Figure-4 stretch

Movement

The position as studies set it up

On this page, the figure-4 stretch means a stretch with one ankle crossed over the opposite knee or thigh. Three studies in living people and one cadaver study used a position of that kind^1,2,5,6.

Study	Position	Dose
2025 crossover trial, 31 physically active participants	Supine, ankle and lower shin on the opposite thigh, hip held at 90° of flexion1	Two 30-second holds1
2026 trial, 28 young adults with limited hip internal rotation6	Named a “supine figure-4 stretch”, one of three static stretches in the session6	Four 30-second holds with 10 seconds of rest between them6
Trial of 45 people with low back pain and deep gluteal syndrome	Supine, the affected-side ankle placed across the other knee, the other foot against a wall5	Three two-minute sets with two minutes of rest between sets, three sessions a week for ten sessions5
Cadaver study, 17 hips	Hip and knee bent so the outer ankle touched the outer side of the opposite knee, hip adducted 30°2	No hold: string displacement was measured in the position2

Flexion is bending a joint. A static stretch is a held stretch. Abduction moves a limb away from the midline of the body, and adduction moves it toward the midline. The 2025 trial placed the leg in flexion, abduction and external rotation (turning a limb outward)¹. The cadaver study instead adducted the hip by 30°².

In the 2025 trial, participants held the position at a mild to moderate stretch and avoided discomfort or pain¹. That trial’s authors wrote that conventional gluteal stretches often need a substantial range of hip rotation to reach the deep gluteal muscles¹. They added that people with restricted hip rotation may find the positions hard to achieve¹.

Other piriformis stretch positions

Studies of the piriformis have used other positions too, each named here as its study named it^6,7:

• Hip flexion with adduction and external rotation, which the authors of a 2014 modelling study describe as the conventional piriformis stretches⁷.
• A “supine adduction piriformis stretch”, used beside the figure-4 stretch in the 2026 trial⁶.
• Cross-legged sitting, studied by copying the pelvis and thigh angles of healthy subjects onto embalmed (preserved) pelvises⁸.

What it loads

The deep rotators

Six muscles lie deep to the gluteus maximus and rotate the thigh outward at the hip³. The six are the piriformis, the two obturators (internus and externus), the two gemelli (superior and inferior) and the quadratus femoris³. The deep hip rotators page covers them in detail.

One study tested four stretch positions on 17 hips from nine embalmed cadavers². Strings were run along the short outward rotators, and all four positions displaced the strings significantly². The study named three positions as causing the greatest length change². In one cadaver study, the crossed-ankle position lengthened the deep rotators but was not among the three positions named as lengthening them most².

In one cadaver study, the crossed-ankle position lengthened the deep rotators but was not among the three positions named as lengthening them most.

The position that moved each string most differed by muscle, in the same 17 hips²:

• The piriformis and superior gemellus strings moved most with 30° of adduction, hip and knee flexed to 90°².
• The obturator internus and inferior gemellus strings moved most with 45° of internal rotation (turning a limb inward), the hip neither flexed nor extended².

How far the piriformis lengthens in other positions

Three sets of figures describe the piriformis in other positions. Each is for a position other than the figure-4, and each used a different method^7,8.

Position	How it was found	Piriformis lengthening
Two conventional stretches: flexion, adduction, external rotation	Bone models from CT scans of seven subjects	About 12% in both7
115° of flexion, 40° of external rotation, 25° of adduction	Computer model built from the same seven subjects’ scans	About 15%7
Cross-legged sitting	Healthy subjects’ angles copied onto embalmed pelvises	11.7% against normal sitting, 21.4% against standing8

A CT scan builds detailed pictures of the inside of the body from X-rays. In the modelling study, the shape of the femur (thigh bone) influenced how much the piriformis lengthened⁷.

