HomeHealth articlesphysiotherapyWhat Is the Treatment Protocol for Piriformis Syndrome?

Physiotherapeutic Management of Piriformis Syndrome

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Piriformis syndrome is a disease that causes sharp buttocks and low hip pain. This article details the treatment protocol of the same.

Written by

Dr. Kayathri P.

Medically reviewed by

Dr. Atul Prakash

Published At December 9, 2022
Reviewed AtApril 18, 2023

What Is Piriformis Syndrome?

Piriformis syndrome is a condition in which the piriformis muscle (it lies in the butt region and extends from the hip to the pelvic area) compresses the sciatic nerve (the largest nerve in the human body and provides sensation to the entire leg except for the inner side) leading to pain, numbness, and tingling in the buttock that may even extend down the thigh and leg. Athletes and people who sit for a prolonged time are at a higher risk of developing this condition.

How Does Piriformis Syndrome Occur?

Abnormal Anatomy: The sciatic nerve usually exits the sciatic notch along the inferior edge of the piriformis muscle. Occasionally the lateral division of this nerve pierces the piriformis, which can compress the sciatic nerve with contraction.

Issues External to the Nerve:

  1. Disc Herniation - In old age and due to weakening, spinal discs tend to displace from their original position.
  2. Irritation Due to Inflammation - Chronic irritation of the sciatic nerve can lead to inflammation, which in turn causes sciatica.

  3. Inflammation Caused by Bulged Discs - An inflamed disc can protrude into the spinal cord and compress the sciatic nerve leading to pain. If the contents from the disc are leaked into the nerves, it can cause inflammation.

  4. Cumulative Trauma - Repetitive exercises such as running that create tension in the sciatic nerve can lead to the weakening of the muscle.

  5. Changes in Gait - Leg weakness and altered gait for prolonged periods can compress and damage the sciatic nerve and also weaken the piriformis muscle.

  6. Prior Hip Surgery - Post hip surgery, piriformis muscles get tightened, and sometimes the sciatic nerve gets injured and may cause piriformis tightness.

  7. Leg-Length Discrepancy - Unequal length of legs on both sides can lead to altered gait and this, in turn, causes piriformis syndrome.

  8. Scoliosis - Scoliosis is a condition in which the spinal cord is abnormally curved, and this leads to compression of the spinal nerves.

What Are the Symptoms?

  1. Patients usually have chronic buttock pain, and low hip pain that extends down the leg through the course of the nerve, and this pain worsens on walking, climbing stairs, and running.

  2. Patients find difficulty while sitting and climbing stairs.

  3. Muscle spasms (cramps) occur near the lower hip or buttock region.

  4. Patients experience a reduced range of motion of the hip and leg on the affected side.

  5. Pain during bowel movements.

  6. Numbness in the lower hip and buttock region.

  7. Prolonged sitting causes pain and numbness.

  8. Pain extending to the posterior aspect of the thigh from the buttock.

  9. The patient might have swelling in the legs.

  10. A limp may be present in some cases.

How Is Piriformis Syndrome Diagnosed?

Straight-leg raise (SLR), and slump testing will be painful, and the most painful test will be resisted external hip rotation from full internal rotation with the patient reclined at 45 degrees of trunk flexion. X-rays are taken to confirm the diagnosis. CT (computed tomography), MRI (magnetic resonance imaging), and electromyography (a diagnostic procedure to assess nerve and muscle dysfunction) are done to rule out other causes.

What Is a Piriformis Test?

The patient is placed sideways with the test leg lifted to the maximum extent. The patient is asked to bend the affected hip to 60 degrees with the knees bent. The examiner stabilizes the hip with one hand and applies downward pressure to the knee. It causes pain in the piriformis muscle if it is tight. If the piriformis muscle is pinching in the sciatic nerve, pain results in the buttock, and sciatica (pain due to the sciatic nerve) may be experienced by the patient. Resisting lateral rotation with the muscle on stretching can cause sciatica.

