Frustrated? Piriformis Syndrome Treatment That Works When Your Pain Has Lasted Longer Than 6 Months

Frustrated? Piriformis Syndrome Treatment That Works When Your Pain Has Lasted Longer Than 6 Months Barefoot Rehabilitation Clinic
Piriformis-Syndrome-Treatment

20 Sep Frustrated? Piriformis Syndrome Treatment That Works When Your Pain Has Lasted Longer Than 6 Months

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If you’re not annoyed and frustrated by the pain in your ass, literally and figuratively speaking, feel free to click through to another piriformis syndrome treatment page.

What I write here is for people who have had butt pain more than 6 months, even though they’ve seen 3-5 other doctors or therapists…

Butthurt O Meter GIF - Butthurt Critical GIFs

… and tried stretching, strengthening, physical therapy, chiropractic adjustments, ice, heat, electronic stimulation, cortisone shots, steroids, and any other magical cure promised to you.

Still here?

Good.

Between 1-4 out of 10 people will have “sciatica” at least once in their lifetimes. (Source)

The longer you’ve had piriformis syndrome, the harder it is going to be to get your problem fixed (and the more you need to understand why you haven’t been fixed yet).

As with any health condition, it becomes really important that you use your mind to think through the “stories” different doctors tell you when it comes to getting rid of your pain.

Check in with your intuition:

Does what this doctor says is my problem make sense?

Does this doctor seem like an honest person?

If you answered “no” to any of the above, find a doctor who you can answer “yes” to. Until then, you risk spending serious amounts of time, money, and energy trying to get fixed when your intuition knew the answer all along.

Here’s the sarcastic, but very real, Piriformis Syndrome Treatment That Worked story.

What causes Piriformis Syndrome?

Once your pain is severe and you’re completely and utterly annoyed, frustrated, and pissed off by the lack of relief you’ve found in self-treatments and doctor or therapist-driven treatments, I’ve found that most people don’t care what the cause of their Piriformis Syndrome is.

These patients just want the pain gone!

Before I start treating a patient at Barefoot Rehab, it’s super important to be on the same page about the cause of Piriformis Syndrome.

If you don’t understand the cause, then your mind will wander off the path of getting fixed to other possible treatments that provide very temporary relief, potentially making the cause of your Piriformis Syndrome bigger.

First thing you need to know is that any diagnosis with the word “syndrome” in it tells us nothing as far as what the tissue-specific (is it a muscle or bone or cartilage or ligament? etc.) cause of the problem is and therefore, what treatment you should be looking for.

So, what is Piriformis Syndrome actually? Or what surgeons are starting to cut open with their scalpel and call Deep Gluteal Syndrome?

Below is an actual surgery for Sciatic Nerve Decompression for Deep Gluteal Syndrome:

It’s glue sticking your piriformis (or one of the other hip external rotators) to the sciatic nerve.

That glue is known as adhesion in the medical world. The illustration shows the “black stuff” in the muscle on the right as glue within your muscles.

piriformis-syndrome-treatment-adhesion

This adhesion forms between your sciatic nerve and one of the hip external rotators:

  • piriformis (actually, very uncommon to get adhesion here)
  • superior gemellus (most common location to get adhesion)
  • inferior gemellus
  • obturator externus
  • quadratus femoris

Here is Dr. Brady of Integrative Diagnosis explaining how nerves get stuck to muscles. Keep reading and I’ll show you an actual treatment for Piriformis Syndrome with BEFORE and AFTER ranges of motion.

In the image below (source), the gluteus maximum has been taken off the image. The sciatic nerve is the thick black line. In your body, it’s as thick as your index finger. It’s quite easy for an expert doctor to feel if the nerve moves or if it’s glued down by what feels like a wad of gum called adhesion.

Orthopedic surgeons have confirmed that adhesion (or what they call “fibrous bands”) on the right side (or lateral side) of the nerve is MOST COMMON.

