Hips and glutes
Piriformis stretch, and the work that comes before it
How the figure 4 and pigeon shapes reach the deep buttock, five ways to control how strong the stretch is, and the hip strengthening the literature puts ahead of it.
Clinically reviewed by Lee Albert, NMT · 8 August 2026
What the shape is doing
The piriformis is a small, flat muscle deep in the buttock, running from the sacrum out to the top of the thigh bone. Its everyday job is rotating the hip outwards and steadying the pelvis when you stand on one leg. Every piriformis stretch, whatever it is called, does the same two things to it: bends the hip and turns the thigh across the body, which puts that muscle and the small rotators next to it on a length.
The complication is what sits alongside. The sciatic nerve passes right there, between or sometimes straight through those muscles, which is why this stretch has two personalities. Done gently, it reaches a genuinely tight area that few other positions touch. Done hard, it compresses and tensions a nerve that was already unhappy, which is why the classic mistake is not doing it wrong, it is doing it strongly. A useful piriformis stretch is felt as a broad deep ache in the buttock. Anything sharp, electrical, or travelling below the knee is a different signal, and the answer to it is to come out rather than to breathe through it.
The same stretch under half a dozen names
Figure 4, reclined figure 4, supine piriformis stretch, reclined pigeon, and the seated version people do at a desk with one ankle on the opposite knee are all the same shape at different depths and in different positions. The names come from different traditions rather than from different anatomy, and picking between them is a question of how much floor you want to be on and how much control you want over the intensity.
One name is worth separating out, because it is genuinely ambiguous. Some sources use thread the needle for the lying-down figure 4. In the Vinys library that name belongs to a different movement entirely: a kneeling rotation for the upper back and shoulders. If you came looking for the buttock stretch, the pages you want are the figure 4 and pigeon ones below.
Gentle, and not first
The best-known published argument about this condition is that the stretch is the second thing, not the first. A case report in the Journal of Orthopaedic and Sports Physical Therapy set out an approach built on strengthening the hip abductors and external rotators and re-training how the hip behaves during ordinary movement, instead of stretching and soft tissue work, and its authors put forward the idea that the muscle may be overstretched rather than overshortened by the way the hip is being used. That is one case, which is weak evidence, and it is the clearest published statement of the position.
The practical version is a running order rather than a ban. Build some strength at the side and back of the hip, so the small rotators are not covering for the large muscles every time you walk. Then use the stretch, gently, for the tightness that remains. The piriformis syndrome guide walks through that order in full.
The sequence
- 1
Figure 4, seated in a chair · 60 to 90 seconds each side
The version that needs no floor and no preparation, and the one to start with when symptoms are active. Ankle across the opposite knee, sit tall, and lean forward only as far as the buttock starts to speak.
- 2
Figure 4, block under the pelvis · 60 to 120 seconds each side
Lying down, with a block lifting the pelvis so the hip is bent less. Less hip bend means less tension along the nerve, which makes this the gentlest floor option in the family.
- 3
Figure 4, hands behind the thigh · 60 to 90 seconds each side
Your hands set the depth and can change it instantly. That matters here more than in most stretches, because it lets you back off the moment a symptom starts to travel instead of unwinding out of a position first.
- 4
Figure 4, with a strap · 2 to 3 minutes each side
A strap round the lower thigh holds the position so the arms can stop working. The deep rotators do not release while the rest of the body is holding on, which is what makes a longer, genuinely relaxed hold worth having.
- 5
Figure 4, foot on the wall · 2 to 3 minutes each side
The bottom foot rests on a wall, so the hip angle is fixed and nothing has to be held at all. Move closer or further from the wall to set the intensity once, then leave it.
- 6
Pigeon, upright · 60 to 90 seconds each side
The kneeling version, with the chest staying up. Folding forward is what adds tension along the nerve and load to the lower back, so upright is the position to use when the back is part of the picture.
- 7
Pigeon, block under the hip · 60 to 120 seconds each side
A block under the front hip levels a pelvis that would otherwise tip sideways, which keeps the spine neutral and puts the stretch where it is meant to be instead of into the lower back.
- 8
Pigeon, with a bolster · 2 to 5 minutes each side
The long restorative one, with the bolster carrying the upper body in the fold. Worth knowing that the fold is still there, so this is a settled-symptoms option rather than an active-symptoms one.
Pick one or two, not all eight. Working down the list from the top is the sensible direction of travel: the seated and supported versions first, the kneeling ones once the shape is comfortable. If any of them reproduces pain travelling down the leg, come out of it. Forcing that stretch into the symptom is the most common way people keep this going, and it is the specific behaviour the research above argues against.
What the research says
Conservative care is where the literature starts. A 2021 review covering surgical and non-surgical options describes medical management and physical therapy as the opening move, with injections and dry needling reserved for when that has not been enough, and endoscopic decompression as a last tier for significant persisting symptoms. Nothing in that sequence begins with a procedure, which matters because buttock pain gets escalated quickly and often does not need to be.
