Glute Exercises: The Top Two to Get Started

After the blog post last week about IT Band Syndrome, several of you asked: “What are the best exercises to activate the glutes?” You ask, you shall receive.

Here is a brief review of the glutes and associated hip musculature. This will help with the exercise portion in a minute.

Definitions

  1. Abduction: leg moves out to the side
  2. Extension: leg moves back, behind body
  3. External rotation: leg rotates out and away from body

Glute maximus (glute MAX) actions at the hip:

  • extension
  • external rotation
  • abduction (superior fibers)

It is active in 3 planes of motion and the main worker at the hip.

Gluteus medius (glute MED) actions at the hip:

  • abduction
  • stabilization (i.e. walking and single leg balance)

Tensor fascia lata (TFL) actions at the hip:

  • abduction assistant
  • internal rotation assistant

Notice the word assistant above. The TFL is just that, a helper. However, this muscle is almost always overdeveloped and dominant; it desperately tries to act as the main hip abductor when that is the role of the glute MED. Clinically, I am always looking for exercises that train hip abduction with minimal TFL recruitment.

Vastus lateralis (VL) actions at the hip:

  • NONE!

This is the largest of the quadriceps muscles and it’s action is to extend (straighten) the knee. It has no attachment to the hip, except to say it communicates with the IT band. But, with dysfunction, the VL loves to help with hip abduction. One of the test positions to test glute strength is to have the patient lay on their side and lift the top leg. Most of the time, patients tell me they feel the outside quadriceps (VL) lifting their leg and not the glute MED. That’s a problem!

Glute MED, Glute MAX, TFL and VL

The following are two initial exercises I use to teach patients how to engage their glute MED and MAX effectively. They take a lot of brain power (remember the post about neuromuscular connections), but they are low-load and easy to do without fancy equipment. Because they are non-weight bearing, they set the patient up for success to learn the muscle-movement connection without worrying about balance.

GLUTE EXERCISE #1: CLAM

This is a very popular rehabilitation exercise. I have likely given this to every single patient with a lower extremity or hip injury. But, I am super picky about how my patients do it.

Benefits of the Clam Exercise

  • Leg on pelvis dissociation: teaches the leg how to move independently on a stable pelvis and trunk
  • Sidelying core stabilization: lying on the side engages the core differently and requires increased oblique activation
  • Decreases leverage of VL to abduct the hip: without the straight leg using IT band tension and VL, the glute medius is forced to begin working
  • Glute MED, superior fibers of glute MAX training (minimal TFL): EMG (electromyographic) research proves that the clam BY FAR has a better ratio of activating glute MED and glute MAX, while limiting the activation of TFL. Above I mentioned that TFL is usually working too much and we are trying to chill it out. This exercise is PERFECT for that!
  • Clam is significantly better at activating the glutes than lunges, squats and bridging. Something to remember!

CLAM EXERCISE: CORRECT FORM. Shoulders, hips and heels are in one line. Hips are flexed to 45º and knees are flexed to 90º. Lift the top left leg up while keeping the heels together and abdominals engaged. The leg moves independently of the body.

 

CLAM EXERCISE: INCORRECT FORM. The pelvis and trunk should NOT move with the leg, but this is the most common error with this exercise.

 

GLUTE EXERCISE #2: FIRE HYDRANT

Imagine a dog at a fire hydrant. Imagine how their hind leg lifts up. Have the visual? Moving on…

Benefits of the Fire Hydrant Exercise

  • Triplanar motion of glute MAX (leg moving): extension, abduction and external rotation. It’s hard to find an exercise that incorporates all three!
  • Glute MED stabilization (leg on ground): trains endurance of glute MED fibers
  • Quadruped (on all fours) abdominal stabilization: this has a functional application (cleaning floors, picking up toys) and pre-plank muscle training.

FIRE HYDRANT EXERCISE: CORRECT FORM. The leg moves out and slightly back without compressing the lumbar spine. The abdominals and glute MED on the opposite leg (right leg in this video) stabilize the body.

 

FIRE HYDRANT: INCORRECT FORM. The weight should not shift over the stabilizing hip as shown in the video.

© 2014 and Beyond. ALL BLOG CONTENT at duncansportspt.com by Lori Duncan PT


ABOUT THE AUTHOR

Lori Duncan, DPT, MTC, CPT is a respected Physical Therapist, Manual Therapist and Pilates instructor in Lafayette, CO. Lori is passionate about preventive physical therapy and education and is a nationally recognized presenter. She can be reached at [email protected] You can also follow Duncan Sports Therapy + Wellness on Facebook & Instagram for more free tips and information.


References: Selkowitz D, Beneck G, Powers C. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther. 2013;43(2)54-64.

Wanger T, Behnia N, Ancheta W, Shen R, Farrokhi S, Powers C. Strengthening and neuromuscular reeducation of the gluteus maximus in a triathlete with exercise-associated cramping of the hamstrings. J Orthop Sports Phys Ther. 2010;40(2):112-119.

132 Comments

  1. Sherry on September 2, 2014 at 8:05 AM

    Yay! I’m doing my clams correctly! (It is my least favorite exercise right now – but I won’t skip them knowing now how much they do.☺️) I do mine with a band too . . . Any tips for that? And I will have to try the fire hydrant. Thanks Lori from Ohio! So enjoy your posts.

  2. Lori Duncan DPT, MTC, CPT on September 2, 2014 at 11:05 AM

    Hey! Keep doing them. They are usually a least favorite because they are hard. The band should go around your distal thighs, not your knee joints, for the best glute workout.

    • Sherry on September 2, 2014 at 8:17 PM

      Thanks Lori – that’s what I do!

  3. To Stretch or Not To Stretch - Lori Duncan PT on November 4, 2014 at 12:50 PM

    […] leg squats, to walking up and down the stairs, to busting out a few clams and fire hydrants (a link to a previous post about these exercises). The warm-up just depends on the activity. Think of […]

  4. […] Glute Max and VMO. If you’ve read any of my previous posts, you know I am a big fan of the Glute Max. This muscle is SO important and massively underdeveloped in almost everyone (athlete and […]

  5. elizabeth on July 19, 2015 at 10:50 AM

    Hi, I was just doing both of these stretches and immediately felt relieve a. I suffer from Piriformis syndrome on one side. When doing the clam the side efected cracked a lot. But there was no pain. My question is should I do both sides equally for both of these excercises? Or should I just focus on the effected side. Thanks. Elizabeth

    • Lori Duncan DPT, MTC, CPT on September 6, 2015 at 7:57 AM

      Hi Elizabeth,

      My apologies for the delayed response. WordPress had you hanging out in spam. YES! Always do both sides. There is actually a neurological trick, called irradiation, that the “good” side will help the “bad” side figure out how to work. Hope that helps!

      • Kat on March 11, 2018 at 9:42 PM

        This is amazing. So glad I found your blog! Same here – piriformis – (one PT told me this could be from years of tennis?) and wondering how many times I should do these. They feel great!
        Ironically, today while walking and right before the eventual pain kicked in, I felt a tension in the Gmini, like it was “crystallized”. You know the feeling? Like they’re tight.
        I was a regular yoga practitioner for years and having a few kids (and eventual piriformis emergence) has messed with my practice, and I feel like it could help a lot. But I don’t want to overstretch the piriformis as you mention in the other article you posted. Sorry to babble. It’s actually amazing to finally have clarity for my “mystery hip pain”
        You rock. Thank you!! ❤️❤️❤️

        • Lori Duncan DPT, MTC, CPT on March 12, 2018 at 8:53 PM

          Hi Kat,

          I’m glad it makes sense! You can do the exercises to mod fatigue (15-20x usually) and work on quality more than quantity. 2x/day is plenty! Hope you feel better soon.

  6. Mac on July 8, 2016 at 3:54 PM

    Hi, most fascinating, THANK YOU! I have piriformis issues. Can you say how often per day, how many sets, and how many reps per set is advised for clam & Fire hydrant exercises? Thanks again!

    • Lori Duncan DPT, MTC, CPT on July 9, 2016 at 2:40 PM

      Hi Mac,

      Thanks for reading. I usually tell people to go to a nice moderate fatique…usually between 12-20 reps. 1-2 sets is plenty and 2x/day. These are more for neuromuscular connection. It’s more important to have quality reps than quantity. Hope that helps!

      • Mac on July 9, 2016 at 2:50 PM

        Lori,
        I can’t say THANK YOU enough. I’m in the middle of a stretching routine RIGHT NOW –perfect timing. 🙂 I know you’re busy, so to take the time to respond so quickly to someone you don’t know… wow, you’re wonderful. THANKS again. Enjoy your summer!

