From the Research
The recommended treatment for piriformis syndrome typically begins with conservative measures including rest, activity modification, and physical therapy, with a focus on stretching exercises targeting the piriformis muscle, as supported by the most recent study 1. The treatment approach should prioritize conservative management, similar to other soft tissue musculoskeletal conditions, as outlined in the study 1.
- Physical therapy should focus on stretching exercises targeting the piriformis muscle, such as the seated piriformis stretch, figure-four stretch, and hip rotator stretches, performed 2-3 times daily for 30 seconds each.
- Pain management often includes nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily).
- For more severe pain, muscle relaxants such as cyclobenzaprine (5-10mg three times daily) may be prescribed for short-term use (1-2 weeks).
- Application of heat or ice to the affected area for 15-20 minutes several times daily can provide additional relief. If conservative treatments fail after 4-6 weeks, more invasive options include corticosteroid or botulinum toxin injections directly into the piriformis muscle under imaging guidance, as described in the study 2. These treatments aim to reduce inflammation and muscle spasm that compress the sciatic nerve as it passes through or near the piriformis muscle, which is the underlying cause of the syndrome's characteristic buttock pain and sciatica-like symptoms. Surgery is rarely needed but may be considered in refractory cases or when there is a clear anatomical abnormality, as noted in the study 3.