Dr. Zatrok's blog
Dr. Zatrok's blog

Dr. Zatrok's blog

Piriformis syndrome and treatment options

by Dr. Zsolt Zatrok

Piriformis Syndrome causes pain deep in your buttocks. The pain is caused by the piriformis muscle compressing the sciatic nerve that passes nearby. This flat, band-like muscle is located under the gluteal muscles, “deep” in the buttocks, at the level of the top of the hip bone. It can be confused with a range of spinal conditions and so often doesn’t get the best treatment. Recently, I’ve had a lot of questions about home treatment options about piriformis syndrom. Therefore, I compiled treatment options in this article. 

piriformis syndrome causes diagram

The piriformis is a key muscle in lower limb movement. It stabilises the hip joint, lifts it sideways and rotates the thigh outwards at the same time. It contributes to walking, to the transfer of weight from one leg to the other, i.e. to maintaining balance. You use it for practically all movements, especially those that require lifting and rotation of the thighs.

The sciatic nerve is a thick and long nerve in the body. It emerges from the spine and passes deep below the piriformis muscle, and less frequently through it. It runs through the buttock, thigh, shin and finally ends in smaller branches on the leg.

Causes of piriformis syndrome

It is generally accepted that the compression of the nerve can be caused by spasm or tension of the piriformis muscle.

However, there are many reasons why this can happen. For example, trauma to the gluteal muscles (accidental bumps, kicks, falls) or, according to other opinions, in the case of runners and cyclists, regular microtrauma caused by repetitive and prolonged movement. These cause chronic inflammation, the muscle reflexively contracts, becomes stiff and if the nerve is too close, “in the wrong place”, it is pushed down, suppressed, which triggers the symptoms.

Diagnosis is not straightforward as there is no detectable lesion on ultrasound, X-ray or other imaging. Moreover, its symptoms can easily be mistaken for sciatica. An experienced diagnostician can detect it by analysing certain movements.

Symptoms of piriformis syndrome

Pain develops deep in the muscles of the buttocks. It can be just tingling or numbness. The pain may be uncomfortably severe, even spreading along the sciatic nerve (which is why it can be confused with sciatica). Sitting, walking, climbing stairs, running, etc., can make the symptoms worse.

Pressure can be applied directly to the muscles under the buttocks.

Pain causes the piriformis muscle to contract reflexively and become rigid. In severe cases, it can become so shortened that the affected side leg twists outwards, with the foot pointing sideways.

It is often unrecognised or misdiagnosed because it is easily confused with other common disorders such as disc herniation, discopathy, lumbar radicular pain (nerve entrapment), sciatica or hip bursitis. According to a US study (1), more than 16% of adult disability is due to chronic low back pain and at least 6% of this is actually piriformis syndrome. Correct assessment of symptoms allows timely and appropriate treatment.

Treatment possitibilities of piriformis syndrome

Traditional medical treatment is based on partial immobilisation. Medicines such as non-steroidal anti-inflammatory drugs are used. If that doesn’t work, then of course steroids or, for those who don’t respond, bolulinum toxin (botox) injections. Fortunately, surgery is rarely recommended (and performed). Physiotherapy methods are also used, such as muscle stimulation or ultrasound treatment

If you have been diagnosed with piriformis syndrome, you can treat it yourself at home. You can combine several treatments for maximum effectiveness. Treatments are designed to eliminate inflammation and relax and then strengthen the piriformis muscle.

Temporarily reduce your training doses

If you keep re-creating the root cause, you are working against recovery. Reducing (not eliminating completely) your training load will help the healing process to overcome the inflammation.

Cool the sore area

Place a bag filled with ice on the painful area for 10-15 minutes. Do not put it directly on the skin, as this may cause frostbite.

Cooling reduces inflammation. When you take the ice off, the body warms the cooled area, which leads to faster circulation. This in turn favours anti-inflammatory processes.

After 10-15 minutes of cooling, allow the muscles to warm up (1 hour off). Repeat 3-4 times.

Overcooling is not good, i.e. do not use this method for more than 2-3 days and do not cool for more than 15 minutes at a time.

Muscle stimulators and the treatment of piriformis syndrome

If you don’t have the time to take a few months off from exercise or are simply lazy to exercise for months, use an electric muscle stimulator device to treat piriformis syndrome. With a quality muscle stimulator, you can relax and strengthen muscles more effectively and faster than exercising, so you can get rid of symptoms faster.