        Appreciative,
        Mac

  7. Jill Seneczko on August 3, 2016 at 8:12 AM

    Lori,
    Your blog on piriformis syndrome was a life changer for my running! I have gone thru PT, ART massage, tennis ball rolling etc..After desperate web browsing to find a better solution, I was so relieved to find your blog and the logic you provided on the biomechanics of the piriformis muscle! I immediately stopped the tennis ball treatment, rested, and started the exercises you recommended. I ran my half marathon with a PR pain free!! Please continue to blog for those of us not fortunate enough to live in CO to come and see you!
    SO thankful,
    Jill S.

    • Lori Duncan DPT, MTC, CPT on August 3, 2016 at 4:06 PM

      Jill!! Thank you so much for reaching out to tell me your story. It makes my day when I can help ANYONE feel less pain in their body. A PR!! Exciting. I truly appreciate your feedback. Happy running to you.

    • steve on May 15, 2017 at 2:11 PM

      Jill, I’m so happy to hear you got to run your 1/2 w/no pain! My piriformis just got mad making my sciatic angry. How long did it take to calm your piroformis down with these exercises?

      • Jill on May 15, 2017 at 8:51 PM

        Steve,
        I believe it was about 2 1/2 – 3 weeks before my race. i recently completed training for a half with no piriformis flare ups. I have spent more time focusing on strengthening my glutes, thanks to Lori’s advice, with the two exercises she recommended along with a mix of squats and lunge type moves. So good so far! Best of luck to you!

  8. Lori Duncan DPT, MTC, CPT on August 11, 2016 at 12:33 PM

    Hello followers of this blog post! For all of you who may need a good, quick glute workout, here is a link to new videos I produced and released yesterday. Please go to this link on vimeo for more information. https://vimeo.com/duncansportspt

  9. Dottie Trail on November 17, 2016 at 11:40 AM

    Lori,
    I am having piriformis issues -a big “pain in the butt”. Also sometimes have pain in the front of my leg. More pain with standing than sitting. I believe I injured it on treadmill, running too far too fast without adequate training. I have been having on and off pain for past 3 months. I plan to start those 2 exercises you suggested but my question is this. Should I also continue to stretch this area? I don’t want piriformis muscle to hypertrophy. I plan to start yoga twice a week, would you recommend that? Thanks much for your help! Dottie

    • Lori Duncan DPT, MTC, CPT on November 18, 2016 at 9:21 AM

      Hi Dottie. Thanks for reaching out. I would actually stop stretching. That usually makes the pain worse (even though it feels good at the time). Yoga can be ok, but please avoid pain into that area. I would avoid pigeon pose for now. Work on those exercises for several weeks so that your brain starts to understand how to use the right muscles. Reach out if have further questions. Lori

  10. Alastair on January 22, 2017 at 3:36 PM

    Hi

    I’m a full time cyclist and have sciatic nerve pain down my right leg. It gets much worse when I’m putting more effort in, in my bum and calf. I’m pretty sure it is a piriformis issue as I notice my knees have a tendency to point in both when pedalling and when doing exercises (single leg squat for example). I’ve seen various chiros and physios all to no avail. After reading your articles it really seems to make sense. Do you think these glute exercises can help?

    Thanks
    Alastair

    • Lori Duncan DPT, MTC, CPT on January 23, 2017 at 10:09 AM

      Hi Alastair,

      Yes, I do. It will time some time and practice, but with patience you can change the neuromuscular recruitment in that area so your brain knows to use the good glutes and not that piriformis. The main power producers in cycling are: glute max, vastus lateralis, VMO, tibialis anterior and soleus. So, with increased load if one of those is not performing well, you may notice symptoms along the chain. Hope that helps!

      • Dottie Trail on January 23, 2017 at 11:04 AM

        My piriformis syndrome thankfully did resolve after 3 1/2 months using a combination of rest, clam shell/hydrant exercises as recommended by you, no stretching and acupuncture. For prevention I plan to cross train for strength (especially glute muscles) and gradually increase my runs in distance and speed. Thanks so much for your guidance! It was much appreciated.

        • Lori Duncan DPT, MTC, CPT on January 23, 2017 at 3:39 PM

          Hi Dottie,

          That is awesome to hear! I appreciate your feedback and VERY happy your pain as resolved. Happy running!

          • Alastair Hepworth on March 2, 2017 at 6:42 AM

            Thanks for your reply. Unfortunately for me, my chronic issues (bad at 22 eh) turned out to be ‘iliac endofibrosis’ – that is, a build up of scar tissue and compression on the iliac artery near the groin. It’s tricky to diagnose as it’s not well known, and the symptoms are often mistaken for a muscular or skeletal issue, which is what happened with me. Luckily I got to the bottom of it, but to anyone with buttock/thigh/calf pain which doesn’t react to treatment, id urge you to get tested for this. It will save you a ton of frustration. I was on the verge of packing in professional sport, but now it looks like I can fully return after surgery.
            Good luck



          • Lori Duncan DPT, MTC, CPT on March 5, 2017 at 9:36 AM

            Hi Alastair,

            Interesting and glad you got a diagnosis. Yes, I always tell my patients that most of the time conservative care (PT) works, but when it doesn’t, it’s time to look in a new direction. Thank you for comment!



  11. Lindsay on February 11, 2017 at 7:17 PM

    Hi Lori,

    I’m glad I stumbled onto your site! I have been dealing with bilateral PS since Sept which produced two numb legs, foot drop and urinary/ pelvic floor tension. I have been through an army of doctors including a team of neurologists that didn’t have a clue what was wrong with me! It finally took going to a Chiro who also specializes in acupuncture, grasten, cupping and physio to figure out that I had a severe hip misalignment that caused all this to happen! I’ve improved ten fold but there are still lingering effects and it seems that stretching doesn’t do much and the tennis ball makes the Piriformis tighten every time! Yesterday I tried again and it will be the last! I’ve moved onto Prolo; hoping it helps.

    • Lori Duncan DPT, MTC, CPT on February 12, 2017 at 2:08 PM

      Hi Lindsay,

      So sorry to hear about all of your pain, but glad someone was able to figure it out for you. In addition to halting the tennis ball (yea!), make sure you are trying to work on activating those good glutes. Please let me know how the prolo goes…I’m interested! Thanks for reading and your comment.

  12. Ron on February 20, 2017 at 5:20 AM

    Hi Lori, I think it’s great that you are able to help so many people through your site. I have been suffering from PS for 9 weeks now. My daughter is also a PT and suggested the same exercises above as well as a few others for my glutes. I am in excruciating pain in the morning and can’t walk until I do some stretches(I know you mentioned above that is only temporary relief) but I can’t function without doing them. My question is I started doing the clams and hydrant exercise 2 days ago but feel worse than ever this morning. Is it something that will diminish over time or should I stop doing them? My daughter always advises don’t do something if it hurts or makes things worse. I have been to doctors, chiros, massage therapists, and of course PT with my daughter but see no end in sight. I might add the pain I get is very localized to my buttocks. I am into fitness, running, biking, weight training, and have not been able to do any of those for 9 weeks. The only thing I do, which feels great is going for 2 one hour walks each day. Any advice is greatly appreciated. Thank you so much.

    • Lori Duncan DPT, MTC, CPT on February 20, 2017 at 2:24 PM

      Hi Ron,

      How cool that your daughter is a PT too! Great profession. Few things. Please stop stretching as much you are craving to do it. I think it may be continuing to keep your symptoms “fresh”. If these exercises are bothering you, I have a feeling form may be the issue. Meaning, for the clams, make sure your feet, hips, shoulders are against the wall and even. Then, make sure those knees are bent to 90. Just move the leg on the body and control any rotation at the trunk/pelvis. When done correctly, they should not bother the piriformis that much and you should feel a burn in your “side glute” or glute med/min. This should feel like a new area to you. Fire hydrants: make sure you are doing a triplanar motion (extension/abd/ER) and not keeping the leg too low below the pelvis. The glute needs that endrange muscle feed. Your daughter is correct in noting to not work through too much discomfort, but there may be some with this diagnosis. However, they should not worsen symptoms. So, that said, try to concentrate on the form and see if that helps. Let me know!

      • Ron on February 20, 2017 at 4:32 PM

        Thank you so much for your quick response. You are awesome. I will pay strict attention to my form and follow your advice. I will let you know how I make out over time. I hope I can find relief soon. Thanks again

  13. Ron on February 21, 2017 at 7:10 AM

    Hi Lori,

    I did feel better doing it with the form you suggested. I have one final question, as I know this is your profession and and I don’t want to take advantage of your generosity. I have read that I should sleep with a pillow between my knees and knees bent at 90 degrees. Waking up and getting out of bed is the worst part of the day as I feel my muscles spasm and irritate the nerve. Is there anything I can do to prevent that nerve irritation during the night? I feel like this delays my healing. Thank you so much.

    • Lori Duncan DPT, MTC, CPT on February 21, 2017 at 12:47 PM

      Hi again,

      Ice over the area can be really helpful. The pillow may help too, try it. But, you may be most comfortable on your back with pillow gently under knees to relax the area. Sidelying can feel a little “invasive” at the hip when the symptoms are so acute. Happy to answer your questions. And, glad the form fix was helpful.

