The figure-four stretch is the one most people are handed when a therapist suspects the deep buttock muscles are tight. It is named for the shape your legs make. What it cannot do is tell you why your buttock hurts.
What the piriformis and deep rotators do
The piriformis is a small, flat muscle running from the sacrum to the top of the thigh bone, with five smaller muscles around it. Together they turn the thigh outward and hold the ball of the hip steady in its socket. The sciatic nerve passes right beside the piriformis, which is why it gets blamed for pain running down the leg.
Piriformis syndrome is less common than it sounds
Buttock pain has many sources: lumbar discs and joints, the sacroiliac joint, hamstring and gluteal tendons, the hip itself. Piriformis syndrome is a diagnosis of exclusion, made only once those are ruled out. A 2004 review in Orthopedic Clinics of North America put it at up to 5 percent of low back, buttock and leg pain, and noted that imaging rarely helps and long sitting makes it worse.
Lying figure-four
- Lie on your back, knees bent, feet flat.
- Cross one ankle over the opposite knee so the legs form a four.
- Reach through the gap, hold the back of the supporting thigh, and draw it toward your chest until you feel a pull in the buttock of the crossed leg, not a pinch at the front of the hip.
- Keep your lower back on the floor and keep breathing.
Seated figure-four
If the floor is hard to get to, or you have been told not to lie flat, use a chair. Sit tall with both feet down, cross one ankle over the opposite knee, let that knee drop outward, and lean forward from the hips with a straight back until you feel the stretch.
How long to hold it
Thirty seconds is the usual answer, and it comes from research. A 1994 trial in Physical Therapy with 57 adults compared 15, 30 and 60 second hamstring stretches over six weeks: 30 and 60 both improved range more than 15, and 60 added nothing over 30. Cleveland Clinic suggests three 30 second holds per side, up to twice a day. Your therapist sets your dose.
Pair it with strengthening
A tight-feeling muscle is sometimes overworked, not short. A 2010 case report in the Journal of Orthopaedic and Sports Physical Therapy treated one patient's piriformis pain with hip strengthening and movement retraining alone, no stretching, and his pain resolved. One patient proves little, but most plans pair stretching with strength work.
If your program includes strength work for the outer hip, see our side-lying hip abduction guide
Get assessed rather than stretching through it if you have numbness, weakness or pins and needles in the leg, pain after a fall, pain that wakes you at night, any change in bladder or bowel control, or buttock pain not improving after about a month of consistent exercise.
Doing this stretch in a guided session
People drift on hold time at home, letting go at 12 seconds and calling it 30. In a KineTrue guided session the camera times each hold and records which side and how many, so your therapist can see whether the stretch was done as prescribed.