Piriformis syndrome: Treatment in 4 weeks with 3 exercises

Last Updated on by Martin Kielema

The piriformis syndrome is a very limiting injury which can take months to recover if you don’t treat it right.

Luckily for you, we’ve found a way to treat your piriformis syndrome correctly. And we’ll teach you exactly how to do it yourself.

Your piriformis syndrome will go away!

If you need immediate pain relief, you should buy this piriformis cushion. It reduces the pressure on the muscle when you sit, therefore reducing your pain.

I’ll explain what the piriformis syndrome is and how you can treat it the right way. I’ll also show you how you can do a piriformis test yourself to discover if you have it.

After that, I’ll show you how you can treat your piriformis syndrome yourself.

Finally, I’ll try to answer the most frequently asked questions about piriformis syndrome.

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So keep on reading.

  1. What is piriformis syndrome?
  2. What are piriformis syndrome symptoms?
  3. What causes piriformis syndrome?
  4. How long does piriformis syndrome last?
  5. How can I do a piriformis syndrome test myself?
  6. Which piriformis syndrome treatment can I do myself?
  7. What can and can’t I do with piriformis syndrome?
  8. Frequently asked questions about piriformis syndrome

What is piriformis syndrome?

The piriformis syndrome is a neurological injury. Your piriformis muscles cause the compression of your sciatic nerve.

To understand the mechanism behind the piriformis syndrome, you’ll need to know the anatomy of your gluteal region.

Your sciatic nerve runs from your back through the back of your leg to your foot. It controls the muscles located here. It also innervates the skin of your thigh so that you can feel touch.

In your pelvic region, your piriformis muscle covers the sciatic nerve. The piriformis muscle originates from your sacrum and SI-joint. It attaches to the greater trochanter at the outer side of your thigh bone.

The function of your piriformis muscle is to rotate your leg to the outer side when you lift it behind you extended. It also abducts your thigh when you raise it flexed in front of you. Your bodyweight shifts more towards the middle. If this didn’t happen, you would be out of balance and not able to walk.

Piriformis syndrome is also known as “wallet sciatica” or “fat wallet syndrome,” as the condition can be caused or aggravated by sitting with a large wallet in the affected side’s rear pocket.

Now I will discuss the most common symptoms of piriformis syndrome and why they arise.

What are piriformis syndrome symptoms?

Two main symptoms can point you towards a piriformis syndrome. I’ll discuss both of them and explain why they appear.

The first and most pronounced symptom is a pain in the buttocks. Excessive use of your piriformis muscle causes the pain. This disproportionate use damages the tissue, making it stiffer.

When your piriformis muscle becomes stiffer, it pressurizes your sciatic nerve. This nerve passes under the piriformis muscle. The pressure irritates the sciatic nerve. This irritation causes a radiating pain at the back of your leg. This pain can go through your leg to your calf muscle. It is the second sign through which you can recognize a piriformis syndrome.

Sometimes the symptoms look similar to a herniated disc.

Sometimes it even radiates to your back causing lower back pain.

Also, piriformis syndrome reduces your ability to walk, sit for an extended period and to bend forward to pick something up.

What causes piriformis syndrome?

piriformis syndrome cause

The primary cause of the piriformis syndrome is overuse of the piriformis muscle.  Different activities can cause this overuse.

Bending and getting up many times in a short period

The muscles in your buttocks help you to get up after bending down, like when you work in the garden.

Imagine you’re in your garden removing the weed. You bend over and pick up one plant at the time. After an hour or two, you’ve turned and got up many times. Each time you get up, you use your piriformis muscle. So you can imagine that after two hours your piriformis muscle is used a lot and is tired.

If it’s trained regularly, this is not a problem.

It’s like working out in the gym. When you do it for the first time or not very regularly, you are more likely to injure yourself during your training. But if you train four times a week, it’s improbable that you will get an injury. So if your piriformis is trained well because you work in the garden all the time, it won’t be a problem. If you do it only occasionally, you’re more likely to injure yourself.

When you expect a baby, you can expect a piriformis syndrome as well

During pregnancy, a woman can experience the symptoms of piriformis syndrome. This condition is called pregnancy sciatica. It’s the piriformis syndrome caused by pregnancy.