What Are the Treatment Protocols for Piriformis Syndrome?

  • Pharmacological management is done by prescribing NSAIDs (non-steroidal anti-inflammatory drugs), muscle relaxants, and neuropathic pain medications.

  • Physical therapy through various stretching exercises, soft tissue mobilization, ultrasound, and lumbar spine treatments.

  • Osteopathic manipulative (bone manipulation is done by applying pressure to the muscles and soft tissues to allow them to heal) treatment has been found to increase the range of motion (ROM) and decrease pain.

  • Iontophoresis and botox injections have also been helpful.

  • Surgery is the last resort.

What Are the Physiotherapeutic Interventions?

  • Targeted stretching of the muscles like the hamstring, hip abductors, extensors, and external rotators.

  • Ultrasound and heat therapy.

  • Myofascial (fascia that is present around the muscles) release to relieve tightness.

  • Manual therapy, soft tissue, and joint mobilizations.

  • Deep massage.

  • Electrotherapy (electrical energy is sent to the affected area to ease the pain).

  • Patient education.

Rehabilitation Exercises:

Try to avoid activities that will trigger or aggravate the pain. Manage the pain using heat therapy and ice packs. Stretching muscles like the hamstring, hip abductors, extensors, and external rotators can reduce pain and increase the range of motion. Try doing the following stretches:

1. Piriformis Stretches: Try lying down on the floor with knees bent, pulling the left knee towards the chest, grasping it with the right hand, and holding the stretch for five seconds. Do the same in the opposite direction. Repeat thrice a day. One should try lying down on the floor with their knees bent and place their right ankle over the left and pull the left thigh towards the chest. Hold this position for five seconds. Do the same in the opposite direction. Repeat thrice a day.

2. Hamstring Stretches: After placing two chairs in front of each other, sit in a chair, place the heel of one leg on another chair and try to lean forward and hold this stretch for 30 seconds. Repeat this exercise thrice a day. Lie flat on the floor and try to lift one leg straight up towards the ceiling. Grab a towel and wrap it around the thigh. Hold this stretch for 30 seconds and repeat it thrice a day.

3. Standing Hamstring Stretches: Try to place the heel of the affected leg on a stool that is about 15 inches high. Keeping the knees straight, try to lean forward, bending at the hips. Hold this stretch for 15 to 30 seconds thrice a day. Repeat the same in the opposite direction.

4. Resisted Hip Abduction: Stand near the door in such a way that the affected leg is away from the door. Tie elastic tubing around the ankle of the affected leg and the other end of the tube to the door to keep the unaffected leg stable. Extend the affected leg sideways and return to starting position.

5. Partial Curl: Lie on the floor with hands straight and knees bent. Try to curl up forward until the shoulder is off the floor. While doing this, try to tighten the abdomen and stretch both hands. With hands stretched away toward the knee and held in this position for three seconds. Relax and repeat ten times thrice.

6. Quadruped Arm or Leg Raise: Try to get down with a cow pose with arms and legs touching the floor and face facing the floor. Tighten the abdomen and try to reach the left hand outward, and try lifting the right leg away. Hold this position for five seconds. Repeat in the opposite direction.

7. Stretch IT (Iliotibial) Band Supine Hip Rotation: Lie down on the floor with knees bent and place the right leg over the left knee and use the right leg to pull the left leg down. Hold this position for ten seconds. Repeat in the opposite direction. Do this ten times twice a day.

8. Stretch Piriformis Supine Crossed Leg: Lie on the back with knees bent and right ankle across left leg. Place your right hand on your hip to keep the pelvic area on the floor. Grasping the knee, pull the thigh inward while trying to move the right knee inward until a stretch is felt. Hold this position for ten seconds. Relax and repeat in the opposite direction. Do this ten times twice a day.


