One of the commonly suspected tissues contributing to sciatica pain is the piriformis muscle, and as a result, the piriformis stretch, aka “the pigeon stretch” is often prescribed to address this problem. A lot of people ask me if the pigeon stretch is a good stretch. The answer to this is that it is based on context. In order to identify the effectiveness of this stretch, it is important to understand the piriformis muscle, anatomy, function, and its possible role in sciatica pain.
The piriformis muscle is a triangular muscle that starts from the base of your spine to the outer hip bone. It has a few major responsibilities: 1) turns your feet out when standing and 2) helps with crossing your leg over the other. It acts as a hip stabilizer.
The sciatic nerve which exits the spine at L4, L5, S1, S2, and S3 either passes under/through/over the piriformis depending on the anatomy of the person. Often times it is suspected that a tight piriformis is the cause of sciatic nerve irritation.
The role of the pigeon stretch is to stretch this muscle out to relieve pressure off of the nerve. In essence make the piriformis muscle “less tight”. However, if you look at how the pigeon stretch, the hip is rotated so that the foot is inward, and the knee is pushing out. This accounts for only about 50% of stretch on the piriformis muscle itself.
So while the stretch can relieve some tension in the muscle, we have to address the reality that muscles don’t just spontaneously get tight. The stretch may take the edge off and provide some relief in the tissues. My issue with the stretch is that if the sciatic nerve is running under the piriformis, and you are stretching out the muscle, there will be even more irritating force placed on the nerve itself. And when you compress a nerve, you also compress the blood vessels surrounding it, which can starve it of oxygen. As a result, there is a risk of further irritation of the sciatic nerve. If the piriformis muscle is the culprit to the pain, there needs to be a system to address this tissue.
1) We need to understand why is this muscle misbehaving in the first place? Is it how we walk, stand, or sit? Take a look at your feet in standing, they should be straight ahead (meaning ball of foot and heel are at 12 o’clock and 6 o’clock). What about your hips in relation to your shoulders? Your hips should be sitting underneath your shoulders.
2) Could this muscle be overactive as a result of sciatic nerve irritation further up the chain? What does bending forward, backward, side to side, or twisting do your pain? If your spine motions influence how your piriformis/buttock/sciatica pain feels, then we need to address that first.
3) We need to have a plan to prevent this muscle from becoming “tight” in the future. Could it strengthening, positioning? You can stretch a muscle until you are blue in the face, but unless you have a plan to prevent that muscle from getting tight, you can be wasting your time.
Another thing to consider when looking at the effectiveness of the pigeon stretch is its impact on the hip joint itself. If you are lacking hip flexion (aka knee up), hip external rotation (crossing your leg), or abduction (knee out), then the pigeon stretch can be helpful. But again be careful because it does place a fair amount of tension on that sciatic nerve if the stretch truly addresses the piriformis muscle.
Here 2 alternatives to the pigeon stretch that I like to provide for my clients:
Do you like to use the pigeon stretch? Does it work for you?