Depending on the severity of the patient’s sciatica-type pain and other symptoms, a number of treatment options may be recommended by a health care professional. A comprehensive approach to managing pain along the sciatic nerve from piriformis syndrome may include a combination of:
Stretching exercise for piriformis syndrome
A number of stretching exercises for the piriformis, hamstrings and hip extensors may help decrease the painful symptoms along the sciatic nerve and return the patient’s range of motion.
Piriformis stretch for sciatic nerve pain
Each piriformis stretch should be held for 5 seconds to start, and gradually increased to 30 seconds, and repeated three times each day.
Hamstring stretch for sciatic nerve pain
There are a number of ways to stretch your hamstrings (the large muscle along the back of the thigh).
Again, try to work up to holding each stretch for 30 seconds and repeat three times each day.
Ice
At the onset of pain, lie in a comfortable position on your stomach and place an ice pack on the painful area for approximately 20 minutes. Repeat as needed every 2 to 4 hours.
You may find it more helpful to combine a gentle massage with the ice. Lie on your stomach and have someone gently massage the painful area with a large ice cube. If you apply ice directly to the skin (instead of a cold pack), limit it to 8 to 10 minutes to avoid an ice burn.
If specific activities are usually followed by increased pain, it may be a good idea to apply ice immediately following the activity.
Heat
Some people find it helpful to alternate cold with heat. If you use a heating pad, lie on your stomach and place the heating pad on the painful area for up to twenty minutes. Be sure to avoid falling asleep on a heating pad, as this may lead to skin burns.
In addition to basic stretching, a comprehensive physical therapy and exercise program can be developed for each patient’s individual situation.
Deep Massage
Deep massage (manual release) by a physical therapist is thought to enhance healing by increasing blood flow to the area and decreasing muscle spasm.
Range of motion exercises
A physical therapist can develop a customized program of stretching and range of motion exercises to help stretch the muscle and decrease spasm.
Since most episodes of pain include some type of inflammation, non-steroidal anti-inflammatory medications (NSAID’s) (such as ibuprofen or naproxen) may help decrease inflammation in the affected area.
For severe sciatica pain, a local anesthetic and corticosteroid may be injected in directly into the piriformis muscle to help decrease the spasm and help alleviate the sciatica pain. The purpose of an injection is usually to decrease acute pain to enable progress in physical therapy. For persistent piriformis spasm that is resistant to anesthetic/corticosteroid injections, an injection of botulinum toxin (a muscle weakening agent) may be useful.
The application of electrical stimulation to the rear with a transcutaneous electrical nerve stimulation (TENS) unit or interferential current stimulator (IFC) can help to block pain and reduce muscle spasm related to piriformis syndrome.
