How to Heal Piriformis Syndrome Pain: The Most Effective Stretches, Workouts, and Therapy Options

Introduction

Dealing with piriformis syndrome pain can be frustrating and exhausting. If you have a deep ache in one buttock that sometimes shoots down your leg, you’re not alone – this condition can feel like a stubborn sciatica that just won’t quit. As someone who has helped many patients with piriformis issues, I understand how this pain can disrupt your daily life. The good news is there are effective ways to heal and manage piriformis syndrome. In this post, we’ll explore the most effective stretches and workouts for piriformis relief, plus cutting-edge therapy options (like shockwave therapy) that can help you find lasting relief. Our approach at Unpain Clinic (here in Edmonton) is warm, empathetic, and evidence-informed – we won’t just ask “Where does it hurt?” but “Why does it hurt?”. Let’s dive in and start your journey to being pain-free.

(Disclaimer: The information below is evidence-based and intended to guide you, but every individual is different. Always consult a healthcare provider for personalized advice. Results may vary.)

What is Piriformis Syndrome and Why Does the Pain Persist?

Piriformis syndrome is a condition in which the piriformis muscle – a small, deep muscle in your buttock – irritates or compresses the sciatic nerve. This irritation can cause buttock pain that often radiates down the back of the thigh (and sometimes even to the calf or foot), mimicking sciatica. Unlike classic sciatica from a herniated disc, piriformis syndrome is caused by a problem in the buttock region, not the spine. In fact, research estimates piriformis syndrome accounts for only about 0.3% to 6% of all cases of low back pain/sciatica – so it’s relatively uncommon, but often underdiagnosed. It was only recently (2019) recognized with its own diagnostic code, which shows how overlooked it’s been.

Why does piriformis syndrome happen? Sometimes there are clear causes, and other times it develops insidiously. Common triggers include muscle overuse or injury (for example, a fall on the buttocks or an intense bout of exercise can injure or inflame the piriformis). In some cases, anatomical anomalies – such as an unusually shaped piriformis or a sciatic nerve that takes an unusual path – can predispose you to this syndrome. More often, piriformis syndrome is secondary to other issues: an imbalance in hip muscles, poor posture, gait abnormalities, or even prolonged sitting can lead to the piriformis muscle tightening up or spasming. When the piriformis tightens, it can press on the sciatic nerve running underneath it (or through it, in some people), causing that trademark radiating pain.

Symptoms of piriformis syndrome typically include a dull ache in the buttock, tenderness deep in the gluteal area, and pain that worsens when sitting for long periods or with certain movements. Many patients report it’s hard to sit on the affected side – some even sit with their weight shifted to the other buttock. Turning your hip or leg outward (for instance, crossing one ankle over the opposite knee) might trigger pain. There’s often a tender spot near the sciatic notch (a bony landmark in the buttock), and any maneuver that increases piriformis muscle tension (like a stretching test) can reproduce the pain. These four signs – buttock pain, pain aggravated by sitting, tenderness near the sciatic notch, and pain with piriformis stretch – are commonly used by clinicians to recognize piriformis syndrome. Sometimes numbness or tingling down the leg can occur, but typically the primary complaint is deep buttock pain.

One frustrating aspect of piriformis syndrome is that it can come and go. You might have days or weeks of little pain, and then suddenly a long car ride or an aggressive workout flares it up. Why does piriformis syndrome pain come and go? The piriformis muscle (and the sciatic nerve) can get irritated by certain activities and then calm down with rest. For example, increased sitting, especially on hard surfaces or with poor posture, can tighten the piriformis and spark a flare. Conversely, staying active and doing your stretches can settle it down, making the pain subside for a while. Many patients find their piriformis syndrome behaves in a cyclic manner – flaring up during times of overuse or prolonged sitting, then easing when they modify their activities. This on-and-off nature can make it tricky to pin down the cause, and sometimes people think “it went away” only to have it return later. The key is addressing the underlying cause, not just the symptoms, so it doesn’t keep sneaking back.

