Exercises / Hip & gluteal
Piriformis stretch (flexion-adduction-external rotation)
- Stretch
- Hip & gluteal
- Mat
Hip flexion combined with adduction and external rotation. A 3D modelling study quantified which combination lengthens piriformis most.
Also called figure 4 stretch, figure-four stretch, glute stretch, piriformis stretch.
Where you stand
No published distribution for this exercise yet. We add one only from a peer-reviewed study.
Muscles worked
- Piriformis
- Gemellus superior
- Obturator internus
- Gemellus inferior
- Quadratus femoris
- Obturator externus
- Gluteus maximus
Filled: primary. Outlined: secondary.
How much
Common clinical dose: 3 × 30-second holds.
Start: Supine
Steps
- Lie on the back and bring the hip toward the chest.
- Cross the leg over the body (adduction) and rotate the foot outward (external rotation), or place the ankle on the opposite knee and pull the thigh up.
- Hold at a comfortable stretch.
Cues
- Stretch in the buttock, not the groin
- Keep the pelvis flat
Common mistakes
- Forcing through anterior hip pinching
Used for
- Deep gluteal pain
- Hip external rotator tightness
Take care (1)
- Deep gluteal syndrome is a diagnosis of exclusion; screen for lumbar radiculopathy.
Evidence (1)
- Two conventional stretches lengthened piriformis similarly (~12%); 115° flexion, 40° external rotation and 25° adduction increased elongation to ~15%.1
References (2)
- Gulledge BM, Marcellin-Little DJ, Levine D, et al. Med Eng Phys. 2014;36(2):212-218. Comparison of two stretching methods and optimization of stretching protocol for the piriformis muscle
- Neumann DA. Elsevier. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 3rd ed.