A physical therapist works with a female patient who is in her third trimester of pregnancy. The patient complains of persistent low back pain, radiating from the sacrum to the hip joint along the sciatic nerve distribution. The therapist determines that tightness in the right piriformis muscle is contributing to the patient's discomfort. In order to stretch the muscle, the patient should be positioned on the patient's left side with the affected hip in what position?

• A. Lateral rotation and adduction
• B. Medial rotation and abduction
• C. Medial rotation and adduction
• D. Lateral rotation and abduction

Answer: (C)

To lengthen the piriformis, place the hip in a position that places the muscle on stretch. When the patient lies on the left side with the right (affected) hip on top, turning the thigh inward (medial/internal rotation) and bringing it toward the midline (adduction) places the piriformis fibers along their length, creating a stretch across the hip joint. This lengthens the muscle from its origin on the anterior sacrum to its insertion on the greater trochanter, helping relieve sciatic-type symptoms that can arise from piriformis tightness. In a third-trimester pregnancy, side-lying is safer than supine, and the described internal rotation with adduction specifically targets the piriformis. Other positions would typically place the muscle in a shortened configuration or fail to lengthen it effectively.