Diagnosing piriformis syndrome can be challenging. There’s no single definitive “piriformis syndrome test” like an X-ray or blood test. Doctors and physiotherapists usually diagnose it based on your history, symptoms, and a physical exam. They may do specific exam maneuvers – like the FAIR test (Flexion, Adduction, Internal Rotation test) – which stresses the piriformis to see if it reproduces your pain. Often, imaging (like MRI) is done to rule out other causes (for example, a lumbar disc herniation). Interestingly, in one review of many piriformis cases, only about 30% had MRI findings confirming the diagnosis. This means most cases are diagnosed clinically. That same review noted that when diagnosis was made without clear imaging evidence, patients had a higher chance of treatment failure or needing surgery later. In other words, some people get treated for piriformis syndrome when in fact the pain might be coming from something else – which is why a thorough assessment is so important.

Why can the pain persist chronically? Piriformis syndrome causes pain that persists when the underlying muscle-nerve irritation hasn’t been fully resolved. If all you do is rest and take painkillers, the piriformis muscle might stay tight and chronically inflamed – so as soon as you resume normal activities, the pain returns. Or there may be contributing factors keeping the piriformis irritated (for instance, an imbalance where other hip muscles are weak, forcing the piriformis to overwork). Without addressing those, the syndrome can become a lingering issue. Additionally, the sciatic nerve itself can become sensitized if it’s been compressed for a long time – meaning it becomes more reactive and painful even with less provocation. This is why piriformis syndrome often requires a multifaceted approach to truly heal: relaxing the piriformis muscle, calming the nerve, correcting any mechanical imbalances, and improving your movement patterns. We’ll get into the specifics of how to do that, from home stretches to advanced therapies.

Before jumping into treatments, it’s worth noting that piriformis syndrome is often confused with other problems. The symptoms overlap with common sciatica (from a disc) and with something called “deep gluteal syndrome” (a broader term for any sciatic nerve entrapment in the buttock). A skilled clinician will consider all possible causes. In some cases, what seems like piriformis syndrome could actually be due to trigger points in neighboring muscles like the gluteus medius or minimus (sometimes called “pseudo-sciatica”). That’s why at Unpain Clinic we take a whole-body approach – we make sure to pinpoint the true cause of your pain (be it piriformis or something else) so we can treat it effectively.

What Research Says: Evidence-Based Ways to Relieve Piriformis Syndrome

When it comes to treating piriformis syndrome, scientific research suggests a combination of conservative therapies can be quite effective. Let’s summarize the key findings from studies and clinical trials, so you know we’re not just guessing here:
Physical Therapy and Exercise: Exercise is often the first line of treatment. Gentle stretching and strengthening can improve piriformis syndrome symptoms for many patients. In fact, even short-term piriformis muscle stretching has been shown to improve patients’ ability to carry out daily activities (meaning better function in day-to-day life) according to clinical trial findings. A simple home program can make a difference. Strengthening certain muscles is important too – one study in 2024 found that doing a single session of targeted hip exercises (specifically glute bridges and clamshells, which activate the glutes and hip rotators) immediately improved patients’ balance and stability. Because this routine was so easy and helpful, the researchers suggested that patients incorporate these exercises into their daily activity for piriformis syndrome. The bottom line: targeted exercise therapy can significantly help, and it’s a core part of piriformis syndrome management.

Medical Management (Medication): There’s no magic pill for piriformis syndrome, but medications can support your recovery by reducing pain and inflammation. Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs, like ibuprofen or naproxen) are often used to reduce inflammation around the sciatic nerve and piriformis muscle. In more stubborn cases, doctors may prescribe muscle relaxants or stronger analgesics for short-term use. These can provide temporary relief but don’t address the root cause (the tight muscle or nerve compression). Steroid injections are another medical option: injecting a corticosteroid (or anesthetic) around the piriformis can decrease inflammation and pain. Some patients get significant relief from a well-placed piriformis injection – but for others, it might be temporary. There’s also Botox® (botulinum toxin) injections, which aim to actually relax the piriformis muscle by partially paralyzing it in a controlled way. A 2021 literature review noted that medications, physical therapy, and injections (steroid or botulinum toxin) all show promise for piriformis syndrome, with few adverse effects. In other words, these treatments can be effective and are generally safe, so they’re worth considering in a comprehensive plan. (Always have injections done by a qualified professional using imaging guidance for safety and accuracy.)

