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Piriformis Syndrome and How Physical Therapy Can Help

by | Feb 2, 2021 | Back Pain Buffalo, Back Physical Therapy, Hip Injuries, Hip Physical Therapy, Lower Back Pain, Sciatica Physical Therapy | 6 comments

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Hip pain of senior woman at home, healthcare problem of senior concept

Piriformis Syndrome is a condition that occurs when the piriformis, a muscle located deep within the buttocks region, irritates the sciatic nerve, a large nerve starting in the lower back that runs to the thigh, leg, and foot. When one suffers from Piriformis syndrome, they generally experience pain, numbness, or tingling originating in the buttock that frequently radiates to the thigh and leg.  In severe cases weakness in the thigh and leg can also be reported. Luckily, those who suffer from Piriformis syndrome do have treatment options that can effectively reduce the symptoms of the syndrome. These treatments are generally performed by a physical therapist with extensive knowledge regarding the syndrome and other conditions like it. The following physical therapy treatments are just a few ways a physical therapist can help an individual with Piriformis syndrome.


One of the most straightforward ways a physical therapist can help an individual with Piriformis syndrome is by instructing them on how to do particular stretches. A physical therapist will instruct the patient regarding the proper ways to do particular stretches and prescribe a regimen of a few exercises to be performed at home.  According to studies, patients who do the stretches prescribed by their physical therapist both during physical therapy treatment sessions and at home see a 60-70% increase in leg range-of-motion (the range one is able to move and stretch their leg). Essentially, the technical goal of these types of stretches is to improve the elasticity of the deep buttock muscles that are cause Piriformis syndrome in order to reduce the debilitating effects of the condition. Physical therapy for Piriformis Syndrome may also include the use of weights or other tools in addition to stretching in order to increase their effects.

Myofascial Release Therapy

The second most common way that physical therapy can help with Piriformis syndrome is through what is called Myofascial Release Therapy. This therapy aims to release restrictions and tightness in particular muscles and other connective tissues in order to increase flexibility and range-of-motion in a particular area. Usually, this type of therapy involves stretching the patient’s leg in a specialized way from anywhere between 90 to 120 seconds and then moving it back to its original position. The physical therapist performs multiple repetitions of this movement in order to encourage more mobility in targeted tissues and muscles.

Physical Therapy Combined with Medication

Lastly, physical therapy can also help those with Piriformis syndrome through a combination of the above physical therapies along with medication. This type of medication is generally a combination of steroids or other anti-inflammatories that reduce the severity of particular Piriformis syndrome symptoms. Thanks to the steroids, the patient is generally then able to respond more favorably to some of the more aggressive physical therapies by their physical therapist. In cases where symptoms are more resistant to treatment, patients may require Botox injections to help relax muscle spasm and tightness responsible for Piriformis syndrome. According to studies, not only does this method work faster than physical therapy alone, but the recovery is generally more profound.

Do You Have Piriformis Syndrome?

If you or someone you know is currently suffering from Piriformis syndrome, they do not need to keep living with the pain. It is highly recommended that those with Piriformis syndrome seek the help of a physical therapist for the aforementioned treatments and possibly any other specialized treatments that the physical therapist suggests, as the above methods are tested and can help improve sufferer’s quality of life.

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  1. Danin Squires

    I am suffering from sever leg pain that is believed to be caused by the sciatic nerve impinged in the piriformis muscle. This has been been on going for years and I have tried everything possible to treat this problem. The pain is sever whenever i bear weight on the left leg; walking, standing, stairs, ect. The pain is at relief when i sit. I am desperate for relief and to get my active lifestyle back.

    • Matt Smith

      Sorry to learn of your pain. There are many treatment options out there but it sounds like you have already attempted several of them. Stretching and rest are often first lines of defense but from the sounds of it you likely have attempted these. There are several manual soft tissue releases you could try if you haven’t already. A manually trained PT could help you here. If you are still resistant to these more conservative options a corticosteroid injection or even a lidocaine injection might help however an orthopedic consult would be necessary to determine if you are a candidate. Have you considered that your failure to thrive might stem from the possibility that it is not truly piriformis syndrome that you are dealing with? Lumbar stenosis and spondylolisthesis are often free from back pain with first symptoms originating in the buttock or even further into the lower extremity. Lumbar x-rays would be useful to rule out these diagnoses if you have not already. I hope that this helps. I would be curious to hear what measures have already been undertaken in your evaluation. Feel free to right back. I would love to hear more detail. Perhaps I could be of better assistance.

