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Physical Therapy for Piriformis Syndrome

Piriformis Syndrome

Piriformis syndrome is characterized by a constellation of symptoms ranging from a dull ache in the buttocks to debilitating pain radiating down the leg.

Fortunately, physical therapy for piriformis syndrome offers a targeted and effective treatment path.

This comprehensive guide delves into piriformis syndrome, its signs and symptoms, potential causes, and, most importantly, how physical therapy can help manage and alleviate this condition.

What Is Piriformis Syndrome?

Piriformis syndrome is a neuromuscular disorder leading to discomfort, tingling, or numb sensations in the buttocks, extending along the sciatic nerve through the lower thigh and into the leg.

The condition occurs when the piriformis muscle irritates or compresses the sciatic nerve.

What Is Piriformis Syndrome

The piriformis muscle helps in hip rotation and is essential for lower body movement. It runs diagonally from the lower spine to the upper surface of each femur (thighbone), with the sciatic nerve running underneath or through the muscle. In some people, the sciatic nerve passes through the piriformis muscle, making it more susceptible to compression.

Physical therapy for piriformis syndrome is the main treatment for the condition.

Signs and Symptoms of Piriformis Syndrome

The signs and symptoms of piriformis syndrome primarily center around pain and discomfort in the buttock region, which can radiate down the leg following the sciatic nerve path.

It's worth noting that the symptoms can vary in severity from person to person, and they often worsen with certain activities or positions. Here are some common signs and symptoms:

  • A deep, aching pain in the buttock on one side

  • Pain that may extend from the buttock down the back of the thigh, calf, and even into the foot, which may worsen with activities like climbing stairs, running, or walking long distances and after sitting for long periods.

  • Tingling or a pins-and-needles sensation radiating from the buttocks down the leg and sometimes into the foot

  • Numbness along the sciatic nerve

  • Tightness or stiffness in the hip or buttock area, especially after prolonged sitting or lying down

  • Difficulty sitting comfortably, often shifting weight from one buttock to the other

  • Pain when moving from a sitting to a standing position or vice versa

  • Occasionally, a noticeable limp while walking due to discomfort or muscle tightness

What Causes Piriformis Syndrome?

Piriformis syndrome occurs when the piriformis muscle irritates or compresses the sciatic nerve, leading to a range of symptoms, including pain, numbness, and tingling along the nerve path.

What Causes Piriformis Syndrome

Several factors can contribute to the development of piriformis syndrome:

Muscle Spasm or Tightness: A spasm in the piriformis muscle can put pressure on the sciatic nerve. Muscle tightness can also compress the nerve, leading to irritation and pain.

Overuse or Strain: Repetitive motions or activities that put strain on the piriformis muscle, such as long-distance running or excessive stair climbing, can lead to inflammation and muscle spasms.

Trauma: Direct trauma to the buttock area, such as a fall or impact during sports, can cause inflammation or spasms in the piriformis muscle, affecting the sciatic nerve.

Anatomical Variations: Some people have a sciatic nerve that runs through the piriformis muscle rather than beneath it, which makes them more susceptible to piriformis syndrome.

Posture and Biomechanical Factors: Poor posture, including prolonged sitting with legs crossed or an uneven gait, can put extra strain on the piriformis muscle. Imbalances in other muscle groups, such as weakness in the hip abductors, can contribute to piriformis syndrome.

Other Medical Conditions: Hip osteoarthritis or lumbar disc herniations can cause compensatory movements or postures that strain the piriformis muscle.

Pregnancy: The shift in weight and posture during pregnancy can put extra stress on the piriformis muscle.

Sedentary Lifestyle: Prolonged sitting or inactivity can lead to muscle tightness and imbalances that may contribute to piriformis syndrome.

After diagnosis, the medical professional will prescribe treatment, including physical therapy for piriformis syndrome.

How Piriformis Syndrome Can Be Treated With Physical Therapy

Physical therapy for piriformis syndrome is often a primary treatment approach. The goal is to reduce pain, improve mobility, and prevent future episodes.

While treatment plans are individualized based on the severity of symptoms and the patient's overall condition, here are some common elements of physical therapy for piriformis syndrome:

Stretching Exercises: A variety of physical therapy exercises for piriformis syndrome will include a piriformis stretch and hip flexor stretch, hip abductor, and core strengthening.

Manual Therapy: The therapist may use techniques like massage or trigger point therapy to relax the piriformis muscle and surrounding tissues, as well as joint mobilization to improve the mobility of the hip joint, thereby reducing strain on the piriformis.

Modalities: Heat/Cold Therapy reduces acute inflammation and relaxes the muscle. Ultrasound can promote tissue healing by increasing blood flow to the affected area.

