Piriformis syndrome treatment

Piriformis syndrome treatment is another super common condition I see clients for on a regular basis. The medical definition is:  Sciatica that is caused by compression or irritation of the sciatic nerve by the piriformis muscle and is characterized by pain, tingling, and numbness in the buttocks often extending down the leg.

Clients often get this diagnosis after a lower back disc issue has been ruled out. Regular massage therapy sessions along with physical therapy is the standard treatment of care. 

What is piriformis syndrome 

Let's go over why you are feeling so much pain! The piriformis muscle is inflamed and in a full spasm. It's a thin flat muscle that starts at the hip joint and attaches to the base of the tail bone. And the sciatic nerve runs right through the middle. When we sit on our butt bones aka ischial tuberosities, that bony landmark can irritate the inflamed piriformis muscle. So sitting for long periods of time is the number one trigger. Your ischial tuberosities press on one the the main active trigger points. And not in a good way. 

Most people only have symptoms on one side. Usually the right leg. Because that is the side that gets the most irritation from driving. Long car rides if you are the driver can make getting out of the car and walking super painful. 

Sitting too long isn’t the only cause. Piriformis syndrome is also an overuse injury. Cyclists and runners are at risk if they have too many muscle imbalances. Endurance sports are very repetitive in nature. It’s that constant motion at a high impact that turns muscle imbalances into an overuse injury. You can learn more about this in another blog post I wrote about massage for runners. 

Common symptoms of piriformis syndrome 

What does piriformis syndrome actually feel like? You will notice a deep aching pain in the entire glute muscle. Usually only on one side. There is an overall pain that goes down the affected leg. Starts by stopping at the back of the knee. And as your symptoms progress without treatment that dull aching pain will go all the way down to the foot. The foot can also start cramping from sitting too long. There is a major key difference between piriformis syndrome and sciatica. With sciatica you can draw a line to the direction your pain is going. It’s not an all over aching feeling. However you can have sciatica and piriformis syndrome at the same time. As I have mentioned before, sitting makes your symptoms worse. When you are in the middle of a flare up the overall hip function gets tight and painful. You can read more about massage for lower back pain in another blog post I wrote. 

Why massage therapy works for piriformis syndrome 

Massage therapy is one of the main piriformis syndrome treatment suggestions from doctors. We know that massage helps to bring blood to the area. I personally use trigger point therapy often. This helps to give the nervous system a reboot. And  takes the pressure off the sciatic nerve. Massage in general does have a calming effect on the soft tissue. This is going to help that piriformis muscles from constantly being in a spasm 

Massage techniques 

Now let's go over what techniques I offer that help give you the most relief. The most popular service I offer is deep tissue massage. This is detailed focused work. Massage cream is used. The areas that I focus on are hamstrings, glutes. Right on the tail bone and lower back. Face up I go over the quads and IT Band. Just to make sure the pelvis is even and level. To go over all these areas it is going to take me an hour. You can learn more about the benefits of deep tissue massage HERE.  

Myofascial release is another popular option. There are no massage products used. Clients need to come in wearing workout shorts. This is also detailed focused work. I work on similar areas as the deep tissue massage. But there is more position changes on the table. Especially when clients are on their backs. There are a few different leg movements I have clients do while pinning down an area that doesn’t stay in its correct position in movement. This will also take me an hour.  

Cupping is also another great option. Cupping works by using vacuum pressure to pull and separate multiple layers of soft tissue at once. I use a combination of stationary cups and cups I glide. Pretty much work on the same areas as the deep tissue massage and myofascial release. You will have marks on your legs from cupping. So keep that in mind. The marks can last up to 10 days.          

How many massage therapy sessions will you need

Not going to lie. Piriformis syndrome can take many months to heal. One of the main reasons is because sitting for long periods of time flares up that inflammatory response. Here is what a treatment plan will look like. For chronic pain a weekly massage  is going to help stop that pain spasm pain cycle. Once your pain starts to lessen and becomes more localized bi-weekly sessions help to keep the piriformis muscle from spasming less. And maintenance is every 4-6 weeks. 

If your pain is down to the foot. Plan on at least 4 weeks of weekly massage sessions before the pain only travels to the knee. Then it is another 4 weeks before the pain is just in the glute area. Once the pain is just in the glute area. That area does take the longest to 100% heal. I would plan on 4-6 months. Once you get to the only plan in the glute area you can get improvements with bi-weekly massages. 

Other therapies to try 

Other complementary therapies to try are chiropractic adjustments. Misalignment with the SI joint, lower back and pelvis do put extra tension on that piriformis muscles. Acupuncture is going to help with the swelling and get the nerves to calm down. Acupuncturists can also place needles right into the active trigger points. I personally find this more effective than dry needling. And they also use cupping as well. Physical therapy should also be done. PT is going to help deal with those muscle imbalances that cause piriformis syndrome in the first place.

Keep up with walking breaks throughout your day. Especially for those clients that work at a desk for many hours a day. Yoga and Pilates will also help to stretch you out and get those tiny stabilizer muscles activating properly. 

When to talk to your doctor 

Things to look out for and seek other forms of treatments from your primary care provider. Extreme tightness in the lower back, down the legs that also goes into the groin area. Starting to have problems with bladder and bowel functions. The affected leg becoming weaker over time and having difficulty picking up your feet.    

FAQ about piriformis syndrome treatment  

If you are looking for a massage therapist in the West Boylston area that’s experienced in  piriformis syndrome treatment. I would love to help you feel better. You can book your appointment directly through my online calendar.

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