  14. Ron on February 21, 2017 at 1:01 PM

    Thanks so much. I have tried both the pillow under the knees as well as between them and laying on my non-affected side. I feel fine then but some time during the middle of the night it all seizes up. I guess from lack of movement. I will try icing it and see if that helps. Thank you.

  15. Ron on February 23, 2017 at 7:47 AM

    Hi, I am curious if any readers can comment on how long it took to recover from this injury once following the above protocol. I realize every person and injury is unique, but is there a rough estimate of 3-4 months, 6-8 months, etc? Also, since doing these exercises, my gluteus medius seems to go into a painful spasm from time to time. Usually 5 or 6 hours after completing the exercises and it lasts anywhere from 10-15 minutes, until can walk it off. Has anyone else experienced that and is it because the muscle just is not used to the workload, and are there any suggestions on how to prevent it? I am amazed at how weak these muscles are on me.
    Thank you.

  16. Ron on February 28, 2017 at 7:36 AM

    Hi Lori,

    I just want to share my story. After my 7th day of doing the glute exercises and NOT stretching, I am feeling so much better. My past 2 mornings I have gotten out of bed and did not have my typical spasms. I hope anyone that comes across this site, will find relief as I did. It is amazing to me that I had read thousands of articles online and only your site, and the guidance from my daughter emphasized doing these glute exercises, and you were the only one that said “please stop stretching”. I am not yet 100% but I am no longer in pain, and am seeing improvement every single day. I am curious with all the professional in the healthcare field, why this is not mentioned as a standard protocol for piriformis syndrome in any other article on the internet that I came across.

    Thanks so much for your guidance. I am not not ready to pick up my training where I left off, but there are significant signs I am on the road to recovery.

    One thing I did recently that I hope may benefit others is when I started to feel the onset of a spasm or nerve irritation, laying on my back or standing, I would put the bottom of my left foot(bad side) against the inside of my right knee. I think this put the piriformis in a relaxed position because all the pain would disappear. I also found sleeping on my bad side, slightly angled toward my stomach, with a pillow between my knees, hugging another pillow at my chest and a pillow under my head, was very comfortable.

    Thanks again for your help,
    Ron

    • Dottie Trail on February 28, 2017 at 9:17 AM

      What helped me (along with not stretching and doing the glute exercises) was acupuncture. After 3 months of unrelenting piriformis pain, I went for 1 acupuncture treatment and have been pain free since.

      • Ron on February 28, 2017 at 12:10 PM

        I have also heard that a lot of people were helped by acupuncture. I don’t know anything about it and probably incorrectly assumed it desensitized the nerves, which I feared could mask the underlying source of the problem.

        • Dottie on February 28, 2017 at 1:14 PM

          Hum, good point.. I just went ahead with it and it worked, but would probably be a good thing to research.

      • Lori Duncan DPT, MTC, CPT on March 1, 2017 at 3:13 PM

        Yes, good acupuncture can be very helpful with pain. Glad you’re feeling better Dottie!

      • Ron on March 10, 2017 at 8:28 AM

        I have been feeling really great since following Lori’s prescribed exercises and avoiding stretching, but I still get morning pain in my buttocks and hamstrings for about 15-20 minutes until I do my glute exercises along with McKenzie . After that I am fine as long as I don’t sit for more than 20-30 minutes. Going to add acupucture into the routine today per your success. I feel I am 80% healed and hope this will help get me to 100% as you are. Thanks

    • Lori Duncan DPT, MTC, CPT on March 1, 2017 at 3:12 PM

      Ron, I am so happy you are getting some relief. To be honest, I’m not sure why this isn’t standard thinking, but it’s not. I am a very “out of the box” therapist/thinker and even when I learned this in school 12+ years ago, it just didn’t make sense. We learned to stretch the piriformis and press on it to release it. And, I just kept thinking: “Why are we pressing a nerve?” So, I’m happy this article is bringing relief to a very treatable condition. Keep up the glute work!! Lori

      • Ron on March 2, 2017 at 6:04 AM

        Thanks so much Lori. Sometimes I over-analyze things, but I often wondered why if for example when I had a hamstring injury or strained calf muscle, I was told, “don’t stretch an injured muscle. Wait until it’s healed, then incorporate stretching for future prevention”. Yet with the piriformis they say to stretch it. It doesn’t make sense to me.

        I have also found doing Mckenzie exercises along with your glute exercises to be extremely helpful. I don’t know much about it and was under the assumption McKenzie was only for herniated disc sciatica, and not piriformis syndrome, but I wonder if a herniated disc can also trigger piriformis syndrome.

        Ron

        • Lori Duncan DPT, MTC, CPT on March 2, 2017 at 6:30 AM

          Hi Ron,

          I’m not a McKenzie therapist, but yes it is used for spine issues. At the top of the blog it does state to have a professional clear your spine to ensure it is not the source of the pain. Google can’t help with that :). Have you had an image of your spine? Sciatica (pain down the leg from pressure on the sciatic nerve) can be caused at the root source (the spine) or at the piriformis (muscle issue). Hope that helps with any clarification.

          • Ron on March 2, 2017 at 10:48 AM

            Hi Lori,

            Thanks. I did have xrays done, and they said my spine looked pretty normal and healthy but they did say a herniated disc wouldn’t show up in an xray and only an MRI would show that. Based on evaluations they felt it was the piriformis. Given that your glute exercises have me almost back to 100%, leads me to believe it was piriformis syndrome, yet given that doing them along with Mckenzie makes me feel even better, made me wonder if i could have had both.

            Ron



        • Nick on November 22, 2017 at 6:13 PM

          Hi @Ron, I have just been reading through people’s stories and sounds like yours is very similar to mine. I have been told recently by a physio friend of mine that “true” piriformas is quite uncommon and that piriformas is usually a secondary issue primarily caused by a lower back issue (bulging disc) usually from like deadlifting or something. I had great back relief in the back from Mckenzie / Cobra stretch exercises. Still working out the piriformas part of it – about to do these exercises.

          Lori does this sound right to you?

          Cheers
          Nick

          • Lori Duncan DPT, MTC, CPT on November 26, 2017 at 7:21 PM

            Hi again Nick,

            I would disagree a bit. Piriformis syndrome is a secondary issue (true) but usually from weak glutes and they compensate to help. True sciatica (disc/stenosis on nerve at spine) can cause pain into the piriformis, but that does not mean to piriformis is compressing on the nerve. McKenzie therapists usually believe that extension (Cobra) will fix most spine issues. Not usually true, but glad it has helped in your case. Sciatica (pain from compression of a nerve root(s) at the spine) and Piriformis Sydnrome (pain from compression of the sciatic nerve that runs under the piriformis) are two different things. Hope that helps.



  17. Cathal on February 28, 2017 at 6:43 PM

    I am so Thankful to you for posting these exercise tips. I suffered from severe sciatic pain for 4 months and was on strong pain killers and in bad pain. All the other exercises I have tried only made things worse. These have worked brilliantly within a week of doing them several times a day I was off the pain killers. Now after one month I am 95 percent better. I am back driving and excercising and able to sit down again. My back feels better than it has done in years and i am confident of a full recovery in the next few weeks.

    What more can I say.
    Thanks so much.

    • Lori Duncan DPT, MTC, CPT on March 1, 2017 at 3:14 PM

      Wow! 1 week. That’s awesome. Glad you’re feeling better and finding your glutes was the answer!

  18. Sapna agarwal on March 9, 2017 at 8:59 AM

    Hi lori. I am an amateur long distance runner. I have PS sonce six months with one and off relief. I loft heavy weights and do stretching regularly after work out. I started running after a gap of four montha wen i found considerable improvement in my ps.within two months of running i feel same numbness in my left butt but this tym without the radiating pain down the legm should i continue doing my weights if the pain doesnt interfere and what my running regime. I was training for TCS 10k schedued for 21 st may. Do let me know.thanks in advance wl start doing the two glutw exercises from today. God bless you for being so reachable.

    • Lori Duncan DPT, MTC, CPT on March 10, 2017 at 8:59 PM

      Hi Sapna,

      If lifting does not cause you pain, you are likely ok. However, maybe stop that stretching to the glute/piriformis area. That usually is a trigger for the symptoms to reappear. Yes, do the exercises and ensure you are feeling those glutes propel you through space…not your hamstrings or back! Thanks for reading.