During pregnancy woman obviously, gain weight. It is a  natural process. Unfortunately, this also increases the pressure on your pelvic region.

Because of the weight, walking becomes harder as mentioned before you use your piriformis muscle a lot when you walk. Because your weight has increased, the tissue has to work harder when you walk. The overuse causes it to tighten up and puts pressure on your sciatic nerve.

The second contributing factor is an increase of laxity in your pelvic region.  A particular hormone is produced to prepare your body for giving labor.  It’s called the relaxin hormone, and its purpose is to loosen your ligaments. These ligaments usually keep your pelvic girdle together. When you give birth the baby needs to pass the pelvic girdle.

The hormone loosens the ligaments that keep the different parts of your pelvic region together. The increased space for the baby makes it easier to pass through. One of the consequences is that your pelvic girdle muscles need to work harder to compensate for the pelvic instability, including the piriformis muscle. Therefore the chances are that you’ll overuse it, causing tension and compression of the sciatic nerve.

Fortunately, the symptoms usually disappear by itself after the baby is born.

piriformis cushion

Hip pain, a stiff hip, hip arthritis, and the piriformis syndrome

A stiff hip can also be a cause for the piriformis syndrome.

Your piriformis muscle takes part in many movements your hip can make. When you have a stiff joint, the tissue has to work harder to move your hip due to higher resistance. The increased power will lead to overuse of the muscle resulting in the piriformis syndrome.

One of the main reasons for developing a stiff hip is hip arthritis. Hip arthritis means that the cartilages in your hip joint disappear — the lack of cartilage results in less mobility of your hip joint.

The loss of mobility is how hip arthrosis can lead to a stiff hip resulting in the piriformis syndrome and hip pain.

How long does piriformis syndrome last?

Your piriformis syndrome can last for several months if you don’t treat it the right way. However, if you use the exercises I’ll describe later, it will only last for about four weeks.

In severe cases, even with the right exercises, it can take months to heal. The reason is usually that the piriformis syndrome is an outcome of another, more significant problem. In those cases, you’ll have to solve the main issue before you can cure your piriformis syndrome.

How can I do a piriformis syndrome test myself?

What you’ve learned so far is what the symptoms of the piriformis syndrome are and what the leading causes are.

You’ve got a good indication of whether or not you are suffering from piriformis syndrome.

If you’re not sure yet there are a few simple tests that you can do yourself to find out if you have the piriformis syndrome yourself.

These tests look very similar to the exercises that you have to do to cure your piriformis syndrome.

The first indication that you have the piriformis syndrome is a tight buttock. You can feel your piriformis muscle at the lower part of your buttocks, close to where your leg starts. You should feel a difference between your sensitive side and your healthy side. At the tender side, you should notice a delicate point. It feels like a little ball, and it hurts when you put pressure on it. On your healthy side, this ball is absent.

The second indication is when you’re stretching your piriformis muscle. In this example, I’m treating my left piriformis muscle:


    • Grab your left knee with your left hand.
    • Grab your left ankle with your right hand.
    • Pull your left knee toward your right shoulder.
    • Pull your left ankle also towards your right shoulder.
piriformis stretch

Now you should feel the stretch and tightness in your buttocks area. Tightness is quite normal in this muscle. However, when you have the piriformis syndrome, you should notice a big difference between your right and left side. When you don’t have it, both muscles feel pretty much the same.

The third indication is a lack of mobility of your sciatic nerve. There is a simple way to test this:

  • Lay down flat on your back.
  • Lift the leg on the painful side extended with your toes pointing towards you.
schiatic stretch

If you miss mobility of your sciatic nerve, you will feel nerve pain in your calf and your hamstring just after lifting your leg. When you do the same with your other leg, you will notice that there is a difference between the two.

sciatic stretch normal

A healthy leg without sciatic nerve problems can be lifted as high as 90 degrees. With sciatic nerve pain, you will stop at around 60 degrees because of the stretching feeling.

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Best piriformis syndrome treatment

Now you know the cause of your pain, it’s time to start your piriformis syndrome treatment. To successfully treat your piriformis syndrome, we’ll have to tackle all the factors that contribute to the forming of the piriformis syndrome.

This way, you’ll break the vicious circle that maintains your piriformis syndrome at this time. You have to perform three exercises, but it will take a while before your pain significantly reduces. The easiest way for quick pain relief is to buy this piriformis cushion.