One study measured the muscle in living people. It used shear wave elastography, an ultrasound method that estimates how stiff a tissue is, in 21 healthy young men⁹. Stiffness, taken as the measure of stretch, rose in step with hip adduction from 0° to 20° to 40°⁹. With the hip flexed, it was higher in maximum external rotation than in maximum internal rotation⁹. Of 12 positions, the piriformis was most stretched in maximum external rotation with 110° of flexion and 40° of adduction⁹.

The gluteus maximus and the sciatic nerve

The gluteus maximus (the large muscle of the buttock) covers the deep rotators³. It is placed to extend the hip, rotate it outward and assist abduction¹⁰. The 2025 trial called its ankle-on-thigh stretch a gluteal stretch¹.

The sciatic nerve is the large nerve that runs from the lower back down the back of the thigh. It leaves the pelvis below the piriformis and rests on several of the other deep rotators¹¹. How it moves in the buttock depends on the knee⁴. With the knee bent it shifts backwards and outwards, and with the knee straight it moves deep into a tunnel there⁴.

How the body adapts

Straight after one session

Two trials measured the hip straight after a session that used this position^1,6. Passive range is how far a joint moves when an outside force moves it; active range is how far a person moves it unaided.

The 2025 trial was a crossover trial, a study in which each person tries every option in turn. Its 31 physically active participants held the stretch twice for 30 seconds¹. The findings were these¹:

• Passive hip range of motion improved¹.
• Active hip rotation changed minimally: internal rotation fell 1.56% and external rotation rose 2.94%¹.
• A device that applies controlled forces along the femur produced significantly greater gains in hip rotation than the stretch¹.

The 2026 trial randomised 28 young adults with limited hip internal rotation to static stretching or to controlled articular rotations⁶. These are slow active circular hip movements⁶. The 14 who stretched did three static stretches, one of them the supine figure-4⁶. Their mean passive internal rotation was 26.4° before, 33.2° straight after and 32.7° fifteen minutes later⁶. The change in internal rotation did not differ significantly between the two groups⁶.

Both trials’ authors noted limits. The 2025 authors studied healthy young adults and did not account for long-term effects¹. The 2026 authors tested a single session, so it is unclear whether repeated stretching would give similar results⁶.

Wider evidence on stretching gives some context. A meta-analysis is a study that pools the results of several earlier studies. One of 47 studies found a single bout of stretching gave a small increase in range of motion¹². A review found the improvement typically lasted less than 30 minutes¹³. It proposed that the gains may come from lower muscle and tendon stiffness or from better stretch tolerance (how much stretch a person will accept)¹³.

Over weeks

Longer studies tested stretching programmes for hip range of motion as a whole. In one, 24 young men whose hip mobility was limited were split at random into four groups for six weeks¹⁴. The two home stretching groups gained significant hip range, with rotation improving by as much as 56%¹⁴. A group that trained core endurance and motor control, without stretching, also gained range, significantly so only in rotation¹⁴. The large passive gains were not matched by any increase in the hip range used during four movement tasks¹⁵.

In people with buttock or pelvic pain

A 2015 review prefers the term deep gluteal syndrome for buttock pain from a sciatic nerve trapped outside the pelvis, not by a spinal disc⁴. A 2020 review describes it as including piriformis syndrome, whose page covers the definitions and trials in full¹⁶.

One trial in this group used the ankle-over-knee position. It allocated 45 people with low back pain and deep gluteal syndrome to the stretch, a compression exercise or a control group⁵. All three groups also had heat and electrical nerve stimulation⁵. Pain fell significantly in all three, and pain scores did not differ significantly between them⁵. The authors noted that participants could not be blinded and that the sexes were unevenly spread between groups⁵.

A systematic review searches for all the research on a question in a set, checkable way. A 2023 systematic review of approaches for deep gluteal syndrome rated the overall quality of evidence as low¹⁷. It concluded that no single non-surgical approach can be put ahead of another¹⁷.

Progressive overload

The three studies of this position in living people each report one dose, listed in the table under Movement^1,5,6. The progressive overload page covers the principle in general.

