretch

The pretzel stretch helps lengthen the piriformis and the other external rotators of the hip.

How to do the stretch:

1. Lie on your back on a mat or other cushioned surface.
2. Cross one ankle over the opposite thigh.
3. Draw the knee toward your chest until you feel a gentle stretch in the hip.
4. Hold for at least 20 seconds, then switch sides.

2. Knee-to-chest piriformis stretch

This exercise targets the piriformis as well as the muscles on the outer hip. If you notice knee pain during the stretch, stop at once.

How to do the stretch:

1. Lie on your back on a mat or similarly soft surface.
2. Bring one knee toward your chest while keeping the other leg straight.
3. Point the foot toward the opposite hip and hold the stretch for around 20 seconds.
4. Repeat on the other side.

3. Seated twist

The seated twist helps loosen the muscles on the outer hip as well as the torso.

How to do the stretch:

1. Sit on a mat with your legs extended in front of you.
2. Bend your left leg and place the shin horizontally across the floor in front of you; set your right foot behind your left knee.
3. Bring your left elbow across the front of your right knee and gently press down on the outer side of the knee.
4. Hold for at least 20 seconds, then switch sides.

What else can help?

There isn’t a universal agreement on the single best treatment for piriformis syndrome. In addition to regular self-massage and stretching, you may find the following helpful:

• Take frequent breaks during long periods of sitting.
• Alternate applying heat and cold to the sore area for about 15 to 20 minutes each.
• Use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin to manage pain.
• If symptoms persist, consult a physical therapist who can design a personalized rehabilitation plan with targeted stretches and exercises.

The bottom line

Massaging the piriformis can be an effective way to reduce symptoms of piriformis syndrome. Regular self-massage combined with stretching can help relax the muscle and decrease pressure on the sciatic nerve. Useful tools include a foam roller, a tennis ball, or a similar-sized ball.

Home massage of the piriformis is generally safe when you begin gently and progress slowly. If your symptoms worsen, stop immediately.

If symptoms do not improve over time, follow up with your physician or a physical therapist for further evaluation and guidance.