Dry Needling and Acupuncture: Dry needling is a technique where a thin needle (like an acupuncture needle) is inserted into the muscle – often to release myofascial trigger points (“knots”). For piriformis syndrome, dry needling can help relax the piriformis muscle and reduce pressure on the sciatic nerve. A 2023 clinical trial compared ultrasound-guided dry needling of the piriformis versus a standard exercise program. After three months, both groups improved significantly in pain relief, physical function, and disability scores, and neither was superior. This suggests that dry needling is as effective as therapeutic exercise – and it can be a great option if someone has trouble doing the exercises. The authors concluded that dry needling is a useful minimally invasive treatment to consider, especially for patients who may not tolerate or adhere to an exercise regimen. Acupuncture (a related technique rooted in traditional Chinese medicine) may also provide relief for some individuals, though specific research on acupuncture for piriformis syndrome is limited. The principle is similar – stimulating the muscle and nerve area to promote healing and pain relief.

Advanced Injections (PRP and Hydrodissection): Beyond steroid or Botox injections, newer regenerative techniques have entered the scene. Platelet-Rich Plasma (PRP) involves drawing a small amount of your blood, concentrating the platelets (which are rich in growth factors), and injecting that into the injury site to promote healing. In piriformis syndrome, PRP is still being studied, but early results are promising. A randomized trial in 2022 on piriformis syndrome patients compared a single PRP injection to a saline injection (placebo). Both groups improved, but the PRP group had faster and greater improvements in pain and function in the first week. By one month, outcomes were similar between PRP and placebo, suggesting the main benefit of PRP was an earlier relief. The researchers noted a repeat PRP injection might be needed for longer-term effect. So PRP isn’t a guaranteed cure-all, but it appears to accelerate early recovery for some. Another technique is hydrodissection, where a fluid (like saline with a bit of anesthetic) is injected under ultrasound guidance to physically separate the piriformis muscle from the sciatic nerve if they’re stuck together by adhesions. A small 2022 report found that ultrasound-guided hydrodissection with dilute anesthetic provided effective relief with lower risk, suggesting it could be more convenient than repeated steroid or Botox shots in certain cases. These advanced treatments would typically be considered if standard conservative measures aren’t sufficient and are usually done by specialists (like sports medicine physicians or pain management doctors).

Surgical Options: It’s worth mentioning that surgery is rarely needed for piriformis syndrome, but in refractory cases it is an option. Surgery for piriformis syndrome usually involves releasing the piriformis muscle (cutting the tendon to relieve pressure) or decompressing the sciatic nerve in the buttock. Because piriformis syndrome can be hard to conclusively diagnose, surgery is approached with caution – you don’t want to operate unless you’re quite sure the piriformis is the culprit. A systematic review of case reports in 2025 found that across many patients, about 58.9% ended up needing surgery (often because conservative treatments failed or the diagnosis was confirmed during surgery). Keep in mind that published case reports tend to bias toward severe cases (milder ones don’t get reported), so this doesn’t mean most people with piriformis syndrome need surgery – it means that among the tougher cases doctors wrote up, many went to surgery. When surgery is done, the more modern approach is endoscopic piriformis release, which is minimally invasive. This has a higher success rate and fewer complications compared to older open surgery techniques. The success rates in literature are fairly high, and many patients do get relief after surgical release. However, all surgeons (and we at the clinic) strongly emphasize exhausting conservative treatments first. Surgery carries risks, and if there’s any uncertainty about the diagnosis, an operation might not help or could even make things worse. The general consensus: reserve surgery as a last resort for cases that just do not improve with comprehensive non-surgical care.