On what the physical therapy should contain, the most cited single paper is a 2010 case report by Tonley and colleagues. A thirty year old man with two years of buttock and posterior thigh pain, whose symptoms were provoked by stretching the piriformis, was treated instead with strengthening for the hip extensors, abductors and external rotators plus correction of excessive hip adduction and internal rotation during functional tasks. Pain resolved and his functional score rose from 65 out of 80 to 80 out of 80. It is a single case, and it should be read as a well-argued hypothesis rather than as proof.
Stretching is not idle, though, and it would be dishonest to write this page as if it were. A 2024 controlled trial compared stretching against compression exercises in people with chronic low back pain and deep gluteal syndrome, the wider name this problem now sits under. No group changed the electrical activity of the calf muscles, and all groups including the control had less pain, but only the stretching group's disability score improved relative to the compression group. For sciatic symptoms in general, NICE NG59 keeps the frame simple: tailored self-management advice, encouragement to continue normal activities, and an exercise programme chosen around the person.
Sources
- 1Tonley et al., treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation, case report (JOSPT, 2010;40(2):103-11)
Describes management centred on strengthening the hip extensors, abductors and external rotators plus movement re-education rather than stretching the piriformis, and proposes overstretching rather than overshortening as the underlying problem.
- 2Shamsi et al., stretching versus compression exercises in chronic low back pain with deep gluteal syndrome, controlled clinical trial (BMC Sports Science, Medicine and Rehabilitation, 2024)
Neither intervention changed calf muscle electromyography and all groups had less pain, but only the stretching group's disability score improved relative to the compression group.
- 3Vij et al., surgical and non-surgical treatment options for piriformis syndrome, literature review (Anesthesiology and Pain Medicine, 2021)
Medical management and physical therapy are the opening approach, with injections and dry needling used when that is insufficient and endoscopic decompression reserved for failed conservative management with significant symptoms.
- 4NICE NG59, low back pain and sciatica in over 16s (2016, last updated 29 July 2026)
Provide tailored self-management advice including encouragement to continue with normal activities, and consider a group exercise programme (biomechanical, aerobic, mind-body or a combination) chosen around the person's needs, preferences and capabilities.
Common questions
Is the piriformis stretch the same as the figure 4 stretch?
Yes. Figure 4, reclined figure 4 and supine piriformis stretch all describe the same shape: hip bent, thigh turned across the body. Pigeon reaches the same muscles from kneeling. Worth one caveat: some sources also call the lying figure 4 thread the needle, while in the Vinys library that name belongs to a kneeling rotation for the upper back.
Why does the stretch make the leg symptom worse?
Because the sciatic nerve runs right alongside the muscle you are stretching, and in some people straight through it. Bending the hip and turning it inwards puts tension on that nerve as well as on the muscle. A deep broad ache in the buttock is the muscle. Sharp, electrical or travelling below the knee is the nerve, and that is the signal to reduce the depth or come out.
Should this be stretched or strengthened?
The order is the useful answer. The most cited paper here describes strengthening the hip abductors and external rotators with movement re-education instead of leading with the stretch, on the reasoning that the muscle is being overworked rather than being short. A separate trial in deep gluteal syndrome found the stretching group's disability improved relative to a compression group, so stretching is not being ruled out. Strength first, stretch after, gently.
Is this sciatica?
The symptom overlaps and the origin differs. Sciatica usually refers to irritation where the nerve leaves the spine, and this is irritation further along, in the deep buttock. It is largely a diagnosis of exclusion, made once the spine has been ruled out, which is why the piriformis syndrome guide treats it as a label to arrive at rather than start from.
How long should the stretch be held?
The library holds these between one and three minutes, and up to five for the supported pigeon. Length is less important than being able to stop holding on: if the arms, jaw or breath are working, the position is too strong and a lighter version will do more.
Can it be done at a desk?
Yes, and for a problem this closely tied to sitting that is the version most likely to actually get done. Ankle across the opposite knee, sit tall on a chair that does not roll, lean forward from the hips rather than rounding the back, and stop at the first honest sensation rather than the strongest one.
Get it assessed rather than stretched if there is weakness in the leg or foot rather than just pain, numbness around the groin or back passage, any change in bladder or bowel control, or if the symptoms followed a fall. Buttock pain has several causes worth ruling out, and this one is normally identified only after the spine and the hip joint have been excluded.
Also called piriformis stretch, piriformis stretches, figure 4 stretch, deep gluteal stretch, piriformis stretch for sciatica, seated piriformis stretch. Movements are drawn from the clinically authored Vinys library. This page is general movement information, not medical advice, and it is not a diagnosis. How the method works.