Globus sports muscle stimulators (Runner Pro, Cycling Pro, Triathlon Pro) or Genesy 300 Pro all of them provide the programmes you need: a combination of pain relief, muscle relaxation and muscle strengthening can give you a definite improvement in as little as 2-3 weeks. Even with regular stretching and stimulator use, you may need a long period of up to 2-3 months to achieve complete resolution of symptoms.

[message title=”Cycling Pro” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • Built in programs for piriformis and sciaticaGlobus cycling pro with built in programs for piriformis and sciatica
  • Additional cycling related warmup, recovery and strenght exercises
  • multifunctional electrotherapy device
  • TENS | EMS, NMES, FES | MENS, MCR | Iontophoresis
  • max. 4 channels (8 electrodes)


[message title=”Runner Pro” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • Runner pro - Built in programs for piriformis and sciaticaBuilt in programs for piriformis and sciatica
  • Additional running related warmup, recovery and strenght exercises
  • multifunctional electrotherapy device
  • TENS | EMS, NMES, FES | MENS, MCR | Iontophoresis
  • max. 4 channels (8 electrodes)


Loosen and strengthen your piriformis!

You can also relax and strengthen the muscle with gymnastic exercises. True, you’ll need a few months to do this. Some of these exercises.

Piriformis syndrome stretching exercises


Piriformis stretch: Lie on your back. Pull one knee up, keeping the sole of the foot on the floor. Cross your other leg over it. Grasp your knee and slowly pull it towards your opposite shoulder. Hold for a few seconds. Repeat 20x on each side. Gently increase the duration of the hold.

Strengthening Exercise 1: Lie on your side. Pull your knees up so that both your hips and knee-foot joint are at a 60-degree angle. Now rotate your overhead thigh (lift your overhead knee). Hold for a few seconds, then release. Make sure your ankles are touching all the time, i.e. don’t lift your ankles! Repeat 10 times on each side.

Strengthening Exercise 2: Descend to all fours. Lift one knee to the side. Hold for a few seconds. Release back to the ground. Repeat 10 times on each side. Each day increase the time you hold by 1 second.

Treat with therapeutic ultrasound

Ultrasound has excellent anti-inflammatory properties, how it works is tt warms the treated tissues and relaxes stiff muscles. It accelerates the resolution of inflammation. Treat once a day for 15-20 days. Apply medium intensity for 10 minutes (one palm area over the painful area). If you are using ultrasound devices, don’t forget to apply gel on the skin (these gels come with the products usually, or you can just get one once you ran out). The piriformis muscle is deep, therefore, use a therapeutic ultrasound with a frequency of 1Mhz for treatment.

Stop ultrasound treatment after 12 days of treatment – even if some of your symptoms are still present. You should not have more than one ultrasound in the same place. You should take a break of 3-4 months before you can have treatment in the same place.

[message title=”M-Sonic 950 therapeutic ultrasound” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • Ultrasonic frequency: 1.0MHzSciatica, ultrasound device
  • Transducer area: 4.0cm²
  • Power: 1.6W/cm2
  • Max. power: 6.4 W (continuous mode)
  • Cycle time: L (5%), M (50%), H (100%)
  • Waveform: Pulsating, Continuous


[message title=”SonoStim 1032 Combined TENS/Therapy Ultrasound” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

  • TENS on channel 1SonoStim 1032 combined ultrasound and TENS unit
  • Ultrasonic frequency: 1.0MHz
  • Transducer area: 4.0cm²
  • Power: 1.25W/cm2
  • Max. power: 5.0 W
  • Cycle time: L (30%), M (40%), H (50%)
  • Waveform: pulsating


Microcurrent Treatment

Microcurrent is a less common electrotherapy method today. The most effective method for pain and inflammation relief is using it at home, in my opinion, it will become one of the most widely used treatments in the near future. Find my practical treatment with microcurrent devices here.

Treat 2-3 times a day for 20 minutes each time.

[message title=”Genesy 300 Pro” title_color=”#ffffff” title_bg=”#1e73be” title_icon=”” content_color=”#000000″ content_bg=”#ededed” id=””]

    • multifunction electrotherapy devicegenesy 300 pro multifunction electrotherapy device, facial neuritis
    • TENS | EMS, NMES, FES | MENS, MCR | Iontoforezis
    • max. 4 channels (8 electrodes)


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