Shockwave Therapy (ESWT): One emerging treatment for piriformis syndrome pain – and one we specialize in at Unpain Clinic – is Extracorporeal Shockwave Therapy (ESWT). Shockwave therapy uses acoustic pressure waves delivered to the painful area to stimulate healing and reduce pain. You may have heard of shockwave for plantar fasciitis or tendon issues; now it’s being applied to deep muscle problems as well. How can it help piriformis syndrome? By sending these healing waves into the piriformis muscle and surrounding tissues, we aim to break the pain-spasm cycle, improve blood flow, and reduce fibrosis (scar tissue) in the muscle. Research is growing: a 2024 case study reported that applying shockwave therapy to a patient with piriformis syndrome resulted in significantly reduced pain levels, decreased piriformis muscle tightness, and even less swelling of the sciatic nerve on MRI after treatment. That’s objective improvement – the nerve was less irritated on imaging, which is pretty exciting. Another line of research (mostly in lab studies) suggests shockwaves may promote nerve regeneration and healing at the cellular level. While we need more studies to fully prove the benefits for piriformis syndrome, these early findings align with what we see in our clinic: many patients who have “tried everything” notice meaningful relief after shockwave therapy. It’s also very safe when done properly – non-invasive, no needles, no drugs. (You might feel a bit sore after a session, similar to how you’d feel after a deep massage, but that’s usually short-lived.)

In summary, the research tells us that healing piriformis syndrome often requires a mix of therapies. Conservative treatments like exercise and physiotherapy should be the foundation – they help a good number of people (approximately 40-50% recover well with these alone). For those still in pain, minimally invasive options – dry needling, injections, shockwave – can provide that extra relief and resolve the issue without surgery. And in the rare scenario that surgery is needed, endoscopic techniques have a high success rate when the diagnosis is confirmed.
Most importantly, studies reinforce that treating piriformis syndrome isn’t about one magic cure. It’s about addressing muscle tightness, nerve irritation, and any contributing factors in the whole body. This is exactly how we approach it at Unpain Clinic: a holistic game plan built on evidence-based therapies. In the next section, we’ll walk you through what that looks like, including some of the cutting-edge modalities we offer for piriformis syndrome pain.

Treatment Options at Unpain Clinic

At Unpain Clinic, our mission is to find the root cause of your piriformis syndrome pain and fix it – not just provide a temporary Band-Aid. Located in Edmonton, we’ve helped many patients finally break free from the cycle of “it hurts, I rest, it comes back again.” Our approach is warm, one-on-one, and backed by the latest research. Here’s what you can expect when you come to us with suspected piriformis syndrome:

1. Comprehensive Initial Assessment: We always start with a thorough evaluation. Piriformis syndrome can be tricky to diagnose, so we take our time in the first session to really understand your unique case. This 60-minute Initial Assessment (conducted by a licensed physiotherapist or chiropractor) will look at your whole body. We’ll discuss your history – when did the pain start, what activities aggravate it (sitting, climbing stairs, running?), and what you’ve tried so far. Then we perform a detailed physical exam: checking your spine alignment, hip mobility, muscle strengths and flexibility, posture, gait, and specific piriformis tests. Often, this comprehensive approach reveals contributing factors that others might miss. For example, we might discover that you have very weak gluteal muscles or a stiff sacroiliac joint, which is causing the piriformis to work overtime and pinch the nerve. Or perhaps an old ankle injury has altered your walking pattern, leading to piriformis strain. We also palpate (feel) the deep gluteal area to pinpoint tenderness and tension. By the end of this assessment, we will map out your pain pattern and its causes and explain to you exactly what’s going on – so you leave with clarity. (Important: our Initial Assessment is exam-only; we typically don’t do treatment on the first visit. This is so we have time to find the “why” before we start any “fix.” We’ll detail what’s included in this assessment in the CTA at the end of this post.)

2. Shockwave Therapy & EMTT: One of the hallmark treatments we offer for piriformis syndrome pain is Extracorporeal Shockwave Therapy (ESWT), often paired with EMTT (Electromagnetic Transduction Therapy). As noted earlier, shockwave is a non-invasive therapy where acoustic waves are delivered into the muscle and tendon tissues. In piriformis syndrome, our focus is to use shockwaves to reduce the piriformis muscle spasm and promote healing in the irritated sciatic nerve. The therapy itself is done with a handheld device pressed against the skin over your buttock – it delivers pulses that you’ll feel as rapid taps. We adjust the intensity to keep you comfortable (most patients describe it as tolerable and even oddly relieving – definitely “relatively painless” compared to the chronic pain they feel). What does shockwave do? It increases blood circulation in the muscle, helps break up scar tissue or adhesions, and triggers a biological healing response. In practical terms, if your piriformis is like a tight, knotted-up rubber band choking the nerve, shockwave helps it loosen and relax by reducing fibrosis and encouraging muscle fibers to reset. We’ve seen patients who had persistent pain for months finally get relief after a few shockwave sessions – it can truly jump-start a stalled healing process. And because shockwave can reach deep tissues, it’s ideal for piriformis which lies underneath other gluteal muscles.