This cushion reduces pressure on your painful piriformis muscle, which will immediately reduce pain.

In the meantime, you can work on solving the problem permanently.

These exercises will address:


    • Piriformis stretch to reduce the tension on your piriformis muscle
    • Piriformis training to increase its loadability
    • Stretching your sciatic nerve to solve your radiating pain
    • Mobilizing your hip to reduce piriformis muscle tension
piriformis cushion

By regularly performing these exercises, you will address the overuse of your piriformis muscle, which will cure your piriformis syndrome.

It is best to do the exercises on a yoga mat which you can buy here. On a yoga mat, it’s easier to perform the activities correctly because a bed is often too soft and the floor is often too hard.

If for some reason these exercises don’t help you enough, there are a few other options that can help you. I will also discuss these options later here.

But first, start with the first exercise.

Piriformis syndrome exercise 1: Piriformis stretch

The first and most important exercise is the piriformis stretch. A recent study shows that piriformis stretch relaxes your piriformis muscle and relieves your pain.

This exercise will decrease the tension of your piriformis muscle. Relaxation of your piriformis muscle is essential to lower the pressure on your sciatic nerve. Only then can your sciatic nerve recover, eliminating the radiation in your leg.

Perform the exercise like this for your left side:


    • Grab your left knee with your left hand.
    • Grab your left ankle with your right hand.
    • Pull your left knee toward your right shoulder.
    • Pull your left ankle also towards your right shoulder.
    • Hold this for 20 seconds and repeat three times.


You can also watch this youtube video to see how to perform the exercise correctly. Perform this exercise as often as you can during the day.

The other thing you can do to reduce the tension on your piriformis muscle is massaging the painful spot. When you do this, I would recommend this massage oil. It makes the tissue nice and warm, which will relieve your pain fast. It is also great for relieving other painful muscles. It’s the same oil I use.

Piriformis syndrome exercise 2: Piriformis training

The second exercise you’ll have to do is piriformis training. With this exercise, you’ll train all the muscles in your buttocks area.

Training your piriformis muscle is necessary because it’s often an overuse injury. You’re asking more from your piriformis muscle then it can deliver. When you don’t increase its performance level, the imbalance between what you ask and what your piriformis can provide remains. That’s why the pain will remain as well.

A recent case study proved that training your piriformis and other gluteal muscles is an effective treatment to overcome piriformis syndrome. However, you’ll have to keep in mind that this was a single case study. We need more research before we can make any conclusions, but in my experience, this works very well.

Perform the exercise like this:


    • Lay down on your healthy side
    • Extend your leg
    • Pull your toes towards you
    • Lift your leg
    • Repeat this ten times
    • Do this three times


You can also watch this video to see how to perform the exercise correctly. Training the muscle will restore the balance, which will lead to your recovery in the end.

When the exercise becomes too easy this way, you can also add some weight through these ankle weights.

By adding these weights, you can increase the strength of your piriformis muscle even further, thus achieving even better results.

You can choose between different weights based on your strength.

You can also use these weights for various other exercises.

And later, if even this becomes too easy, you can do steps at home.

If you step every day, you’ll not only increase the strength of your piriformis muscle but also of all other muscles in your leg.

Also, you will increase your stamina and the cartilage in your knee, thereby reducing problems of osteoarthritis.

Piriformis syndrome exercise 3: Sciatic nerve stretch

The last part of your piriformis syndrome treatment is performing the sciatic nerve stretch

A protective layer covers your sciatic nerve. The nerve slides through this layer when you move your leg. It looks a little bit like an electrical wire, like the one above.

What happens when you have piriformis syndrome for a long time is that the nerve gets stuck in the protective layer. Therefore it can no longer move properly. It results in the stretching feeling.

To resolve this feeling, you’ll have to stretch your sciatic nerve. The stretching releases the nerve from its protective layer, giving it more mobility.

Perform the exercise like this:


    • Place your heel on a chair
    • Extend your knee and pull your toes towards you
    • Try to reach for your toes with your hand
    • Hold this for 20 seconds
    • Repeat this 3 times


You can also watch this video to see how to perform the exercise correctly.

When you do these three exercises twice a day, you’ll feel a decrease in pain within days. The activities are designed to break the vicious circle. If you continue to do these exercises, your pain won’t return.