  19. sapna agarwal on March 10, 2017 at 9:11 PM

    A big hug to you . I really appreciate ur generosity. I mean you r really god sent. God bless u. Once i feel better i wl get bak yo you and one more thing i m surprised at ..none of the physios here in india asked me to not stretch the glute/ piriformis. The first thing they do is stretch it or put a ball around to release trigger point. Ur blog was an eye opener of sorts. Thanks and warmth to you

  20. sapna agarwal on March 14, 2017 at 11:29 PM

    Hi lori, sapna here from india.i m in a fix right now and only u can bail me out. I have PS since a long time with on and off relief. How do i get a permanent fix. I m a runner and do lift weights in gym. After i finish my running work out i feel pain in my butt the whole day more so wen i sit . I have started doing the two glute exercises recommended by you. I wnt to know wat all i should avoid during this tym. Shall i run and do weights or not. Yesterday i enrolled for private pilates classes on reformer. I wnt to get back to pain free running and working out It makes me sad and it is depressed to not run or work out as i m very passionate about both. Help and advice from u will be highly appreciated. If i do the glute exercises regularly how much tym u can suggest as recovery from this injury. Thanks in advance

    • Lori Duncan DPT, MTC, CPT on March 15, 2017 at 1:33 PM

      Hi Sapna. Yes, sitting is usually a main aggravator. Avoid stretching, rolling on the ball or foam roller over that area. Happy to hear about the Pilates addition. It’s magic to the body. You may need to take a few weeks off of running to help your body learn where the good glutes are before you return. It can take a few weeks to a few months for people to feel relief. It just depends on how quickly you start to move/run from the the right muscles. Hope that helps! Stay positive.

      • sapna on May 14, 2017 at 7:24 AM

        Hi lori, getting back to you again. I m a runner and lift heavy weights at gym. I have been suffering from piriformis on and off for a while now with intermittent relief. Have been following ur two glute exercises regularly. I have a peculiar case of pain or tingling in my left butt wch sets in immediately after i finish my run. I have not started doing speed work out after my hiatus from running ..just about ok pace running.the dull pain or tingling is there the whole day after run and usually it goes off the next day. I do pilates private session on days i run and alternate days i do strength work out at gym..interestingly i have not observed any pain on days when i lift heavy.
        I do box jumps, heavy squats, burpees and the like. To rule out i went for an MRI today fr the left hip. The impression suggested
        Mild bilateral degenerative sacroiliitis. There are no other abnormalities. What do u derive from this. The pain in my butt/hip is a referred pain to the sacrum degeneration or is it something else..i m a confused lot right now.
        My heart is into lifting and running.but this stops me otherwise. I am a homemaker and mother of two kids aged 10 and 7.please help lori as genuine advice is few and far between from health care providers in this part of the world . Sad to say this but i have suffered from lack of poor diagnosis from PTs. In this situation i feel helpless losing considerable tym away from proper rehab and focussed training.
        Ur advice is solicited
        Regards
        Sapna

        • Lori Duncan DPT, MTC, CPT on May 15, 2017 at 6:37 PM

          Hi again Sapna,

          Gosh, it is so hard to be a PT from “afar” without watching your movement, compensations, etc. But usually the word “mild” doesn’t mean much. Here’s a suggestion. Try 2 weeks of weight lifting and Pilates (no running, jumping, burpees, or anything that bothers you) and see if you can find the good glutes and chill out your likely PS syndrome. AFter the two weeks, email me at [email protected].

  21. Ron on March 16, 2017 at 3:40 PM

    Hi Lori,

    I would be curious on your opinion on this. I went to an acupuncturist this week hoping to get over the last hurdle of eliminating my few minutes of morning sciatic-like pain. After evaluating me he said all my problem was is that my gluteus minimus, glutues medius and piriformis were all contracted when they should be relaxed. He hooked up some device, (I was on my stoamch so I couldn’t see, but I suspect some kind of powerful TENS device), and he said the muscle needed to be electrically reset to get it “uncontracted”. He left it on for 30 minutes and it was quite intense as I could feel it really deep into the muscle and they were shaking and quivering. I had my doubts that this would work but lo and behold, it seemed to do the trick. I know this is not acupuncture. Two questions I am curious about is:
    1. How does this work. If the muscles are already contracted, this is making them contract even more it seems.
    2. If my gluteus minimus and glutes medius were also in the same predicament as my piriformis, could they potentially contribute to “psuedo sciatica”. I know the piriformis is the one next to the sciatic nerve, but could these other muscles also play a role.

    Is it ok to continue doing the glute exercises? I am feeling so good now and think I am just about back to 100%, but if he said my glutes were part of the problem should I avoid training them. It seemed like doing these exercises was doing me a world of good.

    Thank you
    Ron

    • Lori Duncan DPT, MTC, CPT on March 19, 2017 at 1:41 PM

      Hi Ron,

      You’re right. That’s not acupuncture, but that’s fine. Estim is used a lot of ways. It sounds like he may have used it to activate muscles to fatigue so they would relax? My best guess not knowing the parameters. Yes, there are trigger pts in the glute med/min that can cause pain down the leg, but they still need to be activated. Just activated correctly. So, yes, keep doing the exercise to bring in blood flow, healthy neuro connection of how these muscles actually behave. Glad you’re feeling better!!!

      • Ron on March 19, 2017 at 5:42 PM

        Thank you so much for that explanation Lori. It makes a lot of sense.

        Ron

  22. sapna on March 18, 2017 at 7:48 AM

    Hi lori , sapna here from india. I would like to tell u that i have deligently started doing the two glute exercises wch u suggest and i m happy to share that within a week’s tym i feel considerable relief from the nagging butt pain. I m not running for a while.just doing pilates and some strength work out. However there is another thing needs ur address now. On the same side of the butt pain i feel a strange stiffness a little above the butt and a little lower of the lower back, as if smthing is holding me up there .some kind of stiffness , i dont really know how to describe, a pull or tightness. However it doesnt come in way of bending forward or backward. What possibly it could be. Pls throw some light to ease out my stress!!

    • Lori Duncan DPT, MTC, CPT on March 19, 2017 at 1:43 PM

      Hi Sapna. Sounds like some myofascial tightness. Consider getting a massage to help with that myofascial tightness. Glad you are feeling better!!

  23. sapna on March 19, 2017 at 9:15 PM

    Thanks lori!!! Will try and do the needful!

  24. Ron on March 29, 2017 at 9:28 AM

    Hi Lori,

    Once we feel 100% healed from PS, do you recommend light stretching for the muscles,(glutes and piriformis) or should those never be stretched even after being healthy? Also, I know you have an excellent article on foam rolling, and I am curious if light brief foam rolling on the calves, hamstring and glutes is helpful or should be avoided entirely.

    Thanks,
    Ron

    • Lori Duncan DPT, MTC, CPT on March 30, 2017 at 6:32 AM

      Hi Ron,

      Once you feel “healed” it is ok to stretch them just like any other muscle we use. I’m not a huge fan of the famous “figure 4” stretch for the piriformis as I don’t think it is the best stretch for the hip/glutes. But, play around with what feels good. Light foam rolling is ok if you avoid bony areas and rolling over nerves (ie. sciatic nerve). Hope that helps!

  25. Ron on March 30, 2017 at 9:03 AM

    Thanks so much Lori. I will do that. It feels great to feel great again 🙂

  26. Anna on April 4, 2017 at 7:48 PM

    So thankful I came across your article! I’ve been suffering from PS since December and really had a debilitating flare up mid February. I did one month of physical therapy that unfortunately consisted of lots of painful stretching that I now know was probably setting me back since I didn’t find relief. I recently started seeing a chiropractor who basically digs her elbows into my glute/piriformis muscle and low back to breakup scar tissue. I’ve done four sessions and had some temporary relief but as of right now I’m still in pain. Do you think there would be any benefit in continuing the elbow massage? She also recommends I periodically arch my low back by either lying facedown and pushing up with my arms or standing and placing my hands on my low back as I arch. Do you think that is beneficial? The chiropractor thinks a disc issue could be aggravating my piriformis muscle since she told me I have a tight low back. I plan to start your two glute exercises in the morning and will incorporate core work thru plank exercise as well. Hopefully these will help heal this. But didn’t want to have anymore set backs so I wanted your thoughts regarding the chiropractor work since you appear to be very knowledgeable regarding this condition! I’ve never had any issues until this PS occurred and it has been the most challenging thing I’ve faced to try and recover from! So thank you again for taking the time to write these articles, I really hope this is the right direction to get my life back on track.

    • Lori Duncan DPT, MTC, CPT on April 4, 2017 at 9:46 PM

      Hi Anna,

      Sorry you’re having pain and glad you reached out. Yes, please stop all of the elbow digging. It is very dangerous and does not do what is intended. The arch low back is a physical therapy McKenzie technique for disc involvement. Disc herniations do not cause piriformis syndrome and vice versa. They are distinct. Either your sciatic nerve is “ticked off” because something is happening at the spine (ie. herniation, stenosis) or it is “ticked off” because the piriformis is compressing it. They are treated differently, so if you think you have spine involvement I would head to your local orthopedic spine doc and get an MRI.

      • Anna on April 5, 2017 at 6:26 AM

        Thank you! I will cancel my next appointment and look into an MRI to be certain!