One trial progressed a different stretch. The sacroiliac joint is where the sacrum, at the base of the spine, meets the pelvis. A four-week trial in 120 people with sacroiliac joint dysfunction used a five-stretch programme that included a supine knee-to-opposite-chest stretch¹⁸. Both versions of the programme were stepped up each week:

Version	First step	Last step
Loaded long hold	One 60-second hold with 0.5 kg18	One 150-second hold with 2.0 kg18
Conventional	Two 15-second holds per side18	Five 60-second holds per side18

Stretch intensity was capped at a pull that felt strong but comfortable, below 4 out of 10 on a pain scale¹⁸. No adverse events were reported in either group¹⁸.

General stretching evidence, not specific to this stretch, disagrees on dose^19,20:

• A meta-analysis of 189 studies found gains from one session of static stretching were maximised at a cumulative 4 minutes per session¹⁹.
• The same meta-analysis found gains from static stretching programmes were maximised at 10 minutes per week¹⁹.
• Another meta-analysis of static stretching programmes found larger flexibility gains with more repetitions and more time under stretch²¹.
• A meta-analysis of 77 stretch-training studies found no relationship between range-of-motion gain and total stretch duration or weekly frequency²⁰.

Connections

The muscles it stretches

The 2025 trial’s authors aimed the stretch at the deep gluteal muscles, particularly the piriformis¹. The piriformis is one of the six deep hip rotators, which lie beneath the gluteus maximus³.

The joint and the nerve

In one trial the stretch was followed by improved passive range at the hip joint¹. In a laboratory study of nine cadaveric hips, each capsular ligament was the main restraint to hip rotation somewhere in the range of movement²².

The sciatic nerve leaves the pelvis below the piriformis¹¹.

Related pages

The stretch has been studied in people with deep gluteal syndrome, which a 2020 review describes as including piriformis syndrome¹⁶. The stretching page covers held stretches in general, and the progressive overload page covers how training is stepped up.

