self help and self treatment for piriformis syndrome

The very first thing you’ll want to do is to make sure that you are not dealing with a disc problem.  While this can be tricky, There is a simple DIY test that works pretty well for most people (HERE).  Secondly, learn all you can about Piriformis Syndrome.  Knowledge is power, and you simply cannot trust the average doctor (specialists included) to have much of an idea of what to do with people dealing with this common problem.  There are lots of good (as well as poor) online resources concerning Piriformis Syndrome, so be sure to check out everything.  Thirdly, don’t even think about doing something as rash as a “Piriformis Release” surgery without first doing everything in your power to avoid it.  And fourthly, don’t try and train (run, squat, etc) through a Piriformis Syndrome, as you could turn a mole hill into a mountain.

• TRY THE STRETCHES FIRST:  The Piriformis Stretches can be found on my Piriformis Syndrome Page (first link at top of page).  Although this is a great starting point, bear in mind that those of you with hardcore FACIAL ADHESIONS might get worse rather than getting better.  For a good (short) explanation of why, read THIS.   These stretches can be done in combination with Neural Flossing that I talk about below.   Be aware that the average doctor is going to tell you that PS can almost always be relieved (“cured”) by stretching.  This is simply not true.  However, the stretches are worth trying first. 

• TRY CHIROPRACTIC ADJUSTMENTS:  If you think you have PS but have never been to a CHIROPRACTOR, you need to see if it will help.  No; adjustments are not going to solve true PS, but subluxation of the pelvis (loss of normal alignment and motion) can mimic any number of problems, including this one.  I tell patients that if after a few adjustments there is no improvement (or there is great short-term improvement that does not last more than a few days — or even a few hours) your problem likely has to do with the Fascia (FASCIAL ADHESIONS or Trigger Points), and we’ll do a Tissue Remodeling Treatment to see.

• RELEASE THE TRIGGER POINTS AND THE FASCIAL FIBROSIS TO THE BEST OF YOUR ABILITY:  According to the Trigger Point Relief website, “Trigger points in the piriformis are very common, and are usually involved to some extent anytime there is pain in and coming from the gluteal / pelvic region. It is commonly called ‘piriformis syndrome’.  Females are affected far more than males.”  They go on to say how these referral patterns often cause pain in the region of the SACROILLIAC JOINT as well as the HAMSTRING and IT BAND.  To actually release the TRIGGER POINTS themselves, you will need to use a Theracane, lay on a ball (depending on preference, you can use about anything here that’s fist-sized or smaller), or have someone stick an elbow in the area and dig.  A word of caution about the definition of the word “dig“.  One of the singularly worst cases of PS I ever saw was of a woman in her late fifties whose nightmare started with a massage therapist sticking an elbow in her buttock too intensely during a routine massage and going to town. This is reiterated in the quote from the top of the page.

• LEARN HOW TO USE FOAM ROLLERS:  I am not going to spend any real time on this as there are any number of sites out there that are loaded with information (try YouTube).  I RECENTLY wrote about this topic, although not specifically for the Piriformis.

• TRY NEURAL FLOSSING:  Neural Flossing or “Nerve Flossing” is a term used to describe the attempt to move an entrapped nerve back and forth in a flossing motion, through a tissue restriction / adhesion.  Again, this is easy and there are any number of sites that show you how to go about doing it. 

• ACUPUNCTURE / DRY-NEEDLING:  ACUPUNCTURE and dry-needling both use needles, but their philosophy and treatment approach is very different.  Acupuncture is energy-based and is essentially an attempt to restore electrical integrity to the body.   In dry-needling, the clinician uses either an acupuncture or hypodermic needle to repeatedly puncture TP’s or restricted Fascia in an attempt to release it.   The dilemma with PS is the proximity of the Sciatic Nerve to the Piriformis Muscle.

• UNDERSTAND INFLAMMATION AND ITS RELATIONSHIP TO SCAR TISSUE:  This is a biggie for many of you.  It is not only critical to understand what INFLAMMATION is, but to grasp the fact that it always leads to something the medical community calls Fibrosis (I call it microscopic SCAR TISSUE).  I would suggest that you start by reading these three posts on the subject (HERE, HERE, and HERE).

• DEAL WITH YOUR WEIGHT:  OBESITY itself is considered an “Inflammatory” problem.  I would never say that excess weight is the only reason people develop Piriformis Syndrome.  However, excess weight increases your chances of developing PS, right along with almost every other health problem you can name.   Just bear in mind that I have seen any number of people who are all but totally debilitated by this problem who are living a super healthy lifestyle — particularly as far as their diet is concerned, and are fit, lean, and athletic.

• DEAL WITH ABNORMAL LOWER EXTREMITY BIOMECHANICS:  If you have really flat feet, or extremely high arches (I believe that the later is a bigger factor because high arches push you onto the outsides of your feet, putting huge amounts of mechanical stresses on the pelvis), you’ll need to deal with them (HERE).

• STRENGTHENING EXERCISES:  This one is tricky.  Try incorporating certain Yoga stretches into your routine first (for instance, the Cat and Pigeon Poses).   You can then go online and find any number of exercises that are reported to help strengthen the buttock region, and most specifically the Piriformis muscle.  The thing is, when it comes to PS, you never know what might help or what might set everything off.  This is why you add one at a time to your routine each week.  If you add a bunch of exercises and get worse, you’ll have trouble figuring out what did it.

• OTHERS:  Of course there are any number of treatments for Piriformis Syndrome, including the standard drugs (PAIN MEDS, NSAIDS, CORTICOSTEROID INJECTIONS, and MUSCLE RELAXERS).  Prolotherapy, PRP INJECTIONS, Transvaginal or Transrectal massage, COLD LASER, etc, etc, etc, are also options.  However, none of these are really “DIY” approaches.