Piriformis syndrome: Treatment in 4 weeks with 3 exercises

The piriformis syndrome is a very limiting injury which can take months to recover if you don’t treat it right. Fortunately there is a way to reduce your pain quickly.

Luckily for you, we’ve found a way to treat your piriformis syndrome the right way. And we’ll teach you exactly how to do it yourself.

Your piriformis syndrome will go away!

I’ll explain exactly what the piriformis syndrome is and how you can treat it the right way. I’ll also show you how you can do a piriformis test yourself to discover if you really have it.

After that I’ll show you how you can treat your piriformis syndrome yourself.

Finally I’ll try to answer the most frequently asked questions about piriformis syndrome.

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What is the piriformis syndrome?

piriformis syndromeThe piriformis syndrome is a neurological injury. It’s caused by the compression of your sciatic nerve by your pirifmoris muscle.

To understand the mechanism behind the piriformis syndrome, you’ll need to know the anatomy of your gluteal region.

Your sciatic nerve runs from your back through the back of your leg all the way to your foot. It controls the muscles at the back of your leg and your foot. It also innervates the skin of your leg, so you can feel touch.

In your pelvic region, the sciatic nerve is covered by the piriformis muscle. The piriformis muscle originates from your sacrum and SI-joint. It attaches at the other side of your hip to the greater trochanter at the outer side of your thigh bone.

The function of your piriformis muscle is to rotate your leg to the outer side when you lift it behind you extended. It also abducts your leg when you lift it flexed in front of you. This means that your bodyweight shifts more to the middle. If this didn’t happen you would be out of balance and not able to walk.

Piriformis syndrome is also known as “wallet sciatica” or “fat wallet syndrome,” as the condition can be caused or aggravated by sitting with a large wallet in the affected side’s rear pocket.

Now I’ll discus the most common piriformis syndrome symptoms and why they occure.

What are piriformis syndrome symptoms?

There are two main symptoms that can point you towards a piriformis syndrome. I’ll discuss both of them and explain why they appear.

The first and most pronounced symptom is buttocks pain. The pain is caused by overuse of your piriformis muscle. This overuse damages the muscle, causing it to tighten.

Because the piriformis muscle tightens, it puts pressure on the sciatic nerve. This nerve runs below the piriformis muscle. The pressure causes irritation of the sciatic nerve. This irritation causes a radiating pain at the back side of your leg. This pain can go down your leg as far as your calf muscle. This is the second sign you can recognize a piriformis syndrome by.

This is why it sometimes looks like a herniated disc.

sometimes it even radiates to your back causing lower back pain.

Also, piriformis syndrome reduces your ability to walk, sit for a long period of time and to bend forward to pick something up.

What causes piriformis syndrome?

pirformis syndrome cause

The main cause of the piriformis syndrome is overuse of the piriformis muscle. Overuse can be caused by different activities.

Bending and getting up many times in a short period of time.

The muscles in your buttocks help you to get up after bending down, like when you work in the garden.

Imagine you’re in your garden weeding. You bend over and pick up one weed at the time. After an hour or two you’ve bend and got up many times. Each time you get up, you use your piriformis muscle. So you can imagine that after two hours your piriformis muscle is used a lot and is tired.

If it’s trained regularly this is not a problem.

It’s like working out in the gym. When you do it for the first time or not very regularly, you are more likely to injury yourself during your training. But if you train four times a week, it’s very unlikely that you will get an injury. So if your piriformis is trained well because you work in the garden all the time, it won’t be a problem. If you do it only occasionally, you’re more likely to injure yourself.

When you expect a baby you can expect a piriformis syndrome as well

During pregnancy woman can experience the symptoms of a piriformis syndrome. This condition is called pregnancy sciatica. It’s the piriformis syndrome caused by pregnancy.

This is why it occurs:

During pregnancy woman obviously gain weight. This is of course a natural process. Unfortunately this also increases the pressure on your pelvic region.

Because of the weight, walking becomes harder. As mentioned before you use your piriformis muscle a lot when you walk. Because your weight has increased, the muscle have to work harder when you walk. This causes it to tighten up and puts pressure on your sciatic nerve.