        • Ron on April 11, 2017 at 6:45 AM

          Hi Anna,

          Everyone is different and sometimes there’s a little trial and error involved but I had a very similar situation to yours. I started in mid-December with it and suffered for 2-3 months, with some debilitating flare ups in February as well. The 2 things that worked best for me were Lori’s recommended glute exercises along with McKenzie exercises. I also stopped stretching and foam rolling the piriformis. Although a herniated disc does not cause PS as Lori said, I believe in my case and in many others, they can occur simultaneously and be caused by the same thing.

          I also know a lot of people have gotten great relief with including acupuncture in their treatment.

          Good luck and hope you feel better soon

          • Anna on April 11, 2017 at 8:48 AM

            Thank you for sharing your experience, Ron. This past week has been life changing since I started Lori’s glute exercises and I also purchased her exercise series on Vimeo and am feeling better than I have in four months!!! So much misinformation out there for treating this condition , at least in my case. Strengthening my glutes has given me the best results! So thankful I found Lori’s blog or I’d probably still be suffering. I decided if after one week I wasn’t feeling better, I’d look into the MRI. As of right now, I don’t believe that’ll be necessary. Thank you, Lori!!



          • Lori Duncan DPT, MTC, CPT on April 16, 2017 at 7:20 AM

            Anna, that is great to hear!! Yes, a lot of poor information and understanding about this condition. So happy you are getting relief and finding the good glutes! Enjoy those videos 🙂



  27. Leonette on April 21, 2017 at 12:36 PM

    Hi I’ve been dealing with PS since Feb 1 2017, I’m hoping these two old school exercise work! Glad to hear about not streching
    ,it always hurt afterwards,didn’t understand that!!! So thanks I’ll let you all know how it goes ! Thanks for your knowledge Lori!

  28. Angela on April 29, 2017 at 9:55 PM

    Hi- I have been in excruciating pain for the last month from PS. I am so grateful I came across your blog. I just tried these two exercises and I can feel my left piriformis painfully activating when I do the fire hydrant with my right leg. What am I doing wrong? Also, do you know any good PTs in or around Littleton CO that you could recommend. Thanks!

    • Lori Duncan DPT, MTC, CPT on April 30, 2017 at 11:46 AM

      Hi Angela,

      Sorry so much pain! Please don’t do any exercise that brings on the pain. You’re not doing anything wrong, it’s just not the right exercise for you. It’s why I say they are the top 2 glutes, but certainly not the only ones. I adjust movement all the time for my patients so it gives them a positive feed to their body. I don’t know of anyone in Littleton. My apologies. I am in Lafayette,CO if you wanted to come in for an evaluation to see what the deal is and give you some education.

  29. Jose on May 9, 2017 at 9:51 AM

    Hi Dr.,

    I wanted to first thank you for helping alleviate the pain i was suffering from PS 8 months ago. I’ve been pain free for about 5 months and unfortunately it’s back. Are the symptoms between PS and a disk herniation different? Not sure if it was worth my time to schedule a MRI with my healthcare provider.

    I really appreciate the time and am a big fan/supporter.

    Thanks!

    • Lori Duncan DPT, MTC, CPT on May 10, 2017 at 2:19 PM

      Hi Jose,

      Thanks for reading. Glad you had some relief, but not great that it’s back. The symptoms are different. Some can be similar, but they do behave very differently. However, before you spend all of that money on an MRI, we now know from research that most disc herniations will heal with time and good physical therapy. If you want to get a picture to have some peace of mind, then you can look into it. Do you have a PT in your area that you could schedule with?

      • Jose on May 18, 2017 at 8:35 AM

        I do have a PT in the area that I’m working with. Thanks for the reply!

        Also, should I abstain from any physical demanding exercises such as basketball/flag football? Or should I try and play these sports on a minutes restriction?

        Really starting to take a toll on my personal life especially with two little kids that can play all day. Hoping to get better as quickly as possible. How long does piriformis tend to last before it goes away? The last time I had it it seemed like it was around for several months and all of a sudden I don’t remember having pain anymore.

        Thanks!

        • Lori Duncan DPT, MTC, CPT on May 20, 2017 at 8:11 AM

          Hi Jose,

          How long does it last? It just depends. In general, people who are really focused on training the good glute muscles and stopping activity that continually causes pain, feel much relief within 3-4 weeks. But, it just depends. It’s always sound thinking to cease the activity that causes you pain while you’re trying to heal the area. If it doesn’t cause pain, you should be fine.

          • Jose on May 22, 2017 at 8:04 AM

            Hey Lori,

            Thanks for the reply! Sorry for the barrage of questions but I had an x-ray done recently and my doctor is thinking that I may have spinal stenosis of the lumbar. I have a MRI scheduled in two weeks to confirm but he’s pretty confident it will confirm his initial diagnosis.

            Do you have any articles in regards to spinal stenosis? If not, is treatment basically time and strengthening of the core and corresponding muscles?

            Again, I do want to thank you so much for the time. Your knowledge has been a life saver for me and my family.

            Thanks!



          • Lori Duncan DPT, MTC, CPT on May 24, 2017 at 1:42 PM

            Hi again,

            I have not written article yet, but I will! The treatment is different. Spinal stenosis is narrowing of the spinal canal and requires a lot of deep intrinsic abdominal work, multifidus, glutes and scapular stability. Get going with Pilates! And, make sure your PT is moving that spine in all planes…even extension if it doesn’t hurt. It’s an old thought out there that we not should back bend if we have stenosis, but that’s not true. I mean, don’t try a back walkover or anything, but motion in the spine is important to keep the joints healthy. I’m glad you have found all of this helpful…make me happy. Wish I had more time to write all the stuff in my head :).



  30. Cody on May 9, 2017 at 9:40 PM

    Lori
    Love the info on you PS. I have been experiencing buttocks pain and sciatica for the past 4 months. I have radicular symptoms into the post/lat thigh lat calf and bottom of foot. Periodically get a tourniquet type of pain in the big toe. Dermatome distribution of L5/S1. So I got a MRI to see if a disc bulge/pinch nerve was present. Of course, it showed a mild central disc bulge. About 90% of America has those type of findings. But, ESI injections given (X2). No relief.
    The interesting thing is, I only have pain when I’m stationary. If I stand still for longer than 10-15 min or if I sit or lay down, my symptoms are worse. If I’m moving, my symptoms improve. I’ve even noticed that if I exercise briefly or ride my bike, my symptoms improve. I have been concerned that it’s my piriformis and I’ve had some brief PT for it (Message and stretching) and it helps for about 4-5 min but then returns.
    I just ran across your web article/blog on this and did one set of your exercises and it felt pretty good. But once again, return of symptoms after 10-15 min. I still think it’s the Piriformis and I like the theory of the piriformis hypertrophying and the gluets atrophying so, I’m going to keep doing the exercises to see what happens. Also stop stretching exercises.
    My question is, if you have an explanation for the symptoms improving when I’m moving around?
    I will keep you posted on the results of doing your exercise.
    Thanks for the article/Blog and response.
    Cody

    • Lori Duncan DPT, MTC, CPT on May 10, 2017 at 2:23 PM

      Hi Cody,

      To your question: Why are you having improved symptoms moving around? Could be a a lot of reasons. Our bodies were designed to move, so movement usually does feel better. Static positions are challenging on our system and if something is dysfunctional (ie. your glutes) the piriformis may be acting as a stabilizer in static positions…and it is not a stabilizer. Just a guess without seeing your movement and knowing history, but try the exercises and see how it goes! Thanks for reading.

      • Cody on May 10, 2017 at 2:26 PM

        Thanks for responding.
        I’ll keep you posted.
        Cody

  31. steve on May 15, 2017 at 2:22 PM

    Hi Lori, this is good stuff. It’s new to me to not tennis-ball the piriformis. How about icing in addition to these two exercises to get it to calm down?

    • Lori Duncan DPT, MTC, CPT on May 15, 2017 at 6:38 PM

      Hi Steve,

      Sure, ice is always great! No harm in ice. Thanks for reading and I hope you get relief soon.

      • Steve on May 22, 2017 at 4:55 PM

        Thanks! What kind of aerobic activities can I do instead of running while this heals? Also, what about acupuncture, will that help speed the process along?

        • Lori Duncan DPT, MTC, CPT on May 24, 2017 at 1:44 PM

          Hi Steve,

          Cycling, hiking, swimming, rowing? Any of those sound fun to you? Cycling is usually the best because you can really sweat like running. Acupuncture will not heal the nerve per se, but it can be very helpful in breaking up the pain pathway for the area. Give a shot…it won’t make anything worse. Just don’t let them put a needle on the sciatic nerve!

