Piriformis Syndrome: How to Manage This Lower-Body Pain Disorder

2. Natural Piriformis Syndrome Treatment

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Effective treatment for piriformis syndrome depends on what’s causing the underlying muscular damage to begin with, so seeing a professional for a proper diagnoses and advice is the first step in resolving symptoms. After a diagnoses is made, many doctors recommend short-term steroid or anaesthetic injections for stopping muscle spasms and lowering inflammation and pain around the nerves near the piriformis muscle. Your doctor might also possibly prescribe other medications like anti-inflammatory drugs or muscle relaxers.

Injections or medications can be helpful for resolving symptoms quickly and starting you on a path to recovery — however, they aren’t a long-term solution. Ongoing relief from piriformis syndrome usually requires making lifestyle changes, including changing your exercise routine, eating a healthy diet, adjusting your posture and form, and possibly seeing a physical therapist or chiropractor for chiropractic adjustments.

1. Physical Therapy and Osteopathic Adjustments

Many doctors feel that physical therapy and osteopathic adjustments performed by a doctor are two of the best ways to resolve piriformis pain, since these can effectively address underlying problems, such as poor form/posture during exercise or sciatic nerve pain that contributres to inflammation and pain around the piriformis muscle.

A physical therapy protocol for treating piriformis syndrome can include stretching, strengthening and mobilizing the hip joints in various ways, using specific exercises that flex and loosen the appropriate areas. Your therapist might perform myofascial release using a foam roller along the hip thighs and buttocks to break up tissue adhesions and improve healing. Hip joint mobilization, hamstring stretches, plus strengthening the quadriceps, lower back and core are all important for preventing future symptoms from returning. (3)

When visiting an osteopathic physician, osteopathic manipulative treatments can be performed to restore normal range of motion of the hip and decrease pain. Two common exercises are called counterstrain and facilitated positional release, which remove tension from the piriformis muscle. The patient lies in a prone position with the affected side of the body at the edge of the examination table while the osteopathic physician carefully brings the patient’s affected leg over the side of the table, placing it into flexion at the hip and knee, with abduction and external rotation at the hip. This is held for anywhere between 1.5–5 minutes. (4)

2. Yoga and Stretching

Certain stretches or yoga poses can help strengthen the core and lower back, hips, and quads/buttocks while also loosening up and supporting the piriformis muscle. In particular, the strengthening of the adductor muscles of the hip has been shown to be beneficial for patients with piriformis syndrome. (5) You can practice targeted exercises or stretches at home on your own, but it’s a good idea to be taught by a professional first to make sure you don’t injure yourself even more.

Over the long term, lengthening the legs and spine through yoga or other exercises can also help develop good posture, which reduces stiffness, inflammation and pain along the sciatic nerve. Studies have found that yoga is safe and effective for people with piriformis syndrome and sciatic nerve pain. (6) Some of the most important movements for preventing sciatic pain target the hips, hamstrings, glutes and lower back, while building strength in the core and legs and relaxing stiff areas.

The following piriformis exercises can be helpful to do several times per week or more: (7)

  • Laying down supine piriformis stretch with a crossover (moving left knee toward right shoulder).
  • Laying down supine piriformis stretch without a crossover (moving heel toward right shoulder).
  • Laying down supine piriformis stretch assisted by opposite leg (moving right knee toward right shoulder).
  • Hold each position above for 30–60 seconds, and start with three sets of five to 10 repetitions of each stretch two or three times per day.
  • After you’ve built up tolerance and pain reduces, you can start to add more weight to hips. At this point you can strengthen legs and hips by performing glute bridges and clamshell leg lifts, or weight-bearing exercises, such as standing mini-squats, “monster walk” side steps, “sit-to-stand” exercises and single-leg mini-squats.
  • After several weeks to months, you can incorporate more challenging exercises, such as lunges, deep squats, and plyometric-style hops and landings.