We often combine ESWT with EMTT in the same session. EMTT is a newer technology that uses high-frequency electromagnetic pulses to reduce inflammation and pain. If shockwave is working mechanically on the tissue, think of EMTT as working on a cellular level – it’s painless; you just lie there with a loop emitting pulses. For nerve-related pain like piriformis syndrome, EMTT can calm down the irritated sciatic nerve fibers and enhance cellular repair. Our clinicians have found that pairing Shockwave + EMTT yields better and faster results than either alone in stubborn cases. Research is catching up: there’s growing evidence that combining mechanical and electromagnetic stimulation can have a synergistic effect on pain relief and tissue healing (for example, studies in low back/sciatic pain populations show improved outcomes with combo therapy). While more specific research on EMTT for piriformis is pending, our clinical experience suggests it’s a valuable adjunct – and importantly, it’s safe and has no known side effects. If you’re curious to hear more, our founder Uran Berisha even discussed shockwave therapy for hard-to-treat back pain in an Unpain Clinic podcast (Episode #7, “How to Relieve Back Pain When Nothing Else Works,” Nov 18, 2021) – explaining how shockwaves can penetrate dense scar tissue and reset muscle patterns in ways other therapies can’t.

3. Manual Therapy & Neuromodulation: Hands-on therapy is often crucial for piriformis syndrome, especially if we find joint stiffness or other muscles contributing. Manual therapy means our physiotherapists or chiropractors will use their hands to mobilize and gently move your joints (like your lumbar spine, sacroiliac joint, or hip) if they’re restricted. Sometimes, piriformis pain is aggravated because joints aren’t moving well – for example, a locked-up hip or spine can put extra strain on the piriformis and nerve. By restoring normal motion with skilled mobilizations or adjustments, we can relieve pressure. We also use soft tissue techniques: think of it like a specialized massage for your deep gluteal muscles. We can apply sustained pressure or stretches to the piriformis and surrounding muscles (glutes, hip rotators) to encourage them to relax and release their grip on the sciatic nerve. Many patients find this immediately relieving – it’s that “good pain” feeling when a tight knot is being worked out.

Neuromodulation in our context refers to techniques that alter nerve activity to reduce pain. One simple form is using therapeutic electrical stimulation (like a TENS unit or similar device) around the irritated nerve. This can help “turn down” the pain signals by essentially confusing the nervous system (the soothing tingling from the stim can override some of the pain messages – the Gate Control Theory of pain). We also have a more invasive option called Percutaneous Neuromodulation Therapy (PNT), where fine needles are inserted near the nerve and then electrically stimulated – but this is only done if needed, and by trained clinicians. The goal of neuromodulation is to calm an overactive nerve or to wake up an underactive muscle. In piriformis syndrome, we might use it to calm the sciatic nerve if it’s super sensitized, or to get your glute muscles firing better if they’ve been inhibited by pain. Combining manual therapy with these neuromodulation techniques is powerful: the hands-on work fixes biomechanical issues, while the modulation fixes the nerve’s “software” response. For example, after we do a piriformis release manually, we might use a few minutes of TENS on your lower back and buttock to reinforce a relaxed state and pain relief. Studies have shown that manual therapy plus electrotherapy can improve sciatica outcomes better than standard care, so we integrate these modalities as appropriate. Throughout, we ensure you’re comfortable – we always communicate with you during techniques (letting us know if pressure is too much, etc.). The session is very interactive.