    • fav bal

      I feel your pain. Literally. Have you had an MRI done? If not you really need one done. My background: I suffered an injury in the Army back in 1994. Which they said I already had and just aggravated itself in there. Yeah, right. My pain, mostly on the right, was on a 1-10 scale a 19/20. I got used to the pain and lived with it until July of this year. I finally had back surgery. I fractured my L5 as well as my Sacrum. The growth of bone pinched my nerves. The ones coming out to the sides of the L5 (sciatics), the one going down the middle into the Sacrum as well as the one coming out of the S1 on the left side. The pain in the right would be the first to act up and it never gave the left side enough time to really flare up. Add to this that my spinal column moved forward since then 11.5mm. The surgeon relieved my pain on the right side and anchored my spine. Except, I dont think he did anything to my S1 on the left. Couple this with me falling when the bench on th picnic table I was sitting on broke. This a month and a half after my surgery. So now my left is causing me the burning pain. Except this one takes a while to subside. It keeps waking me up at night. The one on the right would start subsiding when I squatted, sat or layed down. I had a CT scan and an MRI with contrast done again and was told that it did not show any problem. I come to find out that the quality and how modern the MRI machine is makes a huge difference as well as the Radiologist making the report. Some images do look blurry. So my son’s soon to be father in law, a head anesthesiologist, is getting some good friends of his, Radiologists, as well as his ortho surgeon friend give me their opinion.
      So seek out to have an MRI done because that is the best way to know for sure what problem you really have. I would recommend you have it done in a good modern hospital as they ahould have the most modern machines. That is where I messed up.

      • Matt Smith

        Wow! That is quite a story. When do you see the orthopedic surgeon? good luck.

  2. Deb

    Hello to the sufferer I feel your pain literally. I decided I wanted to strengthen my core to strengthen my back do joined a gym.i do slot of core strengthening and low impact on knee as previous knee surgery from years ago. I don’t think I injured myself at gym I actually started to feel stronger. Had I holiday week off and not as active during that week went back to work where it is quite physical twisting turning lifting and on feet all the time but didn’t injure I don’t think at work either I woke the next day got up and had extrucisting pain in lower back going down into my legs knee and foot. Doctor thinks it’s muscular I’m on Diazapan as back has gone into spasms I also get a nettle string rash feeling around shoulder blades and uncomfortsbility in neck. This piriformis yo me explains all I think. Spasms gone from back but drill slight pain in lower back, a feeling of someone biting my ass and not letting go on both sides drawing down I to both thighs but right hip and knee and both feet. I put right knee pain due to weakness from very old operation. How to I go onto strengthen these areas if the muscle is pinching distinct nerve. I want to stop this pain as nd prevent from happening again. On one hand I feel more relaxed as this piriformis syndrome makes so much sense to my symptoms but not what doctor has diagnosed and says doesnt think it’s sciatica and muscular. How do i say to a professional of medicine the sciatic nerve runs through the piriformis muscle and if this is inflamed it would punch the sciatic nerve giving sciatica symptoms too? How do i ask a professional for a scan on spine to rule out others so I can safely go onto to strengthening exercises to prevent this again without damaging the unknown when they just say its muscular and give me codeine Diazapan naproxen and paracetamol along with an antisickness pill. Would this just not mask what’s really going in if it is? Any advice please

    • Matt Smith

      Sorry to read of your pain. Sounds like quite a predicament. It is hard to arrive at an accurate diagnosis without doing an examination however the presence of lower back pain at the onset of you complaints should warrant first ruling out the lumbar spine as being the originator of your complaints. If piriformis syndrome can be confirmed I recommend that you consider conservative stretching exercises before strength training. Stretching will work to relax the muscle where as strength training can increase the muscular compression upon the nerve. If your condition continues to persist without improvement you might consider consulting a trained physical therapist for a second opinion. After doing a thorough examination they should be better able to understand your disorder and determine if images are necessary to clarify the clinical picture before starting treatment. They could in turn reach out to your physician to request the images on your behalf. All states now have a form of “direct access” allowing patients to be treated by PT’s without a prescription from their doctor. If you do not know of any good therapists in your area you could always reference ( I hope this points you in the right direction. Please reach out if you have more questions and to let me and our readers know how you are doing.
      Best of luck


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