The second contributing factor is an increase of laxity in your pelvic region. To prepare your body for the birth of your baby a special hormone is produced. It’s called the relaxin hormone and its purpose is to loosen your ligaments. These ligaments normally keep your pelvic girdle together. When you give birth the baby needs to pass the pelvic girdle.

The hormone loosens the ligaments that keep the different parts of your pelvic region together. This increases the space for the baby to pass through. One of the consequences is that your pelvic girdle muscles need to work harder to compensate for the pelvic instability. This includes the piriformis muscle. Therefore the chances are that you’ll overuse it, causing tension and compression of the sciatic nerve.

Fortunately the symptoms usually disappear by itself after the baby is born.

Hip pain, a stiff hip, hip arthritis and the piriformis syndrome

A stiff hip can also be a cause for the piriformis syndrome.

As mentioned before your piriformis muscle serves many of your hip movements. When you have a stiff hip the muscle have to work harder to move your hip because of bigger resistance. His will lead to overuse of the muscle resulting in the piriformis syndrome.

One of the main reasons for developing a stiff hip is hip arthritis. This means that the cartilages in your hip joint disappears. The lack of cartilage results in less mobility of your hip joint.

This is how hip arthritis can lead to a stiff hip resulting in the piriformis syndrome and hip pain.

How long does piriformis syndrome last?

Your piriformis syndrome can last for several months if you don’t treat it the right way. However, if you use the exercises I’ll describe later, it will only last for about four weeks.

In severe cases, even with the right exercises it can take months to heal. This is usually because the piriformis syndrome is an outcome of another, bigger problem. In those cases you’ll have to solve the main problem before you can cure your piriformis syndrome.

How can I do a piriformis syndrome test myself?

Penetrex cremeWhat you’ve learned so far is what the symptoms of the piriformis syndrome are and what the main causes are.

This will already have given you a good indication if you’re suffering from piriformis syndrome.

If you’re not sure yet there are a few simple tests that you can do yourself to find out if you have the piriformis syndrome yourself.

These tests look very similar to the exercises that you have to do to cure your piriformis syndrome.

The first indication that you have the piriformis syndrome is a tight buttocks. You can feel your piriformis muscle at the lower part of your buttocks, close to where your leg starts. You should feel a difference between your painful side and your healthy side. At the painfull side you should feel a tender point. This feels like a little ball and it hurts when you put pressure on it. On your healthy side this ball is absent.

The second indication is when you stretch your piriformis muscle.

This is how you can stretch your piriformis muscle. In this example we’ll stretch our left piriformis muscle:

Grab your right knee with your right hand.
Grab your right ankle with your left hand.
Pull your right knee toward your left shoulder.
Pull your right ankle also towards your left shoulder.

piriformis stretch

Now you should feel the stretch and tightness in your buttocks area. The tightness itself is quite normal in this muscle. However, when you have the piriformis syndrome you should feel a big difference between your right and left side. When you don’t have it, both sides feel pretty much the same.

The third indication is a lack of mobility of your sciatic nerve. There is a simple way to test this:

Lay down flat on your back.
Lift up the leg on the painful side extended with your toes pointing towards you.

schiatic stretch test for piriformis syndrome

When you lack mobility of your sciatic nerve, you will feel nerve pain in your calf and your hamstring area soon after lifting your leg. When you do the same with your other leg, you will feel that there is a difference between the two.

schiatic stretch test for piriformis syndrome normal

A healthy leg without sciatic nerve problems can be lifted up as high as 90 degrees. With sciatic nerve pain you will stop at around 60 degrees because of the stretching feeling.

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Best piriformis syndrome treatment

Now you know the cause of your pain, it’s time to start your piriformis syndrome treatment. To successfully treat you piriformis syndrome, we’ll have to tackle all the factors that contribute to the forming of the piriformis syndrome.

piriformis cushionThis way you will break the vicious circle that holds your pifirmis syndrome in place right now. This means that you have to perform three exercises, but they will take a while before your pain reduces significantly. The easiest way for quick pain relief is to buy this piriformis cushion.