Anyone who is reading this and who has had “piriformis syndrome” for less than 6 months with mild pain and the pain was helped by the standard advice of:

  • ice
  • heat
  • stretching
  • physical therapy
  • electronic stimulation
  • massage therapy
  • medication …

… either never had adhesion in this location or had a small amount of it that hasn’t gotten thick enough to cause more intense pain.

Stretching and movement can get rid of tiny bits of adhesion.

There are only two ways to get rid of thicker wads of adhesion.

More on that below.

Now that we understand adhesion, we have to see if you actually have adhesion by determining if Piriformis Syndrome is your correct diagnosis.

How do you know if “Piriformis Syndrome” is the Correct Diagnosis?

Getting the correct diagnosis for your pain, especially when it’s lasted more than 6 months, is a difficult thing to accomplish.

The wrong diagnosis can leave you feeling silly, wondering how you ever got into such a predicament.

Burn GIF - FreshOffTheBoat YourLabResultsAreIn YourDiagnosis GIFs

The human body is quite the puzzle and it’s not easy for doctors with regular orthopedic, chiropractic, medical, or physical therapy educations to get hard answers right.

Educational institution’s job is to graduate doctors, not create experts.

A discussion of what piriformis syndrome “looks like” is necessary.

If it looks like a duck and quacks like a duck, is it a duck?

It’s a good thing that chimeras (those magical animals that are actually 3 MULTIPLE ANIMALS in ONE) don’t actually exist.

Real-life lion-goat-snakes would scare the bejeesus out of most of us.

Unfortunately, chimeras do exist when it comes to pain, as much as you might not want to believe it.

No Duck GIF - No Duck Sleepy GIFs

Your chimera might be the possibility that you have MULTIPLE problems going on, which will confound the case. If it sounds like you do, I highly recommend you find a musculoskeletal specialist to manage your case for you.

With that said, let’s dive in to getting your diagnosis right.

Let’s assume your Piriformis Syndrome is just a normal duck.

Piriformis Syndrome will typically look like this:

Location of pain (can be any combination of the below locations:

  • Your butt check (you’d rate it at least a “5” on the 0-10 pain scale, where “0” is no pain and “10” is the worst pain ever)
  • Right down the back of the middle of your thigh
  • Right down the back of the middle of your calf OR down the outside of your calf (not the inside)
  • Along the top or bottom of your boot.

Location of nerve symptoms: Possible numbness or tingling in your butt cheek or down the back of your thigh, usually not past the knee.

What makes the pain worse?

  • Walking for a period of time
  • Stretching your “hamstring” like touching your toes or doing a hamstring stretch lying on your back.
  • Lying in bed at night
  • Sitting for a period of time (i.e. caused by direct pressure to the location of adhesion), especially directly on the painful side

Notice in the image below, the individuals are leaning on the opposite hip.

Piriformis-Syndrome-Treatment-How-You-Sit

Can you test yourself at home?

Get your friend, lie on your back, have them straighten your knee and bring your hamstring as high as you can go until you feel not a mild, but at least a “moderate” intensity stretch or pain symptom.

A great confirmation that you have Piriformis Syndrome is when this test reproduces pain precisely in your butt.

“Good” range is higher than 45 degrees (above a 50% grade).

“Bad” range is lower than 45 degrees (below a 50% grade).

hamstring-stretcpiriformis-syndrome-treatment-hamstring-stretch-testh-test-ballpark

At your end range, have your friend push down on the ball of your foot 1-2″ (no more than this).

piriformis-syndrome-treatment-dorsiflexion

If the pulling or pain INCREASES, you can be sure that your sciatic nerve is the problem.  We don’t yet know if the sciatic nerve is being pulled at your piriformis, hamstring, or low back.  Your expert adhesion doctor will confirm that for you.

If the symptoms INCREASED right in your butt, the diagnosis of Piriformis Syndrome becomes more probable.

Are there any other tests you can do?

  • Ultrasound of the sciatic nerve can determine if your sciatic nerve is swollen (Kara et al.)

