“What can I do for piriformis syndrome?”
I was diagnosed with piriformis syndrome and don’t start PT for a few days. My pain and tightness has been extremely debilitating. I can’t sit or lay down comfortably, and during the worst spasms, I can’t even move hardly at all. It’s too tight to do any exercises at all. What can I do to relieve the pain and tightness? I have tried Advil but don’t want to overdo it with medication.
Female | 25 years old
Complaint duration: Months
Conditions: Piriformis syndrome
7 Answers
PhysicalTherapistPiriformisSyndrome
I'm really sorry to hear how debilitating the piriformis pain has been for you—it sounds incredibly frustrating. Since you're waiting to start PT, here are some gentle, non-medication approaches to help reduce the tightness and pain without aggravating it further.
1. Heat and Ice Therapy
Ice: Apply an ice pack to the piriformis area (deep in the glute) for 15-20 minutes at a time to reduce inflammation, especially after spasms.
Heat: Use a heating pad or warm compress for 15-20 minutes when the muscles feel very tight. Heat can promote blood flow and relax the muscle.
Tip: Alternate ice and heat if needed, as some people find it reduces spasms effectively.
2. Supported Positions for Relief
If sitting and lying down are painful, here are two positions to ease tension:
a. Reclined with Pillows
Lie on your back with knees bent and feet flat on the floor.
Place pillows under your knees to relax the low back and hips.
You can try adding a gentle ice or heat pack under your glutes while reclined.
b. Side-Lying Position
Lie on your non-painful side with a pillow between your knees to keep your hips aligned.
Place a pillow under your head for support.
Slightly curl into the fetal position to release pressure on the piriformis.
3. Gentle Muscle Release Techniques
Since stretching feels impossible right now, try these super gentle releases:
a. Guided Breathing for Relaxation
Lie in a reclined or supported position.
Place one hand on your belly, inhale slowly through your nose for 4-6 seconds, then exhale for 6-8 seconds.
Focus on softening your hips and glutes with each exhale.
This may not feel like much, but reducing nervous system tension can ease muscle spasms.
b. Self-Massage with a Soft Ball or Hands
Use a soft ball (like a therapy or tennis ball) to gently roll under the glutes while reclined.
Go very slow and avoid forcing into sharp pain—just enough pressure to encourage relaxation.
If the ball is too much, try light circular massage with your hands on the upper glute area.
4. Avoid Aggravating Positions
Avoid sitting for long periods—even short stints can tighten the muscle further. Stand up or recline as often as possible.
When standing, try to distribute your weight evenly and avoid shifting all your weight to one leg.
When to Seek Immediate Help
If the pain worsens to the point that you’re unable to move at all or you start to notice numbness or tingling down your leg or in your foot, it’s best to check with your doctor right away. This could indicate sciatic nerve involvement, which sometimes occurs with piriformis syndrome.
The key right now is to gently reduce muscle tension without over-stretching or aggravating the area. Focus on supported rest, heat/ice, and gentle mobility if tolerated. Once you begin PT, they’ll guide you through targeted exercises to address the tightness and spasms effectively.
1. Heat and Ice Therapy
Ice: Apply an ice pack to the piriformis area (deep in the glute) for 15-20 minutes at a time to reduce inflammation, especially after spasms.
Heat: Use a heating pad or warm compress for 15-20 minutes when the muscles feel very tight. Heat can promote blood flow and relax the muscle.
Tip: Alternate ice and heat if needed, as some people find it reduces spasms effectively.
2. Supported Positions for Relief
If sitting and lying down are painful, here are two positions to ease tension:
a. Reclined with Pillows
Lie on your back with knees bent and feet flat on the floor.
Place pillows under your knees to relax the low back and hips.
You can try adding a gentle ice or heat pack under your glutes while reclined.
b. Side-Lying Position
Lie on your non-painful side with a pillow between your knees to keep your hips aligned.
Place a pillow under your head for support.
Slightly curl into the fetal position to release pressure on the piriformis.
3. Gentle Muscle Release Techniques
Since stretching feels impossible right now, try these super gentle releases:
a. Guided Breathing for Relaxation
Lie in a reclined or supported position.
Place one hand on your belly, inhale slowly through your nose for 4-6 seconds, then exhale for 6-8 seconds.
Focus on softening your hips and glutes with each exhale.
This may not feel like much, but reducing nervous system tension can ease muscle spasms.
b. Self-Massage with a Soft Ball or Hands
Use a soft ball (like a therapy or tennis ball) to gently roll under the glutes while reclined.
Go very slow and avoid forcing into sharp pain—just enough pressure to encourage relaxation.