This pillow reduces the pressure on your painful piriformis muscle, which will reduce the pain immediately.

In the meantime you can work on solving the problem permantly.

These exercises will adress:

Piriformis stretch to reduce the tension on your piriformis muscle
Piriformis training to increase its loadability
Stretching your sciatic nerve to solve your radiating pain
Mobilizing your hip to reduce pirformis muscle tension

By performing these exercises regularly you solve the overuse of your piriformis muscle, wich will cure your piriformis syndrome.

It is best to do the exercises on a yoga mat which you can buy here. this is the easyest way to perfom the exercises the right way because a bed is often to soft and the floor is often to hard.

If for some reason these exercises don’t help you enough there are a few other options that can help you. I will also discus these options later here.

But first start with the first exercise.
Piriformis syndrome exercise 1: The piriformis stretch

The first and most important exercise is the piriformis stretch. A recent study shows that piriformis stretch relaxes your piriformis muscle and relieves your pain.

This exercise will decrease the tension of your piriformis muscle. Relaxation of your piriformis muscle is essential in order to decrease the pressure on your sciatic nerve. Only then can your sciatic nerve recover, eliminating the radiation in your leg.

In the video below I’ll teach you how you can stretch your piriformis muscle yourself. Perform this exercise as often as you can during the day.

The other thing you can do to reduce the tension on your piriformis muscle is massaging the painful spot. When you do this I would recommend this massage oil. It makes your muscle nice and warm which will relief your pain fast. It is also great for relieving other painful muscles. Piriformis syndrome exercise 2: Piriformis training

The second exercise you’ll have to do is piriformis training. With this exercise you’ll train all the muscles in your buttocks area.

Training your piriformis muscle is necessary because it’s often an overuse injury. This means that you’re asking more from your piriformis muscle then it can deliver. When you don’t increase its performance level, the imbalance between what you ask and what your piriformis can deliver remains. This means that the pain will remain as well.

A recent case study proved that training your piriformis and other gluteal muscles is an effective treatment to overcome piriformis syndrome. However you’ll have to keep in mind that this was a single case study. We need more research before we can make any conclusions but in my experience this works very well.

In the video below, I’ll show you how you can train your piriformis muscle. Training the muscle will restore the balance which will lead to recovery in the end.

ankle weightsWhen the exercise becomes too easy this way you can also add some weight through these ankle weights.

By adding these weights you can increase the strength of your piriformis muscle even more, giving you even better results.

You can choose between different weights based on your strength.

You can also use these weights for various other exercises.

And later when even this becomes too easy you can start doing steps at home.

When you do steps on a daily basis you will not only increase the strength of your piriformis muscle, but also of all the other muscles in your leg.

Also, you will increase your stamina and the cartilage in your knee thereby reducing problems of osteoarthritis.

Piriformis syndrome exercise 3: Sciatic nerve stretch

The last part of your piriformis syndrome treatment is performing the sciatic nerve stretch.

electrical wire

Your sciatic nerve is covered by a protective layer. The nerve slides through this layer when you move your leg. It looks a little bit like an electrical wire, like the one above.

What happens when you have piriformis syndrome for a long time is that the nerve gets stuck in the protective layer. This means that it can’t move properly anymore. This results in the stretching feeling in your leg when you move your leg.

In order to resolve this feeling you’ll have to stretch your sciatic nerve. The stretching releases the nerve from it protective layer, giving it more mobility.

In the video below I’ll show you how you can perform a sciatic nerve stretch yourself.

When you do these three exercises twice a day you’ll feel a decrease in pain within days. The exercises are designed to break the vicious circle. This means that if you continue to do these exercises your pain won’t return.

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Also, make sure to subscribe to our YouTube channel for more video’s. Dry Needling for piriformis syndrome

Dry NeedlingAnother form of treatment for piriformis syndrome is dry needling. Dry needling uses acupuncture needles to treat the trigger point tightness in the muscle.

This treatment can be performed by a physical therapist which took a course for dry needling. This means that not every physical therapist is qualified for dry needling treatment.