Piriformis Syndrome will NOT look like this:

Any of the below data points that are true either:

  • Lessens the probability that you have Piriformis Syndrome … or …
  • Introduces the possibility that you have a chimera (MULTIPLE problems instead of just ONE problem)

Location of pain:

  • Your low back
  • Down the inside, front, or outside of your thigh
  • Down the inside of your calf (not the outside)

Location of nerve symptoms: Numbness or tingling in the front of your thigh, shin, or foot.

What makes the pain worse?

  • Standing
  • Movements of the spine

Can you test yourself at home?

The Pencil Test is like a blood pressure test for your low back. It tells you how healthy or unhealthy your low back is, just like blood pressure tells you how much risk you have for a heart attack or not.

In Barefoot Rehab, we use a pencil ruler to get an exact measurement.

You can just take a simple pencil and grade 1 observation?

  • Is the pencil flat against your low back with a grade of 90% through 65% below (the higher the grade, the healthier your low back is)?
    • The better your grade is, the MORE likely you have Piriformis Syndrome.
  • Or is there space under the pencil with a grade of 40% (the lower the grade, the more likely you have a disc problem).
    • The worse your grade is, the LESS likely you have Piriformis Syndrome.

A very healthy low back – 90% function (fxn) – Notice the pencil is flat for 1.5″:

piriformis-syndrome-treatment-90-percent-pencil-testA C-grade low back – 75% function (fxn) – Notice the pencil is flat for 3″:low-back-funcpiriformis-syndrome-treatment-75-percent-pencil-testtion-75-percent

Or a D-grade low back – 65% function (fxn) – Notice the pencil is flat for 4.5″:low-back-functiopiriformis-syndrome-treatment-65-percent-low-backn-65-percent

Or do you have a major fail – 40% function (fxn) – Notice the space under the pencil:low-back-functipiriformis-syndrome-treatment-40-percent-functionon-40-percent

Then, if you do the Touch Your Toes Test and the speed of your movedment is Yellow-Lighted, then you can be confident you have a disc problem (and NOT Piriformis Syndrome). You can be CERTAIN you have a disc problem if you have pain or tightness in the MIDDLE of the range of motion that gets better as you get to your end range.

Are there any other tests you can do?

  • An MRI can confirm low back disc involvement.

2 Piriformis Syndrome Treatments That Work

Your head may be spinning a bit right now.

Diagnosing pain cases that have lasted more than 6 months and have been failed by multiple doctors requires deeper thinking.

That’s why the very first sentence of this post tried to get you off of this page. If you weren’t ready to use your head, you wouldn’t have spent the mental energy to try to figure out what your problem really is.

Now, you should have confidence whether you have Piriformis Syndrome or not.

If you do have Piriformis Syndrome, there are only 2 treatments that work to remove the adhesion from your sciatic nerve and the hip external rotators.

There is some research stating that a steroid injection works for 50% of patients. If this worked, there was either no or minimal adhesion. If you’re not able to try Piriformis Syndrome Treatment #1 below, I’d do this as the next step before trying Piriformis Syndrome Treatment #2.

Piriformis Syndrome Treatment #1: Get Your Adhesion Removed With Manual Therapy

Healthcare standards universally say to treat conservatively (without getting cut open) before invasively (getting cut open).

This applies here.

A skilled adhesion removal specialist like an Integrative Diagnosis provider can feel where the sciatic nerve is stuck with only his/her hands.

Then, he can remove that adhesion with the help of an assistant.

Below is a live case study with a young professional dancer with a tighter right hamstring than the left. He’s been stretching for years, not seemign to make a dent in his flexibility. The great thing about this treatment is, 3 passes, and 48 hours after the treatment, Ray said:

I’m still tighter in my left hamstring now! Will it stay this way?

I replied, “Of course. There’s less adhesion in your right hip now!”

The results are often immediate, with significant relief happening within 5 treatments.