  32. Arjen on June 1, 2017 at 3:35 PM

    Hi there. I’m from Holland and i found your site googling piriformis syndrom. I’m feeling pain in my left glute, leg, feet for some years now and its a real annoying pain. Something like having a heavy leg. I think i got the pain because of always training quads, not hamstrings/glutes. Also from sitting all day at the office. Feeling benefits already after doing the exercise for 3 days now. So Thanks! Got a question tho. I can only get like 10 clams on each side. Then switch to fire hydrants and get like 5-8 per side. My glutes just cant handle more reps yet. Is this weird? It looks like its also a signal that my glutes are very weak. What do u think?

    • Lori Duncan DPT, MTC, CPT on June 4, 2017 at 2:14 PM

      Hi Arjen,

      Great to hear from you from Holland! Not weird at all. You should be doing quality work, not quantity. If your glutes are weak, 5-8x may be plenty at this point. Work your way up slowly to build the strength/endurance needed for those muscles. Glad you are getting some relief. Continue to monitor your symptoms for any spinal contribution since you’re getting pain into your feet. Thanks for reading!

      • Arjen on June 25, 2017 at 3:15 AM

        Thanks for your answer! I can do more reps already! Do u have to do clams first, fire hydrants next? Or is it also nice to switch up things? And do u recommend to do these exercises multiple times per day?

        • Lori Duncan DPT, MTC, CPT on July 8, 2017 at 7:13 AM

          Hi Arjen,

          You can do them in any order, but usually the clams “kick on” the glutes fastest without recruiting the piriformis. You can do them 2-3x/day as long as you are not fatiguing the glutes and making the piriformis want to pick up “the slack.” Glad you are already at more reps!

  33. Kathryn on July 16, 2017 at 6:27 PM

    I found this blog post a bit ago, as I appear to have Piriformis syndrome, among other issues (all related to tennis). When I do my PT exercises, things are under control.
    .
    My husband started having what appear to be IT Band issues. He has been faithfully doing clams, and he pain has been reduced significantly.

    • Lori Duncan DPT, MTC, CPT on July 18, 2017 at 7:58 PM

      Hi Kathryn,

      Yes, glute exercises can feel like magic in the body when they are needed. Thanks for reading!

  34. Karen on July 26, 2017 at 9:40 AM

    Hi, I just found your site. I ve had an instable pelvis and sijd for 4 years. It seems that is slowly getting better. I found an osteopath who has been adjusting the pelvis. To keep it stable i ve been doing some pilates and gentle yoga along with clam and sidelying leg raises. The piriformis is tight on both sides, mostly the right so i have pain in the adductors and groin. I will try not stretching the piriformis like you suggest. I was also told the oburator internus on the right is tight, then I read not to do clams because it makes aggravates the oburator int. Now. I m confused as what to do. Do you do phone consulations? Can you give me any advice. I will purchase your video. Thanks so much.

  35. Dan on October 13, 2017 at 9:10 PM

    Hey Lori!

    I’ve had debilitating priformis tightness on my right side for 3 months now. I’ve spent hours foam rolling, lacrosse rolling, numerous deep stretches, lying leg raises, single leg glute bridges and theraputic massage… All with temporary minimal improvement. NOTHING WORKED!

    I’ve totally stopped training squats and deadlifts because they would only aggrivate the pain.

    The clam and fire hydrant are EXACTLY what fixed my problem. I can literally feel the glute med & max waking up and functioning again, supporting the entire hip. My TFL is relaxed..

    For someone who does heavy compound lifts, I never would’ve thought my glutes would be inactive.

    You are worth your weight in gold Lori! Thank you so much for this great advice!

    • Lori Duncan DPT, MTC, CPT on October 16, 2017 at 8:42 PM

      Hi Dan,

      Woohoo!!! That’s an awesome story. So very happy these worked for you! Thanks for sharing.

  36. Doug on November 6, 2017 at 4:38 PM

    I’m 51 yrs old and am pretty sure I have PS from kicking soccer balls at my sons practice. It’s been about 2 months and my orthopedic prescribed Meloxicam which I’ve been on for about 2 weeks but it doesn’t seem to do anything. Tried the strectches but like you’ve said it seems to just aggravate everything more. I do find some relief from a muscle relaxer but would you recommend continue taking while doing your recommended excercises? I just did 2 sets of each of the excercises and thought it might aggravate my pirifurous muscle but they didn’t so I will continue and see how it goes.

    • Lori Duncan DPT, MTC, CPT on November 8, 2017 at 6:55 AM

      Hi Doug,

      I can’t really speak to taking meds except to say if you feel relief while trying to strengthen, go for it! I’m glad the exercises didn’t flare your symptoms.

  37. Einat on November 13, 2017 at 7:55 PM

    Hi Lori,

    Your site is refreshing and I started doing the two recommended exercises since yesterday. I was told by an orthodontist that I have a piriformis strain that aggravates the nerve hence real bad leg pain. It’s been going on for the past 3 months (got better with yoga every day) but had some stress in last two weeks and it got much worst, I could hardly walk with major pain. I took some prescribed anti inflammatory for a week and worked on massaging the area and stretching from PT that I was given as well as trying to rest. Applying heat on my lower back and left buttocks seem to help too. It did improve and I’m able to stand for longer now and the pain has subsided some (limping much less) but not nearly back to even 50%. Still having sever pain in the morning, it takes me an hour to get going after stretching which now I know you do not recommend. I do want to try your approach and have two questions: I love yoga and you said it’s ok but no pigeon pose however many other yoga poses such as cross leg one in front of the other stretch the hips and I’m assuming piriformis so should I skip these too? Or just not go deep into it? Second question – massaging and heat to the glutes seem to relieve some of the pain is that ok to continue? Thanks so much for the wonderful support and information. It’s amazing to find this kind of help online.

    • Lori Duncan DPT, MTC, CPT on November 15, 2017 at 7:49 AM

      Hi,

      Criss-cross legs an leaning over stretches the glute area, but keeps the pelvis level. That is key. Try that one instead of pigeon. Stop stretching so much and try to activate your glutes. The sensation is to stretch, I know, but that area needs glute stability/activation. You can massage/heat as long as you’re not disturbing the sciatic nerve. Hope you feel better soon!

  38. Einat on November 15, 2017 at 7:24 PM

    Thanks so much Lori, I have been solely doing your two recommended glute activation training since Saturday and no stretching. I feel less of a need to stretch today… Going to acupuncture tomorrow so hope it will speed my recovery. Thanks so much for your words of wisdom, hope to update soon with great news.

    • Einat on January 12, 2018 at 4:45 AM

      Hi Lori, thanks so much for all you advice. It’s been two month since I started the two glute exercises with lots of improvement. I have been doing some acupuncture, heat and local message. No straching besides light yoga. The leg pain is dramatically less, still have some especially in the morning until my body warms up. I still feel really tight (in the morning mostly) and have some ways to go. I would love your advice as far as what other glute exercises I can do to make it to full recovery.
      I think that my issue was an injury over the summer (leaned over a washing machine to pull something from other side and felt a sharp pain the left buttocks). Maybe it caused a minor tear in the piriformis or connective tissue as at that time I had sharp knife like pain but no leg pain. After a couple of months the sharp pain subsided but the leg pain started (after my back went off and got really stiff) and was bad to a point I could hardly walk. I wonder if it was scar tissue building up and hypoteophy of the piriformis due to the injury. Now that I’m strengthening the glutes I hope it makes life easy for the piriformis so it can recover. That’s my theory…. what do you think? What else can I do?

      • Lori Duncan DPT, MTC, CPT on January 15, 2018 at 7:26 AM

        Hi,

        Yep, that’s the theory. The more the glutes work, the less the piriformis thinks it has to. The best way to continue to progress is try adding the glute to weight bearing. Squats, Lunges (remember the back glute drives the lunge), lateral lunges, etc. Just make sure that glute is firing!!

  39. Nick on November 22, 2017 at 5:53 PM

    Hi Lori, I have had issues with sciatica on and off for a few years now, at least 6 months straight recently – it has really been a struggle and especially at the moment. It feels like 1 step forward 2 steps back! Quite depressing to be honest. I love my sport and took me off the tennis court, hindered my workouts, halted my cycling and just overall really frustrating.

    I have scoured the internet trying to find the solution for me. Recently I was told by a physio that the primary problem is a bulging disc in my lower back, which in turn is tightening the Piriformas, he did a sesssion of dry needling on my back and glute which really helped the next couple of days, and the last couple of weeks I have been working on the disc bulge (cobra stretch 3-5 sec holds) which has really fixed up the back. Honestly I thought I was on the home stretch.

    I was continuing a regular stretching routine and tennis ball release, in the last few days I seems to really flare up the glute with tennis ball release which made the sciatica really bad once again.

    Today I have just come across your blog and it seems based on comments that you have the solution! I have been doing the fire hydrant exercise a while now and resistance band (light) clams infrequently – however by the sounds of thing all the stretching and ball release has been holding my recovery back. I also think my technique for the exercises was not quite right based on your instructions above.

