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• Piriformis Syndrome: Injury Overview
• The Best Piriformis Treatments
• The Best Piriformis Syndrome Stretches and Exercises
• How to Sleep with Piriformis Syndrome

Home Treatments for Piriformis Syndrome

In some cases, for mild to moderate symptoms of piriformis syndrome, home treatment may be effective. Information on how to treat piriformis syndrome at home includes the following:

Rest

Rest can be helpful, especially if certain movements cause irritation. Rest can help the body heal. But too much rest is not usually beneficial. Research indicates treatment may include short-term rest, usually not more than 48 hours. 

Hot and Cold Therapy

Hot and cold therapy involves applying moist or dry heat to the affected area and/or applying ice or cold compresses to the area.

Ice or heat for piriformis syndrome is easy, low cost, and a noninvasive way to decrease pain for piriformis syndrome.

Each treatment works a little differently. For example, applying heat helps dilate the blood vessels. Heat therapy may help relax the muscles and improve blood flow to the area, promoting healing. Cold therapy constricts the blood flow to the area, which may help reduce inflammation.

Some studies indicate that a combination of home treatment, including cold therapy, may reduce piriformis symptoms in 79% of people.

Alternating cold and hot therapy may also reduce the risk of causing muscle spasms, which can occur with cold therapy. In turn, using ice may help avoid increased inflammation that can become a side effect of heat.

Applying moist heat before stretching can also help improve range of motion and the effectiveness of the stretch. Using cold therapy after stretching can assist in reducing inflammation stretching may have triggered.

Alternate hot and cold therapy by applying cold for a minute and alternating with heat for about three minutes. Repeat this for a few cycles.

Stretching and Exercise

Stretching is also a valuable treatment for piriformis syndrome. Research shows that stretching for piriformis syndrome helps promote flexibility, decrease muscle discomfort, and enhance healing. It may also improve mobility.

Several piriformis stretches are effective, such as the following:

Ankle over the knee seated

• Sit in a chair with your feet on the ground.
• Cross your ankle over the opposite knee.
• Push gently on your knee as you slightly lean forward. You should feel a stretch in your glute.
• Hold for 30 seconds.

Knee-to-shoulder stretch

• Lie flat on your back with your legs straight.
• Lift one leg to bend one knee.
• Using the opposite hand, pull your knee towards your opposite shoulder.
• Hold for 30 seconds.

Knees to the side

• Lie on your back with your knees bent and your feet on the floor.
• Stretch your arms out at shoulder level.
• Put your right foot on your left knee.
• Drop both knees to the left side.
• Hold for 30 seconds.

Massage

Massage helps relax the piriformis muscle, which may decrease spasming and pressure on the sciatic nerve. The massage may also promote the release of endorphins, which help fight pain.


Studies also indicate that massage is often beneficial for various types of pain and functional-related outcomes in people with pain. Additionally, massage generally has few adverse effects.

Different types of massage can help treat piriformis syndrome, including:

• Deep tissue: Deep tissue massage involves using sustained deep, slow tissue manipulation to target the inner layers of the muscle. It can help promote blood flow to the piriformis muscle.
• Myofascial trigger point therapy: This form of massage involves applying sustained pressure for 30 seconds to two minutes to the muscle’s trigger points to alleviate tension and pain.

Kinesiology Tape

Kinesiology tape is an elastic, flexible tape made of acrylic and adhesive that supports ligaments, tendons, and muscles during activity. It may help support the piriformis muscles and prevent them from contracting improperly or spasming.

Research in the Journal of Bodywork and Movement Therapies found kinesiology tape may be effective for increasing the range of motion and pain relief in people with trigger points in the piriformis muscle.

Seat Cushions

A seat cushion may be helpful to ease pain due to piriformis syndrome. The purpose is to support the lower back properly and reduce pressure. Although there are no studies specifically on using a seat cushion for piriformis syndrome treatment, it makes sense that relieving pressure on the piriformis muscles may decrease pain.

There are various types of seat cushions made from different materials. Look for a cushion that properly supports your thighs and hips, alleviating pressure points on the piriformis muscle. A cushion should also provide lumbar support and help prevent the lower back from slumping forward.

Sleeping Position

Your sleep position may affect pain related to piriformis syndrome. Sleeping on your back is usually the best position for piriformis syndrome. Back sleeping helps distribute pressure evenly and maintain proper spinal alignment.

Sleeping on your stomach is the worst position for piriformis syndrome since it puts pressure on the muscles and joints and also the neck and spine.

TENS Units

A TENS unit for piriformis syndrome may provide some level of pain relief. Transcutaneous electrical nerve stimulation (TENS) involves targeting certain nerves with low-voltage electricity. TENS stimulates the nerve fibers, which can reduce muscle spasms and block pain.

Studies indicate that people who received TENS therapy for piriformis syndrome reported significantly lower pain than those who did not.

Professional Treatments for Piriformis Syndrome

Professional treatment may be needed when piriformis syndrome treatment at home does not reduce symptoms. Professional treatment may include:

Injections

Different forms of injections are available to help reduce piriformis syndrome. Depending on the type of injection, it may help block pain, reduce inflammation, or ease spasms. Injections may include the following:

• Cortisone: This type of injection for piriformis syndrome decreases inflammation. It may also contain a medication to ease pain.
• Botox: Botox injections work by paralyzing the muscle and decreasing pain.
  

Studies indicate that injections can be useful in treating piriformis syndrome. For example, in one study, a combination of physical therapy and injections using a steroid and lidocaine resulted in 79% of people having at least a 50% reduction in pain for an average of 16 months. 

Injections for piriformis syndrome are typically administered by a healthcare professional, such as a doctor or physician’s assistant.

Ultrasound-Guided Dry Needling

Ultrasound-guided dry needling involves using an ultrasound to guide fine needles into part of the muscle tissue. This leads to increased blood flow to the areas and may cause a healing response.

Research has supported the effectiveness of ultrasound-guided needling for pain relief. For instance, one study found that patients treated for 10 days with ultrasound-guided needling and followed for six months had complete resolution of their pain by the end of treatment.

Acupuncture

Acupuncture involves inserting thin needles into certain points in the body. It is not entirely clear how acupuncture works. The pressure from the needles may release endorphins that reduce pain. Pressure from the needles may also affect the autonomic nervous system and block pain.

Surgery

Surgery is often a last resort for piriformis syndrome treatment. It is only recommended if other types of treatment do not work. Surgical procedures usually include:

• Sciatic nerve decompression: This involves a procedure to ease the compression on the sciatic nerve by moving around or removing the surrounding structures involved in sciatic nerve entrapment.
• Piriformis muscle release: This procedure involves releasing or removing a part of the piriformis muscle to reduce compression of the sciatic nerve.

Studies show that surgical procedures have a high success rate. For example, one study of 239 patients found that 83% of people had satisfactory results.

Physical Therapy

Physical therapy may include exercises to strengthen the area and improve mobility. PT may also include a combination of heat and cold therapy and stretches.

Physical therapy is often beneficial as part of a treatment plan for piriformis syndrome. For example, to achieve about a 70% improvement in symptoms, patients typically follow 2-3 weekly therapy sessions for 2-3 months.

Conclusion

Piriformis syndrome can adversely affect overall functioning and quality of life. It can also affect mobility and lead to chronic pain.

Treatment may include professional options, such as injections, physical therapy, and surgery. Piriformis treatment at home includes rest, ice and heat, acupuncture, and massage.

Finding the right treatment option may take a little trial and error, but it is essential to treat piriformis syndrome before symptoms become worse.

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