Piriformis Syndrome Treatment #2: Get Your Adhesion Removed With Surgery

Or, you can go straight towards getting cut open.

piriformis-syndrome-treatment-surgery1

Interestingly, a common cause of Piriformis Syndrome is previous piriformis release through a steroid injection.(Source – 18:00)

TAKE ACTION NOW: Find a Specialist

Regardless of which Piriformis Syndrome treatment you want, you’ll need to find a specialist as there aren’t many doctors doing this type of work.

To find a doctor/provider to release the adhesion (treatment #1) with  his hands, I recommend finding a provider on Integrative Diagnosis.

If you’ve already tried conservative care with an Integrative Diagnosis provider, I’d contact one of two doctors:

Dr. Hal Martin, lead author of The Endoscopic Treatment of Sciatic Nerve Entrapment/Deep Gluteal Syndrome.

Address: Oklahoma Sports Science & Orthopaedics, 6205 N Santa Fe, Ste 200, Oklahoma City, OK 73118, U.S.A.

Dr. Shane Tipton, lead author of Arthroscopic Decompression of Greater Trochanteric Sciatic Nerve Impingement.

Address: Department of Orthopaedics, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A.

If you can’t get to Oklahoma or North Carolina, these doctors would likely know the closest surgeon to you who can help you with your pain.

If you have questions about your butt pain, please answer all of the questions below about your pain and I can help steer you in the right direction. If you don’t give me all of the answers, I’ll reply and ask you to give me ALL of the answers.

  1. How old are you?
  2. Any trauma to the area?
  3. Where is the pain?
  4. Describe what the pain feels like.
  5. What makes it worse?
  6. What makes it better?
  7. What is your range for the Hamstring Stretch Test?
  8. What is your range for the Pencil Test?
  9. What is your range for the Touch Your Toes Test?
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Dr. Chris Stepien, DC, Full-Body ID Certified, ART Certified, CSCS, and CrossFit Level 1 Certified, fixes your annoying and frustrating pains, even when it's been over 6 months and you've seen 3-5 other doctors or therapists without lasting relief Barefoot Rehab in Denville, NJ. And when you're sad, depressed, or not enjoying life, Dr. Chris wants to hug you. He invites you to reach out, no matter what your concern is. Barefoot Rehab is here to serve you.
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42 Comments
  • Sarah Cummings
    Posted at 10:35h, 01 October Reply

    Great post! Thanks for sharing this information. Such a big help!

    • Dr. Chris
      Posted at 13:15h, 01 October Reply

      : ) Happy to help.

  • Sana thahane
    Posted at 18:51h, 07 March Reply

    Hi Dr Chris I need help

    • Dr. Chris
      Posted at 10:58h, 12 April Reply

      I’m here for you. What kind of help?

    • Jane L Siebert
      Posted at 18:22h, 31 July Reply

      Hi Dr. Chris- I’m needing help with my pain!! Is there a specialist in the Springfield MO area? Have been suffering for 3 1/2 years with butt pain and upper leg pain/hip pain. But went 2 years without any kind of treatment and have spent the last year and a half doing various physical therapy treatment exercises, heat and stem, myo, ART, massage, etc. used to be a runner but now can only walk slowly but it still causes pain . Many of my symptoms and scenarios are similar to the ones addressed in your article and of people responding to you. It hurts when I have to bend over and pick up something or going upstairs etc. Wanting to thing to avoid surgery and steroid injections . I feel like I have the adhesions to the nerve like you mentioned earlier. What other test or examinations do I need ? Wondering about an MRI ?

  • Ginger Berry
    Posted at 19:11h, 21 March Reply

    I suffered 3 plus years before back surgery, 2 level fussion and laminectomy. I had bone on bone rubbing , disk were gone. It’s been 1 year since surgery, doing better in some ways, but still having sciatic pain in buttocks down both legs into the forefoot. Tried just about everything. A pain dr before surgery, gave injections into both periformis muscles and pain completely stopped for 3 hrs all the way down into the toes.
    Would like to try removing adhesions manually. Tried your online address and did not have success!!! Please send me info where I can go and try this. I’m in oklahoma, but will go almost anywhere to try this!!
    Thank You!!