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Dry Needling for piriformis syndrome

Another form of treatment for piriformis syndrome is dry needling. Dry needling uses acupuncture needles to treat the trigger point tightness in the muscle.

A physical therapist who took a course for dry needling can perform this treatment.

Dry Needling works like this:

First, the skin is cleaned with alcohol to prevent infections. Then the needle is inserted into the muscle right in the tender point. The therapist will keep pushing into the sore spot until it relaxes. Relaxation usually happens with a twitch which feels like a little electrical shock.

It usually takes about 2-3 minutes.

After the treatment, the therapist cleans the skin again, and the muscle will be massaged shortly to prevent muscle ache after the procedure.

The theory behind it is that the pressure of the needle forces the trigger point to relax. It will reduce recovery time dramatically.

Unfortunately, there is no study available yet that researched the long-term results of dry needling for the piriformis syndrome. However, in my experience, it works very well, especially in combination with the exercises described above.

There are no severe complications known from dry needling. It might result in muscle ache for a few days or sometimes some skin irritation.

You can’t undergo dry needling when you’re pregnant, when you had surgery in the same area less than six weeks before or when you use blood thinners.

Use a foam roller

foam roller

Using a foam roller can also help you reduce your pain. With the foam roller, you can put pressure on your piriformis muscle and especially the tender point. It will decrease the tension in your piriformis relieving your pain.

Apply heat or ice for pain relief

Applying heat or ice can reduce your buttocks pain. Which one you use depends on what works best for you and for how long you have your pain already.

If your piriformis syndrome started because of a fall or overuse, it’s better to apply ice. It will reduce swelling and suppress the inflammation, which will reduce your pain.

When you have it for a more extended period, you can also apply heat to the painful or tense area. The warmth will relax the piriformis muscle, reducing your pain.

Don’t apply the heat or cold directly on to your skin, but put a towel between it. It will prevent your skin from burning or freezing. Also, don’t apply it for longer than 20 minutes.

What can and can’t I do with a piriformis syndrome?

Knowing how to treat your piriformis syndrome doesn’t cure it right away. That’s why you probably want to see what you can and what you can’t do with your piriformis syndrome.

What you shouldn’t do when suffering from piriformis syndrome is one of the activities that can cause it.

Bending and heavy lifting put pressure on your piriformis muscle causing it to tens up again. Also kneeling and getting up multiple times aggravates your piriformis causing more pain or prolonging it. These are the activities that you should avoid during your recovery.

What you can do are light activities that don’t require flexing and extending your hip with force.

Activities that will help you recover are walking, cycling or swimming. These activities will increase the strength of your piriformis muscle without putting to much pressure on it what will help you to recover.

Frequently asked questions about piriformis syndrome


You now know almost everything you need to know about the treatment of piriformis syndrome. However, there are some frequently asked questions about piriformis syndrome that remain unanswered.

So that’s what I’ll do now.

How long does piriformis syndrome last?

How long piriformis syndrome lasts depends on a few things.

First, the cause influences recovery time. If the reason is still in place, your piriformis syndrome won’t recover. It is because you don’t break the circle the injury is in, like described above.

Also, if the cause was a single overuse incident, it tends to heal faster. Damage of the piriformis muscle and the sciatic nerve is less when the injury was caused in a short amount of time. It means that the recovery time is also less.

When damage is caused over a more extended period, the damage is usually higher as well, resulting in longer recovery time.

The last aspect of the recovery time is how much you do to support your recovery. The more you follow your exercise program and avoid overuse activities, the faster you will recover from your piriformis syndrome injury.

In general, it is safe to say that if you strictly follow your program, you will recover within two to four weeks. If you do not accurately perform your plan, it is more like four to six weeks.

When you don’t follow your recovery program at all, it could take months to recover. 

Will piriformis syndrome injection help me?

A specialist can apply a piriformis syndrome injection when conservative treatments such as physical therapy fail.

A surgeon will inject a strong painkiller directly into your piriformis muscle.

In a study performed with ten patients with piriformis syndrome, the injection showed good to excellent results.

However, it’s also known that these kinds of injections may sort only a short time effect. The study group of only 10 is too small to rule this effect out.

Therefore conservative treatment should always be your priority to cure your pain. If that doesn’t have any effect, you can try a piriformis injection.