Piriformis syndrome is not life-threatening, and also it is not a lifelong condition. After proper therapy, it takes around four to six weeks for it to resolve. After progression, strength training is given to regain normal gait and functioning. Regular exercises that stretch and strengthen the lower hip can help ease the pain. Physiotherapeutic interventions like heat therapy, ultrasound, and electrotherapy have shown significant outcomes in relieving the symptoms of piriformis syndrome.

Frequently Asked Questions


What Treatment for Piriformis Syndrome Works the Quickest?

Treatment options for piriformis syndrome include:
- A couple of days of rest.
- Home workouts that stretch or strengthen the piriformis.
- Me dications that are non-steroidal anti-inflammatory (NSAIDs).
- Massage is an additional kind of treatment.
- Medications that ease muscular tension.
- Physical treatment for piriformis syndrome emphasizes stretching the piriformis.
- Injections of steroids.
- Injections of botulinum toxin.


What Does the Ache From Piriformis Syndrome Feel Like?

A dull discomfort can be felt in the buttock, back of the thigh, calf, and foot pain. Discomfort is felt when climbing stairs, and increased discomfort with extended sitting.


How Can the Piriformis Muscle Relax?

Place the ankle of the affected leg close to the knee on the thigh opposite it. When the patient feels a little stretch around the hip, use the hand to press the knee away from the body gently. Maintain the stretch for 30 seconds. Do this 2 to 4 times.


What Is the Ideal Posture to Sleep in Piriformis Syndrome?

The optimum position is to lie on the back if the doctor has identified piriformis syndrome as the condition. Lie on the back with a pillow between the knees and circular support, such as a towel rolled up under the lower back.


Can Walking Cure Piriformis?

For piriformis syndrome, walking or utilizing an elliptical machine are the best aerobic exercises. If there is no pain, the person can also jog. A solid core can support the piriformis.


What Are Some Piriformis Home Remedies?

The piriformis muscle and sciatic nerve can mend with rest. People should avoid activities that bring on symptoms. Applying ice and heat alternately helps lessen the swelling in the legs or buttocks. An ice pack can be applied for 20 minutes to the target area.


How Long Does Piriformis Healing Take?

While a significant injury can take six weeks or longer to heal, a mild injury might do so in a few weeks.


What Workouts Should People Who Have Piriformis Syndrome Avoid?

Exercises and positions to avoid if a person has piriformis syndrome: Don't sit still for too long. The piriformis muscle and sciatic nerve are under pressure as a result. Moreover, sitting workouts like biking are best avoided as they worsen the situation.


Can Piriformis Syndrome Be Seen on an MRI?

By displaying the normal and aberrant anatomy of the piriformis muscle and sciatic nerve and assisting in excluding other potential causes of external sciatic nerve entrapment, MRI assists in diagnosing piriformis syndrome.


Should Piriformis Syndrome Be Massaged?

Piriformis syndrome symptoms may be lessened by massaging the piriformis muscle. Stretching and self-massage regularly can relieve strain on the sciatic nerve and help the muscle soften up. Use a foam roller, tennis ball, or any ball of a comparable size.


How Can I Tell if I Have Piriformis or Sciatica?

It's crucial to realize that these disorders are distinguished mainly by the type of pain a person experiences. Hence, if a person has hip and buttocks pain, the patient probably has piriformis syndrome. It's probably sciatica if the lower back hurts less and the legs hurt more.


Is Piriformis Syndrome Responsive to Physiotherapy?

With focused strengthening exercises, manual treatment, and movement reeducation, physical therapists can treat piriformis syndrome pain and return to normal movement and range of motion in the affected area.


For Whom Is Piriformis Syndrome a Risk?

Being a woman, extended sitting, direct trauma, anatomical variance, and overuse seen with different sports activities are risk factors for developing piriformis syndrome. Due to piriformis syndrome, the buttock region can experience pain and discomfort that can occasionally extend into the lower leg.
Dr. Atul Prakash
Dr. Atul Prakash

Orthopedician and Traumatology


physiotherapypiriformis syndrome
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