    • Dr. Chris
      Posted at 10:58h, 12 April Reply

      Hi Ginger, sorry for delay. I’d go to Thrive Spine and Sport in Iowa. Check out their reviews. DOn’t waste your time with anyone else.

  • Rhys Myors
    Posted at 00:52h, 24 April Reply

    Hi Dr Chris,
    I’m a Marathon runner, was averaging 60-70m per week
    38yo
    Pain in the centre of left buttock, doesn’t radiate down leg, but my butt gets numb.
    Left side is significantly tighter than right (hamstrings, hips)
    Flexibility is ok about 70deg in the left hamstring.
    Symptoms came in about 2months ago, after a tempo run.
    Have been getting regular PT (not really impressed) stretching 3-4 times a day, lots of rolling and lacrosse ball in my butt. Doing strengthening of my hips as well.
    Pain is pretty much no change. Some days no pain, some days really sore.
    Haven’t run in over a month
    Getting quite frustrated, any advice on someone I could go see in Northern Virginia (I live in Alexandria and work in Arlington)
    Thanks

    • Dr. Chris
      Posted at 10:26h, 24 April Reply

      Hi Rhys, based on what you shared, Im not clear on whether it’s actual piriformis syndrome or a disc problem shooting down. If you’ve done more than 5 treatments without permanent relief in any way, I’d see a new doctor or therapist. 5 visits is the expectation for relief. I don’t know anyone who does adhesion work in Virginia – none of my colleagues are there. You can try some people and see if they help.

  • Parvez s. Shaikh
    Posted at 16:06h, 02 May Reply

    Hi Doctor, I am parvez from India, is suffering from piriform is syndrome for last 10 years, it gets worse at night while in bed, need to massage for 1 hour to get relief, there is no permanent cure, will be very happy if you help me get rid of this pain from right buttock, back middle of thigh, back middle if calf, my email id is shaikhp2001@gmail.com
    Will be very happy if you help guide me to relieve this severe pain

    • Dr. Chris
      Posted at 16:58h, 02 May Reply

      Hi Parvez, unfortunately the problem requires treatment like one of the two above. I wouldn’t be able to give you treatment virtually. I recommend planning on travelling to someone who can help you fix the problem.

  • Lee Miller
    Posted at 02:45h, 07 May Reply

    1. How old are you? 48
    2. Any trauma to the area? No
    3. Where is the pain? Butt, side/front low leg, outer/top of foot.
    4. Describe what the pain feels like. Electric nail gun
    5. What makes it worse? Standing, walking, becomes worse if carrying anything
    6. What makes it better? Hard constant pressure on outside low leg or hard constant pressure on glutes
    7. What is your range for the Hamstring Stretch Test? Farther than the dancer’s range in your video at 113 degrees
    8. What is your range for the Pencil Test? 90% function
    9. What is your range for the Touch Your Toes Test? My palms are flat on the floor

    My flexibility makes me appear normal but the pain at level 8 day/night for more than 12 months

    • Dr. Chris
      Posted at 10:02h, 07 May Reply

      Hi Lee, you definitely have a disc pathology in the low back. It’s not big or significant enough to affect your ranges, but it obviously affecting your L5 and S1 nerve roots (google “Lumbar dermatomes” to see which nerve areas are affected). If you get an MRI, it might be some type of extrusion. I recommend getting one to see what your discs look like.

  • PAUL BASILE
    Posted at 17:38h, 18 May Reply

    dr chris…..WOW real solutions for my seemingly bilateral Piriformis issues. i can’t make it to Denville unless i coordinate a visit to my old stomping grounds in River Edge or Cliffside Park, so can you recommend someone here in Bend OR (or anywhere in OR) that can do this work?

