Mild piriformis syndrome pain may resolve with rest in 1 to 2 days. If the piriformis muscle is acutely inflamed, irritated, or swollen, the pain may persist for several days or weeks, and more targeted treatment will be necessary to prevent the condition from becoming chronic. 1 Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/ If left untreated, deep buttock pain may worsen over time and prolong over a period of 2 years (or more) with a gradual worsening of symptoms in some individuals. 2 Ro TH, Edmonds L. Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging. J Clin Imaging Sci. 2018;8:6. Published 2018 Feb 21. doi:10.4103/jcis.JCIS_58_17 , 3 Tonley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. Journal of Orthopaedic & Sports Physical Therapy. 2010;40(2):103-111. doi:10.2519/jospt.2010.3108
Research indicates that about 85% of people recover from piriformis syndrome pain with non-surgical treatments. 4 Kobbe P, Zelle BA, Gruen GS. Case report : recurrent piriformis syndrome after surgical release. Clin Orthop Relat Res. 2008;466(7):1745-1748. doi:10.1007/s11999-008-0151-5
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How can I relieve piriformis syndrome pain quickly?
Any movement or activity that engages the piriformis muscle can cause piriformis syndrome pain to start and peak immediately. When piriformis muscle pain starts, the following methods can help control the symptoms in the short term:
- Take rest. Resting for 24 to 48 hours may help reduce piriformis muscle irritation and decrease inflammation.
Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/
During this time, cold therapy followed by heat therapy may be tried to help reduce pain and encourage blood flow to the sore muscle. If the pain does not resolve within 48 hours, further treatment may be recommended.
See more information on Heat and Cold Therapy
- Try medication that reduces inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce inflammation and relieve pain in piriformis syndrome. NSAIDs are available over the counter and with a prescription.
- It is important to note that some NSAIDs may not be suitable for all patients due to the potential risk of gastric irritation and cardiac problems. To avoid these risks, consulting a physician before taking these medications is advisable.
- Ask your doctor about medication that relaxes muscles. Tense, spasming piriformis may be calmed by taking muscle relaxants, such as baclofen or cyclobenzaprine. Muscle relaxants are only available through a healthcare provider’s prescription.
See Muscle Relaxants
- Stretch your piriformis muscle. Exercises that stretch the piriformis muscle and increase its range of motion can help heal inflammation in the muscle and improve its strength and endurance. Piriformis muscle stretch is an effective method to relieve piriformis syndrome pain. Consistently performing these stretches can help prevent the pain from returning over time, providing long-term resolution of symptoms.
Watch 4 Easy Stretches For Piriformis Syndrome Pain Relief Video
- Massage the piriformis muscle. Massages can help relieve tightness in the piriformis muscle, encourage blood flow to the area, and speed up healing around the muscle and tendon—relieving pain and improving function. Massaging the piriformis muscle can be self-administered by the patient or delivered by a licensed massage therapist, and can involve a few different techniques:
- Neuromuscular massage: applying firm, sustained pressure over the affected buttock with the thumb and slowly gliding the thumb in an outward direction. This maneuver helps release tension within the tight muscle and surrounding connective tissue, thereby loosening the muscle fibers and releasing pressure on the sciatic nerve.
- Deep tissue massage: applying deep, firm pressure along specific energy lines or meridians in the body using the fingers, thumbs, elbows, and/or knees. This massage provides deep tissue relaxation by improving circulation and releasing toxins.
While medication and rest provide immediate relief of symptoms, they act by temporarily masking the pain. 5 Vij N, Kiernan H, Bisht R, et al. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med. 2021;11(1):e112825. Published 2021 Feb 2. doi:10.5812/aapm.112825 Physical therapy, exercise, and therapeutic massage help directly treat the piriformis muscle and prevent future flare-ups. Piriformis stretches and exercises are best learned from a trained physical therapist and can be easily performed at home. If the piriformis muscle is tender and stretching is not possible, taking an NSAID or muscle relaxant may help reduce pain and engage in the exercises more effectively.
Do injection treatments provide immediate pain relief from piriformis syndrome?
Steroid, local anesthetic, botulinum (Botox), mannitol (a type of carbohydrate), or vitamin B injections may be considered for piriformis syndrome that does not respond to the treatments listed above. 5 Vij N, Kiernan H, Bisht R, et al. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med. 2021;11(1):e112825. Published 2021 Feb 2. doi:10.5812/aapm.112825 , 6 Leng TY, Yin LJ. Use of Mannitol and Vitamins B in Piriformis Syndrome: A Possible Treatment Modality?. J Res Pharm Pract. 2019;8(1):36-37. doi:10.4103/jrpp.JRPP_18_93 The goal of these injections is to help the piriformis muscle relax and heal, thereby reducing pressure on the sciatic nerve.
The duration of pain relief from piriformis syndrome injections varies among patients. Research indicates that a majority of patients (up to 84%) receiving injection treatments for piriformis muscle pain experience immediate pain relief, lasting an average duration of 1 month. 5 Vij N, Kiernan H, Bisht R, et al. Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesth Pain Med. 2021;11(1):e112825. Published 2021 Feb 2. doi:10.5812/aapm.112825
Injections are minimally invasive and are usually considered a safe and low-risk procedure. However, as with any injection treatment, there is always a chance of developing side effects or potential complications, such as allergic reactions, nerve damage, or infection, which must be discussed in detail with the physician before considering these treatments.
Do I need surgery for piriformis syndrome pain?
When the piriformis muscle entraps the sciatic nerve due to anatomic variants or scar tissue formation, piriformis syndrome pain may become chronic, recurrent, or non-responsive to medical treatment—and need surgical intervention. 1 Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/ A surgeon who specializes in musculoskeletal conditions can advise if surgery is an option for piriformis syndrome pain and the potential benefits and risks that may be associated with the procedure.
Surgery for piriformis syndrome is considered in selective patients with debilitating pain despite trying different types of non-surgical treatments for several months. Piriformis syndrome surgery is usually a minimally invasive and elective surgery, meaning it is a surgery that can be planned in advance and scheduled with your surgeon rather than performed urgently/emergently.
Early treatment of piriformis syndrome is crucial in helping the muscle heal and prevent symptom progression. The location and function of this muscle deep in the buttock make it prone to recurrent use, causing daily debilitating pain in some individuals. Medication, physical therapy, and injection treatments can help keep the pain under control and prevent recurrences.
If piriformis syndrome symptoms fail to improve in the initial stages with rest and medication, it is advisable to consult a physician for further evaluation and treatment.
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