    From now I will work on just doing your exercises (do you recommend resistance band for clams?) – no stretching, no ball release and fingers crossed I will have some good news to tell you. Will keep you posted, thank you for sharing your insights!

    • Lori Duncan DPT, MTC, CPT on November 26, 2017 at 7:16 PM

      Hi Nick! Thanks for sharing. You can use the resistance band as long as it is the glute pulling the leg up, not the back. Hope you feel better soon!

  40. Stephanie on January 2, 2018 at 8:37 PM

    Hi! I am so excited to see this! I have been in so much pain that I thought was sciatica since mid September. I have been getting my back adjusted by the chiro, but they have been having trouble getting my sacrum completely adjusted, they keep saying it’s tight. I saw a PT who massaged my right butt and got me started on basic Pilates core strengthening exercises, and I have progressed from being in severe pain all the time to moderate pain as long as I take magnesium and rub magnesium oil on my right nut and leg 3 times a day or more. But I feel like I’m staying at the same level now for weeks. I read about piriformis syndrome tonight and did the tests for it and it does seem to be what I have but I tried the stretches recommended for it and boy was I in worse pain tonight! I’m seeing a physiotherapist in a week so I decided I will try the glute exercises and skip the stretching fand see if I finally can actually be a bit improved by then instead of just learning how to manage the pain better!

    • Lori Duncan DPT, MTC, CPT on January 7, 2018 at 1:58 PM

      Hi Stephanie,

      Yes, skip that stretching! It always makes it worse. Hope you get continued relief with more glute activation.

  41. Harm on January 4, 2018 at 1:10 PM

    Dear Lori,
    The fire hydrant is one of the hardest exercises I’ve ever done. And yes especially on the side where the butt is sore! I barely make it to 10. The clam shells come much easier.
    Thanks for these.
    Regards,
    Harm

    • Lori Duncan DPT, MTC, CPT on January 7, 2018 at 1:58 PM

      Hi Harm,

      Well, if it’s that hard you probably need it! Hopefully it’s getting easier already.

  42. Paul on January 15, 2018 at 1:35 PM

    Hey Lori! I also posted to your piriformis blog but I forgot to say thanks over there, so I’m doing it here! Thank you for having taken the time to answer so many questions and writing these articles. I can confirm here that these exercises work and that not stretching in the beginning is very important!

    Besides the clams and hydrants that you recommend I found a program designed for the piriformis which includes these two exercises to get started but then gives further exercises once you mastered these. It’s called the Powers program named after the professor who put it together and it was a life saver to get me back to action. I thought I leave the link here if anyone else is interested if that’s okay. It took me all in all about 6 month, but I had some other issues going on at the same time and the piriformis was just the outermost layer. Stay strong everyone, there is hope!

    http://www.sportsandortho.com/UserFiles/POWERS%20-%20ALL(1).pdf

    • Lori Duncan DPT, MTC, CPT on January 16, 2018 at 6:40 AM

      Glad you are feeling better. I usually don’t allow links on my blog, but I do respect Christopher Powers, Phd, PT and his philosophy of loading tissue (ie. the glutes in this case) is the same as mine. His program is very similar to those I use in the clinic. For those reading: you must master finding the glutes before you even consider weight bearing (ie. step ups, lateral lunges). Thank you Paul!

  43. Josh on January 17, 2018 at 10:30 PM

    Hi Lori,

    I want to start by thanking you for this blog and spending your valuable time responding to all of us suffering from PS.

    6-7 years ago I had a slipped disk and had dibilitating sciatica in my left leg. I suffered from bad low back pain and sciatica. Eventually, I had to have a discectomy. This solved all of my sciatica issues. Fast forward 6 years and I have very similar dibilitating pain in my sciatic nerve, beginning with serve pain in my piriformis muscle, radiating to the back of my hamstring, skipping my knee and the pain runs through my calf. This pain feels like someone is squeezing my sciatic nerve as tight as possible from inside my leg. This started about 5 weeks ago. I have absolutely no back pain. I have suffered no recent injuries. The minute I sit down, my piriformis radiates with pain and the “squeezing” feeling on my sciatic nerve starts. I have to stand all day at work and I am very limited in what I can do. I have received a steroid injection in my butt (near the affected piriformis), taken a 5 day prescription of oral steroids from my DR, seen a physical therapist for a month, including dry needling of the piriformis, multiple massages, completed daily stretching routines/tennis ball/foam rolling, daily use of an inversion table, and nothing has helped. After sitting for more than 5-10 mins, when I stand up my left leg feels like I have a “dead leg.”

    As someone else mentioned, walking has been my only form of pain relief. However, last weekend I went skiing (I also live in Colorado and had a weekend trip already booked). The drive up to the mountains caused a lot of pain, just from sitting. However, I was pain free from skiing, and after about 4 runs, I was pain free when sitting on the chair lift. I skied all day on Saturday and was absolutely pain free the rest of the evening ( I was even able to sit for an hour at dinner without a pain). I skied on Sunday as well, and was pain free. All of my pain came back after sitting in the car for the 2 hour drive home. The pain is back to being dibilitating in my piriformis and sciatic nerve ( hamstring and calf).

    I just came across this blog today and started with Lori’s glute exercises. I hope to have similar results to others who have experienced a reduction in PS pain.

    Lori- do you recommend any additional exercises or forms of cardio that I can do on a daily basis to alleviate the pain/strengthen muscles around the piriformis. Ideally, I would ski every day as that was complete pain relief, but that’s not realistic. Also, any idea why skiing relieved all of my pain.

    Thanks,
    Josh

    • Lori Duncan DPT, MTC, CPT on January 21, 2018 at 11:48 AM

      Hi Josh,

      You’re probably a quad dominant skier and thus the hip wasn’t loaded as much. You can do any cardio (running usually isn’t great) as long as it doesn’t flare your symptoms. Swimming with a pull buoy, cycling are usually ok choices for this syndrome. Hope you get some relief soon.

  44. Mike Franklin on January 26, 2018 at 5:33 PM

    Lori, like everyone else here, I’ve spent considerable time combing thru PS treatment ideas. Your approach has given me much hope as I’ve been stretching and rolling the past month away with little result. I was a very active and athletic 63 year old, who played basketball daily until knee OA showed up. For that reason my running is awkward on the left side with my not being able to stand a full force normal landing. I believe the PS developed as a result. Several weeks ago, while playing, a sudden and excruciating spasm came on that stopped me in my tracks, unable to take a single step. It eased slowly but it has made sleeping very difficult with a stabbing pain if I move my pelvis or left leg.
    As of 2 nights ago, I’ve abandoned the stretching and rolling and have begun the 2 glute exercises you’ve suggested. I hope to be able to report some good results to you soon.
    Thank you!!
    Mike Franklin

    • Lori Duncan DPT, MTC, CPT on January 29, 2018 at 6:25 AM

      Hi Mike,

      I hope you get some relief soon too! Get your walking normal first before you start to run again. Running with strange biomechanics is very hard on our body. Happy Glute Finding!

      • Mike Franklin on February 1, 2018 at 7:33 PM

        Hi again Lori, I wanted to write just for feedback purposes as I think you’re the type of person who is sincerely interested. You don’t have to respond.
        Here’s an 8 day later update. Daily glute building with the 2 exercises you suggest plus some old fashioned side lying, straight leg lifts with NO stretching or rolling, has measurably decreased the PS pain. The severe pain I was experiencing at night when trying to roll over has diminished also. I’ve stayed away from running even slightly but still shoot bball, ride a stationary bike, walk a treadmill, use a rowing machine and an elliptical every day. What has developed is an occasional strong pain in my knee after my glute exercise that doesn’t feel like the arthritic pain. This feels like it’s not as deep or not in the knee capsule. I want to say it feels like nerve pain and it will disappear within 5 or 10 minutes. Like I said, this is new, developing when I began the glute work. I have been using resistance bands trying to maximize the glute workout.
        Besides that short lived but very bad knee pain, I still feel that deep piriformis ache upon certain movements. I have this instinctive feeling that I want to stretch the piriformis ever so moderately, especially since I had suffered PS about a year ago and the figure 4 stretch eliminated my pain pretty quickly.
        I’m hoping this stubborn muscle will get back to where it should be soon. I’m just getting a tad impatient with it.
        Thanks so much for reading and helping myself and so many others.
        Mike