  • Dr. Chris
    Posted at 20:27h, 18 May Reply

    Hi Paul, fellow New Jerseyan. We don’t have an Integrative Diagnosis Doctors in OR. There’s one in CA (mydrcohen.com). He’s the closest to you. I recommend going to see him. I travel from NJ to Boston or Chicago once/month for my own treatments.

  • Brigitte Biel
    Posted at 14:59h, 19 May Reply

    I have an adhesion problem in my gluteus muscle(s) and I would like advice how to get rid if them. is there a specialist in the UK who can help?

    • Dr. Chris
      Posted at 00:09h, 20 May Reply

      Hi Bridgitte, there are no specialists in UK. Only US and Australia at this time.

  • Chris Crowell
    Posted at 15:31h, 19 May Reply

    Answers to your 10 questions below.
    I’ve had piriformis syndrome for approximately 2 years. I’ve studied it in great depth as the pain is debilitating and I need to fix it. I’ve been to at least 6 physical therapists as well as the Rothman clinic in Philadelphia. The physical therapist was recommended by Rothman and while they were good unfortunately they were not that familiar with this condition. I’ve followed their last advice which was to strengthen the area with mild exercise. That’s improved the condition by about 30% but the improvement has plateaued.
    I was in the process of considering Extracorporeal shockwave treatment. I’ve heard of good results from a piriformis blog I’m on but I have reservations. I’ve heard of the nerve adhesion issue in the items I’ve read but the stretches recommended haven’t helped. To your point I may be beyond a stretching solution.
    As an FYI, I got this by overstreching my piriformis. I was having some back pain and someone recommended this stretch. It worked so well I continued to use the stretch daily for an extended period. However I slowly developed a pain in my buttocks which progressed to where I am today.
    I’m in a great need of help.. I live in Dover Delaware and would gladly travel to your clinic if you could help. Looking for your advice. Thanks. Answers below:
    Age -64
    Trauma – no
    Pain – buttocks follows an exact path of piriformis. Radiates down back of leg when pinching sciatica.
    Description- extreme in the morning, slightly better during the day returning at night and only slightly better during sleep.
    Makes it worse- extended walking
    Makes it better- surprisingly massaging with a roller. However the relief is very temporary.
    Hamstring test – performed at last PT session. I damned near jumped off the table. Incredible piriformis pain
    Pencil test- I’m not sure exactly where but I’m in the ok range..
    Hope you may be able to help. Also interested if you’ve heard of shockwave therapy.

    Thanks

    • Dr. Chris
      Posted at 00:12h, 20 May Reply

      Hi Chris, hard to say whether it’s more disc or piriformis. We’d have to dive into the details with an exam. I recommend you pull a Melissa (https://www.youtube.com/watch?v=FG80em9dh38&t=132s) and drive up here – we’d do a consult, exam, and if we come up with a diagnosis that includes adhesion, treatment, and see how it goes. At minimum, we’d diagnose it so you know what you’re dealing with.

    • Ildiko Toth
      Posted at 20:18h, 05 October Reply

      Hi Chris,

      I have read your lines here on barefootrehab.com and also on another piriformis blog. My story and symptons (ovestretch and then developing piriformis and sciatica) is strikingly similar to yours. I was wondering how much adhesion removal by manual ontegrative therapy finally helped you. How are you doing these days? Have you managed to resolve the problem? I am desperate to avoid surgery. Please let me know what else helped you.
      Ildi

  • Drew Baxter
    Posted at 04:23h, 29 May Reply

    Hi Chris,

    Can you please tell me where the Australian specialists are who can perform this treatment?

    Thanks!
    Drew

  • Drew Baxter
    Posted at 00:28h, 30 May Reply

    THank you. Unfortunately, I’m in Melbourne, they are only in Sydney and Perth..

    • Dr. Chris
      Posted at 07:46h, 01 June Reply

      You’re welcome, yes, that is unfortunate. I recommend doing what you have to do to see one of these specialists. I wouldn’t waste my time with local doctors unless you need to in order to see for yourself that you need an ID Specialist.

