If you ever experienced sciatica, you are all too familiar with the searing pain that shoots down your leg, often accompanied by a burning sensation, numbness, or tingling. The pain can range from mildly annoying to severely debilitating.

While not considered a medical condition, sciatica is one of the most common types of pain. As many as 40% of people will experience sciatica it during their lifetime, the occurrence increasing with age. Yoga can help manage and even prevent flare ups.

But the cause your symptoms may, in fact, not be sciatica. Instead the source of your pain may be due to a deep core stabilizing muscle called the piriformis. Understanding the underlying cause of your pain with a simple self-test is a good place to start to determine which yoga poses will be most helpful in relieving your pain.

Sciatica or Piriformis Syndrome?

Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve, the longest and widest nerve in the body, travels from the lower back through the hips and buttocks and down each leg.

Sciatica is frequently caused by a bone-related compression of the sciatic nerve. Referred to as “true” sciatica, bone-related sciatica usually occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve. This can be due to lumbar disc damage (eg: a herniated or bulging disc) or from conditions such as spinal stenosis or osteoarthritis. By contrast, muscle related sciatica is caused by tightness or overuse of the piriformis muscle. 

The piriformis is a flat, narrow muscle located deep in the buttock. It runs diagonally from the lower spine to the upper thigh bone and serves to rotate the hip, turning the leg and foot outward. Depending on individual anatomy, the sciatic nerve may either run underneath or through the piriformis muscle. When the piriformis becomes tight or overused (often from prolonged sitting or repetitive, vigorous activity like running) it can spasm and cause compression of the sciatic nerve.

Easy Piriformis Syndrome Test

A quick way to determine if the cause of your sciatic pain is the piriformis muscle is to do Reverse Pigeon Pose.

To do Reverse Pigeon, lie on your back and cross the ankle of the leg with pain over the opposite knee. Next, hug the knee into towards your chest and hold for a four breaths. If your sciatic pain immediately feels better, then the pain is most likely being caused by the piriformis muscle.

Other indicators that the piriformis is to blame for your pain include--

• burning in the back of the thigh and calf down to your heel, with stiffness in the legs
• pain from sitting, accompanied by a tingling sensation at the back of your thigh. Standing may be relieve the pain, but there may still be numbness in the toes.
• pain and a pins-and-needles sensation down the outside of your calf to the web space between the little and fourth toes.
• difficulty walking on your heels or on your toes.

Once you have determined the piriformis is the cause of your pain, you can use the following five yoga poses to gently stretch, strengthen restore normal circulation to the piriformis muscle and sciatic nerve. Grab a yoga strap (a bathrobe tie also works well) and let's get started.

5 Yoga Poses to Relieve Piriformis Syndrome Pain

1) Knee to Chest Pose (Ardha Apanasana)

This pose gently stretches the piriformis muscle on each side of the pelvis while engaging your core muscles to support your lumbar spine.

1. Start by lying on your back in constructed rest with your knees bent and feet flat on the floor. Take three breaths, allowing your spine to settle and release into the floor.

2. Exhaling, bring your right knee into your chest, hugging it with both hands. At the same time, draw the muscles of the pelvic floor and low belly in and up, as if you were zipping up tight jeans.

3. As you inhale, allow the belly and pelvic floor to soften as your elbows straighten, allowing your thigh to move away from your chest. Repeat five more times.

4. Finish by hugging the knee into your chest. Stay for three breaths. You may want to circle the right ankle few times in each direction as you hold this position.

5. Release your right foot to the floor on an exhale. Pause with both feet on the floor to notice any sensations in your hip and low back. Be sure to repeat on the left.

2) Rolling Bridge (Setu Bandha Sarvangasana)

Rolling bridge engages the buttocks muscles which helps to increase circulation to the piriformis muscle. It also works to lengthen your hip flexors which are often tight in people with piriformis syndrome.

1. Begin in constructed rest with feet flat on the floor. Rest your arms by your sides, palms down.

2. Exhaling, engage first your pelvic floor, then low belly up to the bottom ribs as you press your feet into the floor and lift your hips. Move slowly and with awareness.

3. Inhale, lifting the hips a little higher if able. Keep your neck long and gaze towards the ceiling.

4. As you exhale, very slowly lower the spine-- upper, middle and then lower-- back to the floor. Repeat four more times. To build strength, try holding the hips up for three to five breaths on the last repetition.