  45. Tara on March 1, 2018 at 11:23 AM

    Hi, I am so glad to come across this blog and praying that I can find relief and healing so I can get back to running. I am a 53-year-old female who started running a little over 7.5 years ago. I ran about 20+ miles a week and was very dedicated to my routine. I also go to the gym for strength and other cardio exercises. The last few years have been very uncomfortable for me as my PS started on one side and now I have it on both sides. I still run but down to only 2 miles at a very slow pace almost a jog and only a few times a week. I have to stretch 10 min before and almost 20 after to alleviate the pain. The pain radiates down into my leg and almost feels like a toothache. I have no back pain. I have been rolling, stretching, massage, PT, tennis ball, Yoga and all provide some relief but it comes right back. Some days it is minimal and others flared so badly I feel like I mentally say “find your glutes” but they can’t be found! I am going to stop the stretches, tennis ball and foam roller. I would like to continue Yoga but no pigeon pose, continue at the gym with elliptical and ARC is this okay? I feel like I will go crazy if I don’t exercise, it is a huge part of my life and I depend on it. Can I walk on my treadmill a few times a week at say 4.0 mph? From all the research that I have done online this has been the best blog I have read in regard to PS. I will start the recommended exercises today and post back in a few weeks. Do you think if I strengthen my glutes they will start doing what they are supposed to be doing? Also I was able to run without this issue for almost 5 years do you think my glutes stopped working? Thank You so much for reading 🙂

    • Lori Duncan DPT, MTC, CPT on March 3, 2018 at 12:47 PM

      Hi Tara,

      Hard to say if your glutes stopped working or if you were ever running from them. Sometimes things just”catch” up to us. Do the exercises to find the glutes, but then you need to apply it to your yoga practice for carry-over. Feel them in crescent, warrior II, frog, etc. Avoid stretching for now. The one I give for this is sitting in criss-cross, sit bones on ground and lean forward. It ensure the piriformis is not getting pulled in a funny way.

      • Tara on March 7, 2018 at 12:33 PM

        Thank You Lori 🙂

  46. Jan Pat on March 4, 2018 at 8:22 AM

    Good morning Lori,

    Thank you for making sense about the stretches. I am 62, F, and believe I hurt myself sitting on a hard chair for 3 hours playing cards. I am somewhat active: I power walk at the rec center and do easy biking, 9 miles tops on flat bike trails.

    I have had pain for five weeks, and have been doing the basic stretching (one leg over the other both in sitting and lying positions, etc ) and trying the tennis ball, none of which helped at all. I have seen two chiropractors and one massage therapist, helped somewhat. My massage therapist is very careful about not being too intense, which he says is hurtful and not helpful.

    I threw out the tennis ball along with those stretches & have been doing your two exercises for about four days. It’s hard to get down to the floor to do them, but once I’m down there and do the exercises, there is no pain. I making sure that my form is good, and I am now up to twice a day, 12 times on each side, two reps.

    Mornings are slow. I usually alternate between ice packs and heat packs Until the pain subsides. We’re not talking intense pain, but rather maybe a four out of 10.

    I have bought a cushion for my rear end and for my back. Those also are very helpful. We are making our way back home this week after snowbirding, and I am not looking forward to sitting six hours in the car for 3 days in a row. Any tips? Thanks!

    Jan

    • Jan Pat on March 5, 2018 at 11:20 AM

      p.s. perhaps I should be more clear about my pain. Right butt pain – glute med & piriformis (according to my chiropractor & massage) w some S3&S4 involvement. Radiates down the back of my rt leg and to calf muscle. Heel is numb & sometimes feels like pins and needles, but there’s no pain; feels like I have a tight sock on when showering. Doesn’t hurt when I bike, hurts a bit when seated and sometimes walking. Hope that helps

      • Lori Duncan DPT, MTC, CPT on March 6, 2018 at 12:50 PM

        Hi again,

        Have you had an image of your spine? Just checking. Piriformis can radiate to the heel, but the tight sock sensation makes me suggest you ensure your spine is ok.

    • Lori Duncan DPT, MTC, CPT on March 6, 2018 at 12:48 PM

      Hi Jan,

      Glad the glute exercises are going well. You can do them on your bed if the floor is hard to get to. Oh man, driving. It is the worst for this condition. Ice can be helpful.

  47. Elle on March 19, 2018 at 2:59 PM

    Hi Lori,

    I’ve been having some pain in my upper butt area on my right leg for a few weeks now. It’s kind of a dull throb/ache and gets worse with sitting. I avoid sitting when I can but I have a 16 hour flight coming up in 2 weeks and I’m worried I won’t make it. I work out 3x/week and do a mix of exercises: squats, lunges, glute bridges, planks, burpees, jumping jacks, deadlifts, push ups, and dumbbell exercises for my arms. I have no pain during any of the exercises only afterwards (like a few hours after and then it goes on for a few days). I’ve never had any pain like this before and I haven’t done anything different during my routine. I did stretch and foam roll but it only felt better in the moment. Should I stop stretching completely and just do the 2 exercises mentioned in this post? Should I avoid any exercises? I really want to stay active. Thank you!

    • Lori Duncan DPT, MTC, CPT on March 21, 2018 at 5:09 AM

      Hi Elle,

      I would not do the figure 4 stretch for now. Try the 2 exercises before you workout to see if it wakes up the good glutes for you to use during your workout. I would only stop the activity that you know is bothering it. So, maybe it’s just the glute bridges or the squats…it likely isn’t your entire workout routine. Hope your pain goes away soon.

      • Elle on March 26, 2018 at 12:17 PM

        Hi Lori,

        I’ve stopped stretching and rested my legs (stopped lower body exercises) and my pain has improved significantly. If I do lunges the pain returns. When doing the clams, i can sort of feel my glutes contracting nut not as much as when I do it with my left leg. During the fire hydrant I don’t feel it in my glutes at all and my range is small. Does this mean I’m doing it wrong or do I need different exercises to target my glutes better?

        • Lori Duncan DPT, MTC, CPT on March 31, 2018 at 6:52 AM

          Hi Elle,

          You may need to try different glute exercises for your brain to figure it out more. I talk about a few others on the Blog Talk: Piriformis Syndrome.

  48. Kym on April 9, 2018 at 8:49 PM

    Hi Lori
    I’m a competitive cyclist with pain.
    3 years ago I had a subgluteal release as it was determined that my sciatic nerve was tethered to my piriformis. This was done by a trusted surgeon ( I work in anaesthetics), however all the MRIs, scans, tests etc I had in the lead up, did not confirm the diagnosis. The surgeon said he’d need to get in and have a look and I trusted him. He confirmed that it was well and truly tethered and the surgery was a success.
    Fast forward 3 years and I’m no different. I have chronic pain and sitting at a desk job all day only exacerbates it.
    I incorporated a strength and conditioning program into my routine about 6mths ago, however only last week whilst racing, I felt the very top of my hammy and into my groin, strain heavily.
    I’m not sure if I’ve overloaded everything with the S&C program.
    However my main issue is this ‘nerve compression’ issue or whatever it is.
    Noone can diagnose it.
    I am seeing a physio/bike fit expert today to look at my positioning on the bike. When I ride, I have constant pain down into the arch of my foot and this side (my left side) is most definitely a weakness.
    What are my options here?
    This piriformis syndrome, the more I read about it, seems to tick all the boxes for me in terms of the symptoms I have.
    My sleeping is disturbed, I have not been able to sleep on this left side for many years now.
    I am a very diligent ‘stretcher’ I will not finish a training session without accompanying it with some work on the spiky ball, foam roller etc.
    Nothing I’ve done to date has helped.
    Really interested in your thoughts on this.
    Thanks kindly
    Kym

    • Lori Duncan DPT, MTC, CPT on April 16, 2018 at 12:42 PM

      Hi Kym,

      Have you had MRI on your spine? Meaning, it sounds like the source or cause of your pain has not been identified yet. I’m not sold it’s just piriformis from your symptoms and history. Also, please stop that ball and foam rolling stuff in that area. It really is an aggravator. Have you thought of Pilates to bring some stability to your body? It sounds like you may be craving that.

      • Kym on October 25, 2018 at 11:19 PM

        Hi Lori
        I am so sorry for the delayed response!
        Yes I have had many MRIs to look at the lower back etc and they have all come back fine. Also had my hip MRI’d as well.
        I do a heap of core exercises to work on this area of strength, have not done a Pilates class persay but many of the exercises prescribed have been on the reformers! Certainly what I do now incorporates a lot of the Pilates principles.
        Interesting that say to leave the ball and foam rolling alone as I was also advised to do this when I strained my hamstring and adductor! I did follow this advice.
        I have since purchased a ‘sit/stand’ desk for work which at the very least changes my positioning throughout the day.
        However, still at a loss as to what the root cause may be?
        Thanks again for your time.
        Kym

        • Lori Duncan DPT, MTC, CPT on October 28, 2018 at 2:41 PM

          Hi again. Well, without looking at your movement it’s hard to know. But, you have may have atrophy pain from poor glute activation after that surgery. I know you are working on your deep abs (core) but the glutes are the base of it. This is not squats and lunges…this is finding the true activation and proper patterning of the glute/hip complex

          • Kym on November 19, 2018 at 8:51 PM

            Thank you so much for your comments, I’m always interested to hear others points of view. I will look into the activation of the glutes with real specificity. Thanks again for your time



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