Piriformis Syndrome: A Pain in the Rear


I authored an article with the above title in the Dynamic Chiropractic journal.

Here is my short version on how to apply these concepts.



  1.  There may be pain in the gluteal region.
  2. The patient may have external foot rotation during walking, laying supine or prone.
  3. The knee to opposite shoulder stretch will be restricted.
  4. The muscle will test weak.


Diagnosis – Piriformis muscle testing



Effectively correcting the piriformis dysfunction involves reducing the hypertonic state.

Thrusting and/or pressing into the sciatic notch will affect the fibers at the origin, while forces applied at the femur head will address the insertion fibers.

Press and hold for 3-5 seconds into these areas in order to stimulate the golgi tendon organs and reduce hypertonicity.





With the patient lying supine, bring the involved-side bent leg across the body and up toward the opposite shoulder. While maintaining this stretch, the tender piriformis fibers can be massaged to release more muscle fiber tension.


I prefer my patients work the good side first and then train the involved side.

Quadruped Hip Abduction: Beginning position is an all-fours position. Instruct patient to keep their knee bent and lift the involved leg in the air to the side until it parallels the floor. This can be done using multiple sets and reps without resistance; or exercise tubing can be used to add resistance.

Side-Lying Clam Exercise: Instruct patient to lie on their side with the involved hip on top; then bend their knees, keep the ankles together and raise the top knee away from the bottom one. Again, this can be done using multiple sets and reps without resistance, or exercise tubing can be used to add resistance.


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