This is how dry needling works:

First the skin is cleaned with alcohol to prevent infections. Then the needle is insert into the muscle right in the tender point. The therapist will keep pushing into the tender point until it relaxes. This usually happens with a twitch which feels like a little electrical shock.

This all usually takes about 5 minutes.

After the treatment the skin will be cleaned again and the muscle will be massaged shortly to prevent muscle ache after the treatment.

The theory behind it is that the pressure of the needle forces the trigger point to relax. This will reduce the recovery time dramatically.

Unfortunately there is no study available yet that researched the long term results of dry needling for the piriformis syndrome. However in my experience it works very well, especially in combination with the exercises described above.

There are no severe complications known from dry needling. It might result in muscle ache for a few days or sometimes some skin irritation.

Dry needling is not indicated when you’re pregnant, when you had surgery in the same area less than 6 weeks before or when you use blood thinners.

Use a foam roller

Using a foam roller can also help you reduce your pain. With the foam roller you can put pressure on your piriformis muscle and especially the tender point. This will degrease the tension in your piriformis relieving your pain.

foam rolling piriformis syndrome

Apply heat or ice for pain relief

Applying heat or ice can reduce your buttocks pain. Which one you use depends on what works best for you and for how long you have your pain already.

If your piriformis syndrome started because of a fall or overuse, it’s better to apply ice. This will reduce swelling and suppress the inflammation. This will reduce your pain.

When you have it for a longer period, you can also apply heat to the painful or tense area. The heat will relax the piriformis muscle, reducing your pain.

Don’t apply the heat or cold directly on to your skin, but put a towel between it. This will prevent your skin from burning or freezing. Also, don’t apply it longer than 20 minutes.

What can and can’t I do with a piriformis syndrome?

Knowing how to treat your piriformis syndrome doesn’t cure it right away. That’s why you probably want to know what you can and what you can’t do with your piriformis syndrome.

What you shouldn’t do when suffering from piriformis syndrome is one of the activities that can cause it.

Bending and heavy lifting puts pressure on your piriformis muscle causing it to tens up again. Also kneeling down and getting up frequently aggravates your piriformis causing more pain or prolonging the pain. These are the activities that you should avoid during your recovery.

What you can do are light activities that don’t require flexing and extending your hip with force.

Activities that will help you recover are walking, cycling or swimming. These activities will increase the strength of your piriformis muscle without putting to much pressure on it. This will help you to recover.

FAQ

Frequently asked questions about piriformis syndrome

You now know almost everything you need to know about piriformis syndrome treatment. However, there are a few frequently asked questions about piriformis syndrome that remain unanswered.

So that’s what I’ll do now. how long does piriformis syndrome last?

How long piriformis syndrome lasts really depends on a few things.

First the cause influences the recovery time. If the cause is still in place your piriformis syndrome won’t recover. This is because you don’t break the circle the injury is in, like described above.

Also, if the cause was a onetime overuse incident, it tends to heal faster. Damage of the piriformis muscle and sciatic nerve is less when the injury was caused in a short amount of time. This means that the recovery time is also less.

When damage is caused over a longer period of time, damage is usually greater as well, resulting in longer recovery time.

The last aspect of the recovery time is how much you do to support your recovery. The more you follow your exercise program and avoid overuse activities, the faster you will recover from your piriformis syndrome injury.

In general, it’s safe to say that, when you follow your program closely, you’ll recover within two to four weeks. When you don’t follow your program closely it will be more like four to six weeks.

When you don’t follow your recovery program at all, it could take months to recover.

Will piriformis syndrome injection help me?

A piriformis syndrome injection can be performed when conservative treatments such as physical therapy fail.

piriformis syndrome injection

Basically a surgeon will inject a strong painkiller directly into your piriformis muscle.

In a study performed with 10 patients with piriformis syndrome, the injection showed good to very good results.

However, it’s also known that these kind of injections may sort only a short time effect. The study group of only 10 is to small to rule this effect out.

Therefore conservative treatment should always be your first priority to cure your pain. If that doesn’t have any effect you can try a piriformis injection. Is piriformis syndrome surgery effective?

Piriformis syndrome surgery consist of cutting loose your piriformis muscle from your hip where it’s attached. By cutting it loose, the tension of the muscle is released. This results in less pressure on your sciatic nerve.