How Piriformis Syndrome Can Be Treated With Physical Therapy

Addressing imbalances in walking patterns or posture can reduce stress on the piriformis muscle and the sciatic nerve.

Therapists may also teach patients the anatomy involved and how to avoid activities or postures that could exacerbate symptoms.

Physical Therapy Exercises for Piriformis Syndrome

Physical therapy exercises for piriformis syndrome aim to stretch and relax the piriformis muscle, improve hip mobility, and strengthen the muscles supporting the hip and lower back.

Stretching Exercises

Piriformis Stretch

  • Sit on a chair with both feet flat on the ground.

  • Cross your affected leg over the opposite knee, making a figure-4 with your legs.

  • Lean forward slightly, keeping your back straight until you feel a stretch in your buttocks.

  • Hold for 20-30 seconds, then release.

Seated Hip Stretch

  • Sit on the floor with your legs extended.

  • Bend your affected leg and cross it over the opposite leg.

  • Twist your torso toward the bent knee and use your arm to push against it, feeling a stretch in your buttocks and hip.

  • Hold for 20-30 seconds, then release.

Strengthening Exercises


  • Lie on your side with your hips and knees bent at 90 degrees.

  • Keeping your feet together, lift the top knee as far as comfortable without moving the pelvis.

Lower the knee back down. Perform 10-15 repetitions.

Hip Abductor Lifts

  • Lie on your side with your legs straight.

  • Lift the upper leg towards the ceiling while keeping it straight.

  • Lower it back down. Perform 10-15 repetitions.

Core Strengthening Exercises


  • Lie face down, then lift your body onto your elbows and toes.

  • Keep your back straight and hold for as long as you are comfortable.

Pelvic Tilts

  • Lie on your back with your knees bent.

  • Tighten your abdominal muscles while pushing your lower back into the floor.

  • Hold for 5-10 seconds.

Positions and Exercises to Avoid If You Have Piriformis Syndrome

If you have piriformis syndrome, some positions and exercises can exacerbate your symptoms by increasing tension on the piriformis muscle and the sciatic nerve.

Positions and Exercises to Avoid If You Have Piriformis Syndrome

Here are some things to avoid:

  • Prolonged Sitting: Sitting for extended periods can aggravate symptoms. If you have to sit for long durations, take breaks to stand or walk every 30 minutes.

  • Cross-Legged Sitting: This position can increase tension on the piriformis muscle, especially on the side where the leg is crossed.

  • Sitting on a Wallet: For men who keep their wallet in the back pocket, sitting on it can create an imbalance and put pressure on the piriformis muscle and sciatic nerve.

  • Deep Squats: Going too deep into a squat can stretch the piriformis muscle excessively, potentially irritating the sciatic nerve.

You should avoid lifting heavy weights and leg curls, jumping or running on uneven surfaces, overstretching, and yoga poses that put your hips into extreme rotation or flexion.

Frequently Asked Questions

-Are There Other Ways To Help Relieve Piriformis Syndrome?

In addition to physical therapy, there are several other ways to manage and relieve the symptoms of piriformis syndrome.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and reduce inflammation.

Muscle relaxants may be prescribed to relieve muscle spasms. Corticosteroid injections into the piriformis muscle can help reduce inflammation and pain. In some cases, Botox injections may be used to relieve muscle tightness, though this is less common.

Some people find relief from piriformis syndrome symptoms through acupuncture and chiropractic adjustments.

-How Long Does it Take to See Results from Physical Therapy for Piriformis Syndrome?

The time required to see results from physical therapy for piriformis syndrome can vary significantly depending on a range of factors, including the severity of the condition, how long you've been experiencing symptoms, your overall health, and how consistently you are able to follow the treatment plan.

Some people report feeling better after just a few physical therapy sessions.

For moderate cases, it might take several weeks (e.g., 4-8 weeks) of consistent physical therapy and home exercises to experience noticeable improvement.

In chronic or more severe cases, it may take several months of dedicated treatment to significantly reduce symptoms and improve quality of life.

It's important to keep in regular contact with your healthcare provider or physical therapist to monitor your progress and adjust your treatment plan as necessary.

Final Thoughts

Piriformis syndrome can significantly hamper a person's daily activities and overall quality of life. With symptoms that can range from mild discomfort to severe pain, the impact of piriformis syndrome can vary dramatically from one individual to another.

Physical therapy stands as a cornerstone in the treatment regimen, targeting symptom relief, functional improvement, and future prevention.

The journey to recovery may vary in length and intensity, but the destination—a life with reduced pain and enhanced mobility—is well worth it. Contact Miracle Rehab Clinic and book your appointment today.

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