Piriformis pain and poor sleep create a vicious cycle. The pain makes it hard to get comfortable, and a restless night in the wrong position can leave the muscle even more irritated by morning.<\/p>\n\n\n\n
\u201cThe key is to maximize good sleep because our recovery happens during our rest,\u201d says Rajan Cheema<\/a>, registered physical therapist and founder of Richmond Physiotherapist (Richmond, BC). \u201cIf you\u2019re sleeping for eight hours, you want to make sure you\u2019re in a good alignment so that the piriformis isn\u2019t in a bad position and inflaming that sciatic nerve.\u201d<\/p>\n\n\n\n The good news: A few small changes can take the pressure off (literally) while you sleep. Here\u2019s what a physical therapist recommends for the best sleeping positions<\/a>, mattress firmness<\/a>, and pre-bed stretches<\/a> for piriformis syndrome.\u00a0<\/p>\n\n\n\n Piriformis syndrome<\/a> is a muscular disorder where the piriformis muscle, located in the lower spine and buttock, spasms and compresses the adjacent sciatic nerve. <\/p>\n\n\n\n Symptoms typically include a painful burning, aching, or tingling feeling in the buttock, hip, or upper leg. There are several potential causes of piriformis pain, including overuse, muscle imbalance, and spinal issues.<\/p>\n\n\n\n Piriformis pain often flares up at night. The piriformis is a stabilizer muscle. It compensates for weak glutes. By the end of the day\u2014after you\u2019ve been walking, moving, and sitting for hours on end\u2014it\u2019s done a lot of work. <\/p>\n\n\n\n And if you\u2019re sleeping in the \u201cwrong\u201d position or your mattress isn\u2019t supportive enough, the piriformis can be overstretched, causing it to hurt even more.<\/p>\n\n\n\n Sometimes, piriformis syndrome can be confused with sciatica<\/a>. The biggest difference between the two conditions is whether or not you\u2019re having low back pain<\/a>.\u00a0<\/p>\n\n\n\n \u201cSciatica stems from the low back,\u201d Cheema says. \u201cTrue sciatica [is] nerve root compression happening at the low back.”<\/p>\n\n\n\n Piriformis syndrome, on the other hand, happens at the glute. While it\u2019s the same nerve, you don\u2019t get that lower back pain\u2014although both conditions will refer down the leg, explains Cheema. <\/p>\n\n\n\n If you\u2019re experiencing painful numbness and tingling, you\u2019re having trouble sleeping, and your pain is impacting your daily life, it’s important to get checked out by a professional.\u00a0<\/p>\n\n\n\n The best sleeping position for piriformis syndrome is side sleeping<\/a> on the unaffected side. Place a pillow between your knees. This keeps your hips and pelvis in alignment, maintaining a neutral spinal alignment between the spine, hips, and femur.<\/p>\n\n\n\n With piriformis pain, it\u2019s best not to sleep in the fetal position<\/a>, on your stomach, or on your back.<\/p>\n\n\n\n \u201cThe biggest reason is your pelvis is going to sink down or it\u2019s going to sink up depending on the position,\u201d says Cheema. <\/p>\n\n\n\n Sleeping on your back with a pillow underneath your knees, he notes, might be OK, though. <\/p>\n\n\n\n \u201cEveryone is different,” says Cheema. “There\u2019s no universal rule. We just know that sleeping on your unaffected side, with the pillow, is probably the best scenario.\u201d\u00a0<\/p>\n\n\n\n What if you\u2019re falling asleep in the right position but waking up twisted? When you\u2019re in a deep sleep, there\u2019s only so much you can do to control the position your body is in. <\/p>\n\n\n\n Doing some dynamic stretches before bed can help keep the piriformis muscle happy so you\u2019re not unconsciously looking for relief while asleep.\u00a0<\/p>\n\n\n\n A pillow between your knees<\/a> can help you maintain correct spinal alignment all night long.\u00a0<\/p>\n\n\n\n Depending on the size of the pillow, you may also want to add a second pillow, this one from knee to ankle. <\/p>\n\n\n\n \u201cAt home, I have a really large pillow, so I just use that,\u201d Cheema says. \u201cIf your pillow\u2019s a bit small\u2026having the one between your ankles is good too.\u201d<\/p>\n\n\n\n Either way, the goal is for your hips, knees, and ankles to all remain neutral. <\/p>\n\n\n\n Set yourself up for a good night of rest by doing some gentle dynamic stretching<\/a> about three to five minutes before you go to sleep. <\/p>\n\n\n\n According to Cheema, keeping this nighttime routine<\/a> low-key is the best way to go.<\/p>\n\n\n\n \u201cBefore you sleep, you don\u2019t really want to do a lot of strengthening, he says. “You want something that\u2019s a little bit more relaxing.