The downside is that this procedure results in pain and a long recovery period. This is because your piriformis muscle is well innervated. This means that it has many pain receptors which results in more pain feeling. Also the muscle sometimes spasms because it thinks that it’s still attached to the bone and still has to work. Therefore you can still feel buttocks pain for a couple of months after the surgery.

A study suggests that piriformis syndrome is effective in the long term. After 2 months most patients returned back to work and a control after 2 years still showed very good results. However you should always try conservative therapy like physical therapy first. Surgery can have serious side effects and should therefore be your last resort.

What are piriformis syndrome exercises to avoid it?

In order to be able to prevent piriformis syndrome you can perform the same exercises as mention under piriformis syndrome treatment.

To prevent piriformis syndrome it’s necessary to have a strong but flexible piriformis muscle. Piriformis syndrome is often an injury caused by an imbalance between load and load capacity.

So in order to be able to prevent piriformis syndrome you’ll need to increase your load capacity or decrease the load on your piriformis muscle.

In general it’s easier to increase your load capacity then to reduce the load you put on your piriformis muscle. Increasing your load capacity can be done by training your piriformis muscle as described before. This will reduce the change of overloading your piriformis muscle.

Can I continue running with my piriformis syndrome?

Piriformis syndrome is a common injury among runners because the piriformis muscle must work hard during running. This means that overuse of the muscle during running is quite common.

I’ve discussed this situation already before.

When the cause of the injury is still in place, it increases the recovery time. Because running can cause piriformis syndrome due to the big load, continuing running will increase the recovery time of your piriformis syndrome.

Therefore I would advise you to stop running for a week or two. Instead of running focus on strength training of your leg and gluteal muscles. This will help your recovery and improve your running. This is because it’s known that stronger leg muscles increases running performance.

So in general I would say that you shouldn’t continue running with your piriformis syndrome. However this doesn’t have to affect your running performance since you have other training options. How to sleep with piriformis syndrome?

This is the best position to sleep with piriformis syndrome:

Lie on your non painful side
Pull you knee’s up to a 90 degrees angle
Place a pillow between you knee’s

This way you limit the tension on your piriformis muscle. Also there is no pressure on the muscle which usually causes pain.

Piriformis syndrome or herniated disc?

There are a few signs to determine if you have piriformis syndrome or a herniated disc.

The first sign is the radiation. With piriformis syndrome the radiation ends around your knee. When you suffer from a herniated disk the radiation goes all the way to your toes.

The second sign is bending. When you bend forward, to pick something up the sensation is different. Piriformis syndrome increases your buttocks’ pain and might intensify the radiation in your upper leg. With a herniated disc this will produce a shooting pain down your leg into your toes.

The third sign is bending backwards. With piriformis syndrome this won’t change a thing. However with a herniated disk this exercise will decrease the radiation in your leg.

These are three simple signs to differentiate between piriformis syndrome or a herniated disk. To be completely sure however you have to take an MRI of your back to rule out a herniated disk. Can piriformis syndrome cause back pain?

The answer is yes and no. I’ll explain:

Piriformis syndrome usually doesn’t cause much back pain. Tight glutes on the other hand can also cause back pain. Also tight glutes can cause symptoms similar to piriformis syndrome.

That’s why I had to answer yes and no. Often gluteal tightness is confused with piriformis syndrome. There is a difference however.

The difference is that with tight glutes the pain in your glutes is more felt on the outer side of your glutes, close to your hip. The piriformis is much more located in the middle of your buttocks.

Also when you put pressure on the painful spot in your glutes you can feel the radiating pain in your back. The trigger point in your glute causes the back pain. If it doesn’t cause back pain then the pain probably has another cause.

By performing the piriformis stretch you can also stretch your gluteus lowering the tension and solving your back pain.

Conclusion

I hope this information will help you solving your piriformis pain and dysfunction. If you have any question left or don’t understand the information feel free to ask by sending an e-mail to info@alwasyfysio.nl.

If you liked the information and thought it was helpful please share it with others so they can also get rid of this nasty pain.