Sources

1. Cotteret C, Almazán-Polo J, Guérineau F, González de-la-Flor Á (2025). The effects of gluteal stretching vs. Lightback® on hip rotation range of motion and posterior chain flexibility in healthy subjects: a cross-over clinical trial.. PeerJ. doi:10.7717/peerj.18523 PMID 39926033
2. McGovern RP, Kivlan BR, Martin RL (2017). LENGTH CHANGE OF THE SHORT EXTERNAL ROTATORS OF THE HIP IN COMMON STRETCH POSITIONS: A CADAVERIC STUDY.. International journal of sports physical therapy. doi:10.26603/ijspt20171068 PMID 29234558
3. Betts JG, Young KA, Wise JA, Johnson E, Poe B, Kruse DH, Korol O, Johnson JE, Womble M, DeSaix P (2022). Anatomy and Physiology 2e. OpenStax. Link
4. Martin HD, Reddy M, Gómez-Hoyos J (2015). Deep gluteal syndrome.. Journal of hip preservation surgery. doi:10.1093/jhps/hnv029 PMID 27011826
5. Shamsi M, Mirzaei M, Hopayian K (2024). A controlled clinical trial investigating the effects of stretching and compression exercises on electromyography of calf muscles in chronic LBP patients with a deep gluteal syndrome.. BMC sports science, medicine & rehabilitation. doi:10.1186/s13102-023-00802-4 PMID 38200475
6. Head PL, Adkins SP, Brantley R, Modrall M (2026). Comparison of Controlled Articular Rotations and Static Stretching on Hip Internal Rotation Range of Motion.. International journal of exercise science. doi:10.70252/IJES2026305 PMID 42517070
7. Gulledge BM, Marcellin-Little DJ, Levine D, Tillman L, Harrysson OL, Osborne JA, Baxter B (2014). Comparison of two stretching methods and optimization of stretching protocol for the piriformis muscle.. Medical engineering & physics. doi:10.1016/j.medengphy.2013.10.016 PMID 24262799
8. Snijders CJ, Hermans PF, Kleinrensink GJ (2006). Functional aspects of cross-legged sitting with special attention to piriformis muscles and sacroiliac joints.. Clinical biomechanics (Bristol, Avon). doi:10.1016/j.clinbiomech.2005.09.002 PMID 16260074
9. Itsuda H, Yagi M, Yanase K, Umehara J, Mukai H, Ichihashi N (2024). Effective Stretching Positions of the Piriformis Muscle Evaluated Using Shear Wave Elastography.. Journal of sport rehabilitation. doi:10.1123/jsr.2023-0240 PMID 38593993
10. Pourahmadi M, Asadi M, Dommerholt J, Yeganeh A (2020). Changes in the macroscopic morphology of hip muscles in low back pain.. Journal of Anatomy. doi:10.1111/joa.13086 PMID 31475359
11. Gray H; Lewis WH (editor) (1918). Anatomy of the Human Body. Lea & Febiger, Philadelphia (20th edition). Link
12. Behm DG, Alizadeh S, Daneshjoo A, Anvar SH, Graham A, Zahiri A, et al. (2023). Acute Effects of Various Stretching Techniques on Range of Motion: A Systematic Review with Meta-Analysis.. Sports medicine - open. doi:10.1186/s40798-023-00652-x PMID 37962709
13. Behm DG, Blazevich AJ, Kay AD, McHugh M (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review.. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. doi:10.1139/apnm-2015-0235 PMID 26642915
14. Moreside JM, McGill SM (2012). Hip joint range of motion improvements using three different interventions.. Journal of strength and conditioning research. doi:10.1519/JSC.0b013e31824f2351 PMID 22344062
15. Moreside JM, McGill SM (2013). Improvements in hip flexibility do not transfer to mobility in functional movement patterns.. Journal of strength and conditioning research. doi:10.1519/JSC.0b013e318295d521 PMID 23591949
16. Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH (2020). Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain.. The bone & joint journal. doi:10.1302/0301-620X.102B5.BJJ-2019-1212.R1 PMID 32349600
17. Hopayian K, Mirzaei M, Shamsi M, Arab-Zozani M (2023). A systematic review of conservative and surgical treatments for deep gluteal syndrome.. Journal of bodywork and movement therapies. doi:10.1016/j.jbmt.2022.12.003 PMID 37949567
18. Patel SJ, Shinde S, Thomas MS, Ambali MP, Kale HY (2026). Effect of Low-Load, Long-Duration Stretching on Pain and Mobility in Sacroiliac Joint Dysfunction.. Cureus. doi:10.7759/cureus.108987 PMID 42311739
19. Ingram LA, Tomkinson GR, d'Unienville NMA, Gower B, Gleadhill S, Boyle T, Bennett H (2025). Optimising the Dose of Static Stretching to Improve Flexibility: A Systematic Review, Meta-analysis and Multivariate Meta-regression.. Sports medicine (Auckland, N.Z.). doi:10.1007/s40279-024-02143-9 PMID 39614059
20. Konrad A, Alizadeh S, Daneshjoo A, Anvar SH, Graham A, Zahiri A, et al. (2024). Chronic effects of stretching on range of motion with consideration of potential moderating variables: A systematic review with meta-analysis.. Journal of sport and health science. doi:10.1016/j.jshs.2023.06.002 PMID 37301370
21. Arntz F, Markov A, Behm DG, Behrens M, Negra Y, Nakamura M, Moran J, Chaabene H (2023). Chronic Effects of Static Stretching Exercises on Muscle Strength and Power in Healthy Individuals Across the Lifespan: A Systematic Review with Multi-level Meta-analysis.. Sports medicine (Auckland, N.Z.). doi:10.1007/s40279-022-01806-9 PMID 36719536
22. van Arkel RJ, Amis AA, Cobb JP, Jeffers JR (2015). The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres : an experimental study.. The bone & joint journal. doi:10.1302/0301-620X.97B4.34638 PMID 25820886

Every source the library cites

Changes

• October 7, 2026 First published.