5. Engage your low belly as you exhale the spine, one vertebra at a time, to the floor. Windshield the knees side-to-side three times to release any tension in the low back and hips.

3) Reverse and Lateral Pigeon (Supta Kapotasana)

Pigeon Pose is one of the best poses for stretching the piriformis muscle. The following reclining variations are much easier on the knees and allow you to stretch the piriformis from multiple angles.

Reverse Pigeon

1. Bring your right ankle to rest on your left thigh, just above the knee. Keeping the right foot flexed, gently press the right thigh away. Release and repeat four more times.

2. For a deeper stretch (so long it does not cause pain), draw the left thigh in towards your chest. Keeping both feet flexed, interlace your hands behind the thigh and draw it closer to your chest. At the same time, press your tailbone towards the floor. The neck should stay long with the chin slightly tucked in. If your chin lifts significantly or you are unable to keep it on the floor, come out of the pose and place a folded blanket or small pillow under your head.

3. Stay here for four breaths before releasing the left foot back to the floor.

Lateral Pigeon

1. To move in the lateral version, keep your right ankle on the left thigh and roll your pelvis to the left, bringing the sole of the right foot to the floor.

2. Grasp your the ankle with your left hand, gently pulling the ankle toward your face as you press your knee away. Reach your right arm overhead at an angle on the floor by your right ear. Stay for four breaths. This can feel intense, so breathe smoothly and steadily.

3. To come out of the pose, release both arms to your sides. Then roll onto your back, releasing both feet to the floor. Stretch both legs long on your mat and rest for three breaths. Then repeat both poses on your left.

4) Half and Full Locust (Ardha Salabhasana)

Just as important as stretching is strengthening the muscles of the buttocks that surround the piriformis and sciatic nerve. The following version of Locust Pose engages the legs to help build great strength throughout the low back and buttocks.

1. Roll onto your stomach with your legs long and hands under your shoulders. Lightly press your pubic bone into the floor to lengthen the low back.

2. Gently draw the elbows and shoulder blades towards one another. Keeping the neck long, inhale your chest and right leg a few inches off the floor. Avoid the temptation to press into your hands and use the muscles of the back instead. Hold her for a count of one, then lower your chest and leg to the floor.

3. Repeat, lifting your chest and left leg as you inhale. Pause for one count before lowering back to the floor. Continue, alternating sides for a total of three repetitions.

4. With the next inhale, lift the chest and both legs off the floor. Remember to engage the muscles of the upper back and buttocks rather than pressing into your hands to lift. Pause in this lifted position for one count, then lower your head, chest and legs to the floor. Repeat twice more.

5. Rest for two breaths with your forehead on your folded arms. Slowly shift your hips side to side to release any tension in the low back.

5) Reclined Hand-to-Big-Toe (Supta Padangusthasana)

This final pose lengthens the hamstrings and increases circulation to the piriformis. If you have lumbar disc damage or SI joint issues, I recommend skipping the twist portion in step 5.

1. Lying on your back, return to constructed rest. Bend your right knee and wrap a yoga strap around the ball of the foot.

2. Flex your right foot and extend it to the ceiling, holding one end of the strap in each hand. It is important to keep the knee straight rather than flexed, so allow your leg to move away from your torso to accommodate any tightness in your hamstrings.

3. Slowly use the strap to guide your leg in a circular motion, making five small clockwise and then counterclockwise circles.

4. Returning to neutral, press your right heel to the ceiling. If comfortable for your low back, you may wish to lengthen the left leg along the floor. Keep the both feet flexed as you take four slow, steady breaths.

4. Next, hold both ends of the strap with your left hand and extend your right arm on the floor at shoulder height. On an exhale, guide the right leg across your body using the strap. Try to keep your left shoulder on the floor. Feel free to prop your right leg using a bolster, folded blanket or pillow. Stay here for four breaths, softening and relaxing into the stretch.

6. To come out, slightly bend your right knee and bring it back to center. Bring both feet back to the floor, releasing the strap. Lengthen both legs, coming into Savasana for three breaths before repeating to your left.

End your practice by hugging both knees into your chest and rock side-to-side a few times. Roll to one side and press yourself up into a seated position. Take a moment to notice how your body and mind feel.

Knowing the difference between true sciatica and piriformis syndrome can guide you choosing the best yoga poses for relieving your pain. Even more importantly, when practiced regularly, yoga can also help prevent it.

Be well!

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