Home Care Protocol for Piriformis Syndrome

If your pain is in buttocks and back of thigh, but does not go below the knee you may have Piriformis Syndrome. This happens when the piriformis muscle (one of the major buttocks muscles) presses on the sciatic nerve. Piriformis syndrome can be caused by the piriformis muscle being
     a.) Too tight OR
     b.) Overstretched OR
     c.) Sprain/strained
 
1.) Reduce inflammation

• For 24 hours use this icing protocol: 10 minutes on painful-side buttocks / 10 minutes off / 10 minutes on again every 2 hours
• Use an over the counter anti-inflammatory treatment, i.e. NSAID and a topical anti-inflammatory
• After 24 hours use heat on the painful buttocks for 10 minutes 1-2x/day to interrupt the pain signal and increase blood flow. However, don't use heat more than this, it can cause inflammation.

2.) Gently Stretch

• It is difficult to tell yourself if the muscle is too tight or to overstretched. When doing the stretched listed below, shoot for the middle ground...a gentle stretch not an intense stretch. 
• Stretch both sides
• Do these stretches first: Gentle Knee to Chest Stretches for Low Back Arthritis  2 - 3 x per day or more.
• If your body says "I need more stretches"  Try this PT's 5 Best Sciatica Stretches for Piriformis Syndrome .  Listen to your body - don't overstretch or push yourself if any of these stretches are very difficult.

3.) Strengthen

• Strengthening exercises help to normalize and stabilize muscle function.
• Do these gentle strengthening exercises first:  4 Exercises for Back Spasm Relief - Stretch and Core Strengthen.  2 - 3 x per day or more. 
  • These are not just for spasm. They gently strengthen the low back, core and buttocks.
  • If these exercises are very easy, increase the intensity to your level of comfort. You can move your body higher, hold your body position longer, and/or do more repetitions. 
  • Always it is most important to listen to your body.

4.)  Balance Exercises

• When a muscle/tendon/ligament is injured as in sprain/strain, the neurological loop with the brain gets out of sync.  The best rehab exercise for a sprain/strain is balance exercise, which strengthens and also resets the neurological loop. 
• NOTE: 
  • If you are elderly, have osteoporosis or have poor balance ability: Be safe and hold on to a counter or door frame while doing balance exercise. Balance ability usually increase rapidly, so don't get discouraged. Do a little bit, at least 3 times a day.
• Do balance exercises for 5 minutes, 3-5 times per day (or more).   
• While doing balance exercise, do not look at your feet. Look across the room or into the distance.
• If you stand on one foot, try to hold your pelvis level.
• Here are balance tools/methods from easier to more difficult:
  • Simply stand on one leg at a time while holding on to a counter or door frame
  • Stand on both feet and/or one foot while using a  balance pad, which provides slight instability.
  • Stand on both feet and/or one foot while using a  balance disc, which provides moderate instability.  
  • Stand on both feet and/or one foot while using a wobble board, which provides a lot of instability.
  • If you use a BOSU ball, stand on the flat side, not the round side. Otherwise you will injure your ankles. This also provides a lot of instability.
• As your balance improves, increasingly challenge yourself by moving your legs, closing your eyes, etc. 
• Always during balance exercises:
  • Be safe
  • Don't look at your feet
  • Hold your pelvis level

The above assumes piriformis muscle pressure on the sciatic nerve.  Here are other common issues that could be causing sciatic-like pain.

• Disc Herniation:  If you pain  is in buttocks, back of thigh and also into the calf and/or foot you may have an inflamed lumbar disc pressing a one or more of the nerve roots that lead to the sciatic nerve. Here is the Home Protocol for Sciatica due to Disc Injury. 
• ITB Syndrome: If you have pain at the lateral thigh and lateral knee you may have ITB Syndrome; Try this PT's IT Band Syndrome Stretches & Exercises.  Listen to your body - don't overstretch or push yourself if any of these stretches are very difficult.

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Kelley LeBlanc, D.C.
Kelley Chiropractic and Wellness
Village at Wexford
1000 William Hilton Pkwy, Ste K100
Hilton Head Island, SC 29928
(843) 321-8119
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