Is piriformis syndrome surgery effective?

Piriformis syndrome surgery consists of cutting loose your piriformis muscle from your hip where it’s attached. Cutting it loose releases the tension of the tissue, which results in less pressure on your sciatic nerve.

The downside is that this procedure results in pain and a long recovery period. It is because your piriformis muscle is well innervated, which means that it has many pain receptors which produce more pain. Also, the muscle sometimes spasms because it thinks that it’s still attached to the bone and still has to work. Therefore you can still feel buttocks pain for a couple of months after the surgery.

A study suggests that piriformis syndrome surgery is useful in the long term. After two months most patients returned to work and control after two years still showed excellent results. However, you should always try conservative therapy like physical therapy first. Surgery can have serious side effects and should, therefore, be your last resort.

What are piriformis syndrome exercises to avoid it?

To be able to prevent piriformis syndrome, you can perform the same exercises as mentioned under piriformis syndrome treatment.

To prevent piriformis syndrome, it’s necessary to have a strong but flexible piriformis muscle. Piriformis syndrome is often an injury caused by an imbalance between load and load capacity.

So to be able to prevent piriformis syndrome, you’ll need to increase your load capacity or decrease the load on your piriformis muscle.

In general, it is easier to increase your load capacity than to reduce the load on your piriformis muscle. Increasing your load capacity can be done by training your piriformis muscle as described earlier. It reduces the overload of your piriformis muscle.

Can I continue running with my piriformis syndrome?

Piriformis syndrome is a common injury among runners because the piriformis muscle must work hard during running. It means that overuse of the tissue during running is quite common.

I’ve discussed this situation already before.

When the cause of the injury is still present, it increases the recovery time. Because running can cause piriformis syndrome due to the big load, continuing running will increase the recovery time of your piriformis syndrome.

That is why I would advise you to stop for a week or two. Instead, focus on strength training of your leg and gluteal muscles. It will improve both your recovery and your running. It is because stronger leg muscles increase running performance.

So, in general, I would say that you should not continue running with your piriformis syndrome. However, this does not have to affect your running performance since you have other training options.

How to sleep with piriformis syndrome?

The best position to sleep with piriformis syndrome is:


    • Lie on your non-painful side
    • Pull your knees up to a 90 degrees angle
    • Place a pillow between your knees


This way you limit the tension on your piriformis muscle. Also, there is no pressure on the tissue which usually causes pain.

Piriformis syndrome or herniated disc?

There are a few signs to determine if you have piriformis syndrome or a herniated disc.

The first sign is the radiation. With piriformis syndrome, the radiation ends around your knee. When you suffer from a herniated disk, the radiation goes all the way to your toes.

The second sign is bending. When you lean forward, to pick something up the sensation is different. Piriformis syndrome increases your buttocks’ pain and might intensify the radiation in your upper leg. With a herniated disc this will produce a shooting pain down your leg into your toes.

The third sign is bending backward. With piriformis syndrome, this won’t change a thing. However, with a herniated disk this exercise will decrease the radiation in your leg.

These are three simple signs to differentiate between piriformis syndrome or a herniated disk. To be entirely sure however you have to take an MRI of your back to rule out a herniated disc.

Can piriformis syndrome cause back pain?

The answer is yes and no. I’ll explain:

Piriformis syndrome usually doesn’t cause much back pain. Tight glutes, on the other hand, can also cause back pain. Also, tight glutes can cause symptoms similar to piriformis syndrome.

That’s why I had to answer yes and no. Often gluteal tightness is confused with piriformis syndrome. There is a difference, however.

The difference is that with tight glutes the pain in your glutes is more felt on the outer side of your glutes, close to your hip. The piriformis is present in the middle of your buttocks.

Also when you put pressure on the painful spot in your glutes, you can feel the radiating pain in your back. The trigger point in your glute causes back pain. If it doesn’t cause back pain, then the pain probably has another cause.

By performing the piriformis stretch, you can also stretch your gluteus lowering the tension and solving your back pain.


I hope this information will help you in solving your piriformis pain and dysfunction. If you have any question left or don’t understand the info feel free to ask by sending an e-mail to [email protected]

If you liked the information and thought it was helpful please share it with others so they can also get rid of this nasty pain.

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