Piriformis Syndrome

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Here’s a structured, evidence-based rehab exercise program for piriformis syndrome, broken into phases for recovery. The program aims to reduce irritation of the piriformis muscle, relieve sciatic nerve compression, and restore mobility and strength.

Phase 1: Acute Phase (Pain Relief & Gentle Mobility)

Goal: Reduce pain and inflammation; begin gentle movement.

Duration: 1–2 weeks (or until pain subsides)

Frequency: Daily

1. Ice Therapy

  • Apply ice to the buttock (15–20 mins) 2–3 times/day to reduce inflammation.

2. Piriformis Stretch (Supine Figure-4 Stretch)

  • How: Lie on your back, bend both knees. Cross the affected leg over the other so your ankle rests on the opposite thigh. Pull the uncrossed leg toward your chest until you feel a stretch in the buttock.

  • Hold: 30 seconds, Repeat: 3 sets

3. Knee-to-Opposite-Shoulder Stretch

  • How: Lie on your back and gently pull the affected knee toward the opposite shoulder.

  • Hold: 30 seconds, Repeat: 3 sets

4. Nerve Glides (Sciatic Nerve Mobilization)

  • How: Sit upright. Straighten your affected leg with toes pulled toward you, then gently bend and straighten the knee.

  • Reps: 10–15, Sets: 2–3

Phase 2: Intermediate Phase (Mobility + Strengthening)

Goal: Improve flexibility, start strengthening hips and core.

Duration: 2–4 weeks

Frequency: 4–5 times/week

1. Clamshells

  • How: Lie on your side with knees bent. Keep feet together and lift the top knee.

  • Reps: 15, Sets: 3

2. Side-Lying Hip Abduction

  • How: Lie on your side, keep bottom leg bent, lift top leg straight up.

  • Reps: 15, Sets: 3

3. Glute Bridges

  • How: Lie on your back, knees bent. Push through heels and lift hips up.

  • Reps: 15, Sets: 3

4. Seated Piriformis Stretch

  • How: Sit on a chair, cross one leg over the other, and gently lean forward.

  • Hold: 30 seconds, Repeat: 3 sets

Phase 3: Advanced Phase (Strength & Return to Activity)

Goal: Restore strength, control, and functional movement.

Duration: 3–6 weeks

Frequency: 3–4 times/week

1. Single-Leg Bridges

  • Progression from glute bridges to challenge stability.

  • Reps: 10–12 each leg, Sets: 3

2. Monster Walks (with Resistance Band)

  • How: Band around ankles or knees, take wide steps side-to-side.

  • Distance: 10–15 steps in each direction, Sets: 3

3. Step-Ups

  • Use a low platform or step.

  • Reps: 10–12 each leg, Sets: 3

4. Standing Hip Extensions (with Band or Cable)

  • How: Stand and extend your leg straight back against resistance.

  • Reps: 15 each leg, Sets: 3

Maintenance Phase

Goal: Prevent recurrence by maintaining hip/glute strength and mobility.

Include weekly:

  • Dynamic warm-ups before activity (e.g., leg swings, walking lunges)

  • Regular glute/core strengthening

  • Stretching post-exercise

Important Notes

  • If symptoms worsen, stop exercises and consult a physical therapist.

  • Avoid prolonged sitting; consider a standing desk or periodic movement breaks.

  • Focus on form over speed in all exercises to prevent compensation.