If the ball is too much, try light circular massage with your hands on the upper glute area.
4. Avoid Aggravating Positions
Avoid sitting for long periods—even short stints can tighten the muscle further. Stand up or recline as often as possible.
When standing, try to distribute your weight evenly and avoid shifting all your weight to one leg.
When to Seek Immediate Help
If the pain worsens to the point that you’re unable to move at all or you start to notice numbness or tingling down your leg or in your foot, it’s best to check with your doctor right away. This could indicate sciatic nerve involvement, which sometimes occurs with piriformis syndrome.
The key right now is to gently reduce muscle tension without over-stretching or aggravating the area. Focus on supported rest, heat/ice, and gentle mobility if tolerated. Once you begin PT, they’ll guide you through targeted exercises to address the tightness and spasms effectively.
I would recommend trying a piriformis stretch and fire hydrant exercises. Videos demonstrating how to perform both can be found on Youtube.
Heat is your best friend when you can't exercise due to spasms
Sorry to her about how bad your pain is! I'd recommend sciatic nerve glides and piriformis stretching and prone press ups. Here are a few youtube links of those: https://www.google.com/search?rlz=1C5CHFA_enUS931US933&sxsrf=APwXEdfn0S1sh6NMqNA25pmHuOFD-5r3Kg:1686483564243&q=sciatic+nerve+glides&tbm=vid&sa=X&ved=2ahUKEwillpDukLv_AhU8lWoFHV8fA6MQ0pQJegQIChAB&biw=1311&bih=687&dpr=2#fpstate=ive&vld=cid:43a771d2,vid:XP1yzpFR6ho
https://www.youtube.com/watch?v=8oPHrX_oALk
https://www.youtube.com/watch?v=UqSP7ZrHxRE
Hope these help until you get into PT!
https://www.youtube.com/watch?v=8oPHrX_oALk
https://www.youtube.com/watch?v=UqSP7ZrHxRE
Hope these help until you get into PT!
You could try working on the muscle with a tennis ball against the wall to help decrease the tightness and spasms as well as some gentle mobility: laying on your back doing some gentle hip internal and external rotation, hamstring stretching, if tolerated gentle hip flexor and piriformis stretching, and diaphragmatic breathing.
Some other means to manage your pain and symptoms more conservatively would include heat application followed by gentle hip external rotation stretches. Then followed by ice pack application to reduce tone and muscle spasms. If you are experiencing symptoms that spread into the legs "pins and needles" this may indicate the muscle is compressing the sciatic nerve in which case gentle ROM exercises or nerve glides can help. Please consult a physical therapist in your area that is familiar with orthopedic conditions to guidee you through treatment
Diagnosis of Piriformis syndrome is very broad and does not specify the reason for your problem. It is very important to determine what causes your symptoms in order to address them. History of the injury, mechanism of the injury, past activities, posture, mobility, your neurological and mechanical status, how you walk, and special tests are important in finding the reason for your complaints. Please see a qualified and experienced Physical Therapist who will spend time with you and answer your questions. Do not settle on the quick screen or short visit in the very busy clinic. Demand certified manual therapists and quality care. You are the customer and your insurance reimburses for the rendered services.=20
Reasons could be many: direct impact to the muscle, your SI or your hip joints could be mal tracking, you could have slight dysplasia or small functional rotary dysfunction in the thoracic spine, you could have T-L junction or lumbar spine dysfunction, you could have problem with your knee or ankle on either side (old sprain/injury), etc.
Before you see somebody you can try finding a comfortable position (back with knees bent, either side lying with a pillow between your knees, or stomach on your elbows) to find some relief, little movement is better than no movement and using heat (chronic condition - more than a week) or cold (acute condition). Be sure to use a protective layer between the heat/cold agent and the skin. You could have a sensory deficit in the buttock area and hurt your skin.=20
Taking care of your body is the best investment you can do and it will pay off for the years to come.
Reasons could be many: direct impact to the muscle, your SI or your hip joints could be mal tracking, you could have slight dysplasia or small functional rotary dysfunction in the thoracic spine, you could have T-L junction or lumbar spine dysfunction, you could have problem with your knee or ankle on either side (old sprain/injury), etc.
Before you see somebody you can try finding a comfortable position (back with knees bent, either side lying with a pillow between your knees, or stomach on your elbows) to find some relief, little movement is better than no movement and using heat (chronic condition - more than a week) or cold (acute condition). Be sure to use a protective layer between the heat/cold agent and the skin. You could have a sensory deficit in the buttock area and hurt your skin.=20
Taking care of your body is the best investment you can do and it will pay off for the years to come.
