Treatment and rehabilitation of piriformis syndrome focuses on releasing muscle tension and correcting any muscle imbalances or biomecahnical causes which may be contributing to the condition.
The first priority is to reduce pain then improve the flexibility and condition of the surrounding muscles before returning to full fitness.
Your Doctor may prescribe anti-inflammatory medication such as Ibuprofen. Heat in the form of a hot bath or hot water bottle applied for approximately 20 minutes three times a day can help to release the muscle spasm and encourage blood flow through the muscle.
Rest from activities that produce pain. This is likely to include running. Gentle piriformis stretching exercises should be done but only if pain allows as this should also reduce the pressure on the nerve causing the pain. Stretches should be held for around 20 seconds and done in sets of 2 to 3, repeated at least three times a day. The aim is to stretch and relax the piriformis muscle so in turn it will reduce pressure on the sciatic nerve and relieve symptoms.
Light massage at this stage may also be beneficial in releasing muscle spasm in the piriformis.
Flexibility and conditioning
As soon as comfortable to do so, piriformis syndrome stretches should begin. Hold stretches for 30 seconds and repeat 5 times. Exercises to strengthen the piriformis muscle and other hip muscles can begin. This will help to circulate blood through the muscle and strengthen it so it can cope with the future demands placed on it. Strengthening exercises should be done on a daily basis immediately followed by stretching exercises as the muscle will be more likely to relax into a stretch if it has been worked and warmed up.
Deep sports massage techniques can be used to release the tension in the Piriformis muscle. Massage can be applied on alternate days. At the very least two to three sessions at the start of rehabilitation is a good idea. As the condition improves massage can be performed deeper, but the deeper the massage the longer it should be left between sessions as the muscle will need to recover in the same way as it does with heavy strengthening exercises.
Muscle energy techniques are an excellent way of improving the stretch of the muscle. This involves repeatedly contracting and relaxing the muscle whilst it is being stretched by rotating the femur bone inwards. The athlete lies on their front with the knee bent 90 degrees. The therapist gentle stretches the piriformis muscle by pushing the foot sideways towards the horizontal (as far as comfortable). The athlete then attempts to contract the piriformis muscle by pulling the leg back towards the horizontal while the therapist resists. This is alternated with the therapist gradually increasing the range of motion at the joint.
Foam roller exercises for the piriformis muscle can also help release tension in the muscle through myofascial release.
In addition to the specific piriformis stretches it is important to stretch the hamstrings, groin, hip abductors and lower back.
Read more on piriformis syndrome exercises.
Return to full fitness
Once daily tasks are pain-free, a return to activity program can begin. This should be a gradual process. An example return to running program is given below. How quickly you progress through the program will depend on the extent of the injury and original fitness levels.
- Day 1: walk 4 minutes, jog 1 minute, repeat 3 times
- Day 2: rest
- Day 3: rest
- Day 4: walk 4 minutes, jog 1 minutes, repeat 4 times
- Day 5: rest
- Day 6: rest
- Day 7: walk 3 minutes, jog 2 minutes, repeat 3 times
- Day 8: rest
- Day 9: walk 3 minutes, jog 2 minutes, repeat 3 times
- Day 10: rest
- Day 11: walk 3 minutes, jog 2 minutes, repeat 4 times
- Day 12: rest
- Day 13: walk 2 minutes, jog 3 minutes, repeat 3 times
This programme should be continued until you reach 15 minutes of solid running. You can then continue to gradually increase as normal, provided there are no symptoms.
It is essential that stretching and strengthening are continued throughout the rehabilitation process and beyond.