4. Movement Re-Training and Exercise Therapy: We’re big believers in the mantra that “exercise is medicine.” Once we’ve reduced your pain enough (often through the above modalities) and improved your mobility, we will gradually introduce targeted exercises and stretches for you to do. This might even happen on the second session or so – we won’t wait until you’re 100% pain-free, but we’ll pick the right timing. The exercises are tailored to what we found in your assessment. Commonly, for piriformis issues, we prescribe glute strengthening (to take load off the piriformis). This can include exercises like glute bridges, clamshells, or side-lying leg lifts. If you had weakness in your core or hips, we’ll incorporate core stabilization exercises (planks or bird-dogs, for example) and hip strengthening moves. We also address any flexibility issues: gentle piriformis stretches will likely be taught – such as the figure-4 stretch (lying on your back and crossing one ankle over the opposite knee, then pulling the opposite thigh toward you) which targets the piriformis nicely. Piriformis syndrome stretches are a key part of preventing the muscle from tightening up again. We may also show you hamstring stretches or hip flexor stretches, because tightness in those areas can indirectly stress the piriformis. Our therapists or kinesiologists ensure you do each exercise with proper form. This is crucial – doing the right exercise the wrong way won’t help and could hurt. We often see patients who were given generic “piriformis syndrome exercises” from Dr. Google but they weren’t doing them correctly or doing the ones that their body actually needed. So we coach you through it.

The aim of exercise therapy is twofold: short-term pain relief and long-term prevention. In the short term, moving the body (in a gentle, correct way) increases blood flow and helps the nerve glide, which can reduce pain. We might incorporate specific nerve gliding exercises for the sciatic nerve – these are gentle, controlled leg movements that help the nerve move freely through the tissues, potentially easing pain if it’s caught up. In the long term, stronger glutes and core, and more flexible hips, mean your piriformis won’t have to tense up as much and your sciatic nerve will be less likely to get irritated during daily activities. In essence, we’re fixing the movement patterns that contributed to your injury so you stay better. Research supports exercise for these types of pain: for instance, exercise programs including strengthening and stretching have been shown to significantly improve sciatica-like symptoms over time. It’s not an overnight cure, but consistency pays off. Don’t worry – we won’t overload you with a million exercises. You’ll get just a few key ones to do at home between sessions, and we’ll progress them as you improve. Remember, your active participation is critical. We’ll do everything we can in clinic, but what you do at home (the stretches, avoiding aggravating postures, etc.) will greatly influence your results.

5. Other Modalities and Holistic Care: Depending on your specific needs, we may incorporate additional treatments. For example, some patients benefit from massage therapy focusing on the glutes and lower back – we have registered massage therapists who understand piriformis syndrome and can work as part of your team. We might use Therapeutic Ultrasound or Laser Therapy in certain cases to promote tissue healing (though honestly, for piriformis we find shockwave does a more impactful job). Education is another big component: we’ll coach you on ergonomics and posture. Little changes, like using a cushion or lumbar roll when sitting, taking micro-breaks to stand if you have a desk job, or avoiding sitting on a thick wallet (yes, “wallet sciatica” is a thing!), can prevent piriformis flare-ups. If you’re a runner or athlete, we’ll talk about training modifications and proper warm-ups so you don’t re-strain that piriformis. We also take into account the mind-body connection; chronic pain can be exacerbated by stress and anxiety. Our team might teach you a few relaxation techniques or refer you for mindfulness resources to help calm your nervous system – since a calmer nervous system can dial down pain sensitivity.

Throughout your treatment plan, we emphasize a whole-body, individualized approach. No two cases of piriformis syndrome are exactly alike, so we adjust as you respond. Some patients feel improvement after just one or two sessions (especially with shockwave, many report a noticeable change in pain intensity – for example, going from an 8/10 pain to a 4/10 after a couple of treatments). Others may take a bit longer, especially if the issue was very chronic or if there are multiple contributing factors. We will set realistic expectations and milestones, and we always encourage open communication – if something isn’t improving as expected, we re-evaluate and tweak the plan. Our goal is your long-term success: that means not needing continuous therapy forever. Once you’re significantly better, we’ll move you to a maintenance or discharge plan where you know how to manage on your own (with your exercises and self-care strategies). We truly measure our success by seeing you back to the activities you love, whether it’s sitting comfortably through a movie, hiking, or simply being able to put on your shoes without wincing.

By leveraging the best of technology (like shockwave), hands-on skill, exercise science, and patient education, we aim to provide a one-stop solution for piriformis syndrome that addresses every angle of the problem. In the next section, I’ll share a quick story of a patient who overcame piriformis syndrome pain at our clinic – it might resonate with you if you’ve been struggling with similar issues.