\u201d<\/p>\n\n\n\n He also says that \u201cgentle discomfort\u201d is the goal: \u201cYou don\u2019t want to go to the point of aggravation, and you don\u2019t want any deep long stretches, because when you stretch really deeply, you are overstretching that piriformis and that\u2019s going to compress your sciatic nerve.\u201d<\/p>\n\n\n\n Try these stretches for piriformis syndrome before bed:<\/p>\n\n\n\n Factors like your age and body composition make a big difference in your flexibility. All of these stretches essentially do the same thing, so you don\u2019t have to do them all. Find what feels most comfortable personally and what gives you relief. <\/p>\n\n\n\n The best mattress for piriformis syndrome is a medium-firm mattress<\/a>. While everyone has a different preference, a mattress that\u2019s too firm or too soft can interfere with your alignment. Medium-firm tends to be a good middle ground.\u00a0<\/p>\n\n\n\n \u201cIf the mattress is too firm, what happens is your hips start to arch,\u201d Cheema explains. \u201cYour hips might rise a bit and that\u2019s going to overstretch the piriformis.\u201d<\/p>\n\n\n\n When your hips are out of alignment, the piriformis muscle is either very stretched or very compressed. Either way, this impacts the sciatic nerve. <\/p>\n\n\n\n You can check to see if a mattress is too firm for you by seeing if someone can put their hand underneath your hips. If so, there\u2019s too much of an arch\u2014your pelvis is out of alignment between your femur and your lower back, and you likely need a softer mattress.<\/p>\n\n\n\n By the same token, however, you don\u2019t want to swing too far the other way. A mattress that\u2019s too soft can also make the pelvis sink out of alignment, affecting the piriformis. <\/p>\n\n\n\n \u201cThat\u2019s why, as a blanket statement, we usually say medium-firm is the best for most people,” says Cheema. “There\u2019s going to be outliers for that, but usually medium-firm is good for somebody that has a history of piriformis syndrome.\u201d <\/p>\n\n\n\n Additional factors that can affect your mattress preference include your body composition (a firmer mattress is best for heavier folks, and vice versa) and your sleeping history (what you\u2019re used to sleeping on and whether you\u2019ve had long-term pain). <\/p>\n\n\n\n Your nighttime habits aren\u2019t the only daily routines that matter for piriformis syndrome. What you do in the morning<\/a> is important too.<\/p>\n\n\n\n \u201cAnytime you have some sort of muscle issue or a tendon issue, you don\u2019t want to just get out of bed,\u201d Cheema says. \u201c[The muscle has] probably been stuck in a weird way for the entire night. If you just jump right out of bed, you\u2019re going to overstretch it.\u201d<\/p>\n\n\n\n Follow this five-minute morning routine for piriformis syndrome to safely ease into your day:<\/p>\n\n\n\n It\u2019s also helpful to avoid long, deep holds right away and to do some activation\u2014like a walk around the neighborhood\u2014before any intense exercise. If your healthcare provider has prescribed medication for ongoing inflammation, you\u2019ll want to keep up with that too.\u00a0<\/p>\n\n\n\n Finally, while alleviating pain in the short term can be helpful, the way to reduce or eliminate piriformis pain is to focus on strengthening your glutes<\/a>.\u00a0<\/p>\n\n\n\n \u201cThe piriformis is trying to stabilize you,” says Cheema. “The culprit was your weak glutes all along. So we really want to get into strengthening your glutes at least two to three times a week. That way your glutes can help stabilize your pelvis and then your piriformis doesn\u2019t have to work as hard.\u201d <\/p>\n\n\n\n A physical therapist can create a program with the correct exercises, like clamshells and glute bridges. While piriformis syndrome can come back, with the right movements at the right pace, many people can resolve piriformis pain in two to six weeks.\u00a0<\/p>\n\n\n Find the best mattress for piriformis pain at Saatva<\/p>\n \n What is piriformis syndrome, and how does sleep aggravate it?<\/h2>\n\n\n\n
Best sleeping positions to relieve nerve pressure<\/h2>\n\n\n\n
Pillow ergonomics: knee and hip positioning techniques<\/h3>\n\n\n\n
Nighttime stretches to relax the piriformis muscle before bed<\/h2>\n\n\n\n
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Choosing the right mattress firmness for sciatic\/piriformis relief<\/h2>\n\n\n\n
Morning routine to avoid stiffness upon waking<\/h2>\n\n\n\n
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