Gentle stretches for sciatica / psoas and piriformis muscles
August 28, 2018 7:56 AM   Subscribe

YANMD. I need help finding gentle stretches to relax my chronic sciatic pain; emphasis on stretches for the psoas / piriformis muscles.

I have a history of chronic sciatic pain, and recently aggravated the condition.

Current symptoms: pain stems from my lower left lumbar/hip region where my psoas and piriformis muscles start, and I have intermittent nerve pain down the side of my left leg.

Yesterday, my doctor prescribed me muscle relaxers/NSAIDs and advised heat/ice; she also advised against being sedentary for too long and to at least once an hour, stand up walk around, and do some gentle stretches for my psoas/piriformis/low back/hips/hamstrings. She advised that based on the symptoms I was describing, it sounded like I had strained my piriformis muscle which caused it to spasm and press on my sciatic nerve. I asked her to recommend specific stretches and she referred me to Google(!). I wasn’t thrilled by that but she’s my PCP, and I can’t get in to see my ortho until next week.

Please direct me to good online diagrams / videos of stretches for the psoas and piriformis muscles, especially if they are ones you have done before and they’ve helped you with similar symptoms. It would be ideal if the stretches were modified for those treating sciatica or low back pain.
posted by nightrecordings to Health & Fitness (8 answers total) 35 users marked this as a favorite
I've been dealing with this exact issue, and the best thing for it has been the figure-4 stretch.This video shows it; it's super-simple.

You might also consider foam rolling your glute. The combination of that with stretching is the most effective treatment for me.
posted by asterix at 8:17 AM on August 28, 2018 [3 favorites]

Best answer: Several things worked well for me:

1. foam roller for piriformis/glute/etc. I found it helpful to not be too aggressive about this initially, as vigorous rolling irritated the nerve more. You can use a tennis ball/wall if sitting on a foam roller is too much pressure.

2. psoas release using "constructive rest" as described here. Initially I was skeptical (is it really doing anything?!), but it helped a lot! Really make sure you're laying there in the right position for the time suggested (not doing other things, unless maybe listening to music/podcasts, etc).

3. once the pain got better, working on strengthening/activating glutes. In my case, my glutes are pretty weak from lots of sedentary time/sitting, so when I move around, they don't do their job and the piriformis takes over, which leads to strain. Your ortho can probably help you with more info on this, or refer you to a PT who would also be able to assist.
posted by Knicke at 8:31 AM on August 28, 2018

I was going to recommend the exact stretch that asterix did. You can do a modified version while seated in a chair by putting the ankle of the leg on the painful side on your other knee and then leaning forward. Not as good, but probably more work-appropriate :)

Those stretches plus heat, muscle relaxants and acupuncture fixed mine.
posted by kbuxton at 8:32 AM on August 28, 2018 [1 favorite]

Best answer: I'd find a PT who specializes in pelvic floor work and fix it once and for all. I always thought PT was a waste of time but it turns out it's not if you find a good one. I like the Postural Restoration Institute method (focuses on pelvic alignment) but I also liked the regular pelvic floor stuff too and seeing someone who did active release was somewhat good but not quite it for me. A life time of crookedness corrected in 6 months, amazing.
posted by fshgrl at 8:45 AM on August 28, 2018 [4 favorites]

Same stretches! Tennis ball against the wall was way easier for my to start rolling with and quite quick to relieve some pain. My issues definitely stemmed from stress on my lower back due to very weak core (pregnancy and csection) so rolling on the floor was pretty much impossible at first. The wall and a tennis ball, which over time I switched to a firmer lacrosse ball, was easy to control and more specific and directly applied to problem spots. Do start very gently and keep track of what feels good and effective. I ended up completely focusing on the piriformis after some trial and error rolling everywhere.
posted by Swisstine at 8:45 AM on August 28, 2018 [1 favorite]

When I had similar symptoms a PT recommended this standing variation on the figure-4 stretch to me and it works really well, because you can hold it for longer periods of time. I do it on the edge of the bed before going to sleep and with a couple pillows can read while holding it for several minutes.
posted by googly at 9:04 AM on August 28, 2018

The Egoscue Method of physical therapy helped me get over what was 15+ years of chronic back pain at that point. I started with the exercises for low back pain in the book Pain Free, but there are also some videos on YouTube that you could try.
posted by Lexica at 10:58 AM on August 28, 2018

I had sciatica for six months along with sinusitis and post nasal drip, and when I got the sinusitis cleared up, it took the sciatica with it.

I see from your previous questions that you often have severe fall/winter post nasal drip, and I wonder whether that might be causing your sciatica.

My explanation for the connection in my case is that my post nasal drip was actually cerebrospinal-spinal fluid (CSF) leaking from a lesion at the top of my sinuses, which lowered pressure in my CSF, making the spinal cord collapse a little, which in turn caused the spine to impinge on one of the nerve roots emerging from it, giving rise to the pain of sciatica.

You mention in the post nasal drip question that prescription and OTC medication hadn't helped, and one of the answers mentioned that the timing was consistent with a sensitivity to leaf mold in your region, but antibiotics did do the trick for me.

If antibiotics don't work or are unavailable, there are three herbal products I've used that seem to have real though not overwhelmingly strong antimicrobial activity against both bacteria and fungi: Artemisinin, Goldenseal, and freeze-dried garlic, in order of deceasing potency.
posted by jamjam at 8:41 PM on August 31, 2018

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