3. Rest and Recover the Right Way

Taking a break from repetitive movements or exercises can give the piriformis muscle time to heal, which is important for proper muscle recovery. Try beginning by reducing the types of aggravating exercises/movements you do daily, especially those that put pressure on the hips. Movements and postures that tend to make pain worse include driving or sitting at a desk for a long period, long-distance running, walking/running up hills, squatting, playing tennis, shortening the spine by bringing the knees toward the chests, or climbing stairs. (8)

Most treatment plans call for more movement in general to improve strength and mobility (meaning less sitting for prolonged periods) along with targeted exercises to loosen up inflamed areas. Make sure to always stretch and warm up properly when exercising to avoid injuries. You can practice certain stretches and exercises at home without the need for a doctor visit once you have the hang of them. You can also try to alternate periods of sitting/lying down with short walks during the day to stay active, but allow for more rest between exercises if needed.

4. An Anti-Inflammatory Diet and Supplements

Certain lifestyle, personal and occupational risk factors make it more likely that someone will suffer from muscle and nerve pains. These include older age, high levels of mental stress that tenses muscles, being overweight or obese, sitting for long periods, cigarette smoking, and eating a low-nutrient diet. All of these can increase inflammation, which makes it harder to heal from injuries and increases pain, swelling and complications.

Eating a nutrient-dense, low-processed diet and taking supplements might be able to help you heal faster, maintain a healthy weight over time, and recover better from exercise or training. Try lowering your intake of things like sugar, processed meats, chemically sprayed crops, refined grain products, alcohol and packaged snacks. Include more high-potassium foods and sources of magnesium, including leaf green veggies, sweet potatoes and avocados, to lower muscle spasms and pain. Healthy fats, such as extra virgin olive oil and coconut oil, are also important, along with “clean and lean proteins” (cage-free eggs, grass-fed meat, wild-caught fish) and fermented foodsand other probiotic foods.

Other important factors for reducing bodywide inflammation include avoiding smoking/recreational drugs, lowering stress and sleeping well. Additionally supplements that can help include omega-3 supplements, magnesium, turmeric and CoQ10.

5. Managing Pain

Certain studies have found that many patients benefit from using cold and heating packs to lower pain naturally, which relax muscles almost immediately and prevent more inflammation. These seem to work especially well if performed before physical therapy or stretching sessions at home because they can lower muscle discomfort associated with direct treatment applied to an irritated or tense piriformis muscle. If you injured yourself due to trauma, avoid heat right away. However, after a few days try using inexpensive heating pads set on a low or medium setting, placed on the hips while laying down for about 15 to 20 minutes every day.

Another similar approach that works well is taking warm bathes, especially if you add a muscle-soothing essential oil like peppermint oil, which naturally relaxes muscle spams. Heat loosens up tight muscles and helps increase circulation., but as an alternative to heat, applying an ice pack for 10 to 15 minutes every two to three hours does the trick too. If pain still doesn’t seem to go away naturally, most doctors recommend taking over-the-counter painkillers when symptoms get very bad (like Tylenol or ibuprofen/Advil,which should really only be taken now and then).

Acupuncture and professional massages might also be able to help you manage pain. Acupuncture, which uses tiny needles to target specific pathways in the body, has been approved by the FDA as a treatment for chronic pain and is supported by various studies in relation to reducing chronic muscle pains (including sciatica). (9) Similarly, massage therapy is another nonsurgical, holistic approach to managing muscular pains, since it helps improve blood flow, breaks up tissue adhesions and even releases endorphins, which act like natural pain relievers. (10)

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Dr. Josh Axe, DNM, DC, CNS, is a doctor of natural medicine, doctor of chiropractic and clinical nutritionist with a passion to help people get well using food as medicine and operates one of the world's largest natural health websites: www.DrAxe.com. He is the author of the groundbreaking health book Eat Dirt, which uncovers the hidden causes and cures of leaky gut syndrome. Dr. Axe is an expert in digestive health, functional medicine, natural remedies and dietary strategies for healing. He has been featured on many television shows, including the Dr. Oz Show, CBS and NBC, and has his own Eat Dirt program running on select PBS TV stations. Dr. Axe founded one of the largest functional medicine clinics in the world, in Nashville, TN, and has been a physician for many professional athletes. DrAxe.com is one of the most visited websites worldwide for healthy recipes, herbal remedies, nutrition and fitness advice, essential oils, and natural supplements.