  • PETRINA SKUTTA
    Posted at 19:47h, 05 June Reply

    I’ve had a herniated disc since Jan 2019 and as a result have piriformis pain. I have been seen by a chiropractor, then did physical therapy, then tried two treatments of PRP and therapeutic massage and am still in pain. I live in south Florida by Boca Raton and am wondering if you could recommend anyone I can see down here please. Thank you

    • Dr. Chris
      Posted at 10:19h, 06 June Reply

      Hi Petrina, 2 doctors do this in Florida. Peak Soft Tissue and Veracity Soft Tissue.

  • Michelle Lipoma
    Posted at 03:19h, 06 June Reply

    Hi,
    My 17 y.o son has been having pain in his lower back/right buttock area. He complains of “feeling tight” and running makes the pain unbearable. He will usually get relief from stretching or deep tissue massage but it doesn’t last. He is a baseball player and unable to play at this time. He had a MRI of his lower back which was negative and is currently in PT. He has had a steroid shot which had minimal effects. We live in Baton Rouge,La. His ortho mentioned a performs muscle issue and suggested resting for 28 days which he did. But the pain has returned with minimal activity such as batting. Any suggestions would be appreciated

    • Dr. Chris
      Posted at 10:21h, 06 June Reply

      Hi Michelle, do the hamstring stretch test and pencil test above to get a rough idea of where the problem is. It’s hard to say based on this history if his sciatic nerve is entrapped at the butt cheek or if it’s a disc. I believe Precision Health Group in St. Louis is closest provider to you. They have people who travel across the country for their care and highly recommend not wasting time or money with other providers.

  • Carolina S
    Posted at 12:33h, 15 July Reply

    Hi Chris,
    I found your website as I have been suffering from what has been diagnosed as Piriformis Syndrome in my left side for over 10 months. Since it started, the pain has gotten better, but has basically plateaued, so I do not feel that I am necessarily getting better, but definitely not getting worse. I got an MRI on my lower back and hips, and everything was normal. There is no disc issues causing the sciatic nerve pain. The doctor has told me it is most likely spasms in the piriformis or possibly hamstring that is causing the pain. I have tried just about everything (swimming, pilates, yoga, PT, massage therapy, cupping therapy, myofascial release therapy, foam rolling, stretching, hot/cold therapy, electrical stimulation therapy, etc.), but I can’t seem to fix this problem. I’ll provide all of my details below as requested. Thank you in advance.

    How old are you? 29
    Any trauma to the area? About 10 months ago, I did a high-intensity fitness class where we held a hip bridge for 5 minutes and the next day I ran 5 km in very hot weather, and the next day, I could barely walk or sit in a chair. It was painful to walk or sit, the only relief I had was laying down. I suspect that something in this fitness class or from the run caused some sort of injury. I stopped doing exercise for some time and just focused on swimming and I went to PT for a few sessions. They told me it was a hamstring injury that the muscle had gotten all twisted up inside and they needed to unwind/release it, but I wasn’t convinced with the diagnosis because PT did not help me very much, it almost felt worse after PT. I found relief by starting to do yoga again and I do yoga regularly (2-3 times a week, Bikram and regular). I slowly began to incorporate other fitness (weightlifting, spinning) into my routine again. I never felt pain when doing any exercise. I always warm-up and stretch before and after any exercise.
    Where is the pain? The pain is only when I sit for more than 5-10 minutes. It starts in my hamstring area and radiates down through my calf. Sometimes I also feel pain in my piriformis area when sitting for too long.
    Describe what the pain feels like. It’s an uncomfortable pain, not a sharp pain but more of just a dull pain that is incessant. When I stand up and walk about or stretch, it goes away. But as soon as I sit down again for an extended period of time, it starts up again. I can also feel my muscle twitching sometimes when I sit for too long.
    What makes it worse? Sitting in a chair. Some chairs are better than others. For example, sitting in a car doesn’t bother it so much because the chair doesn’t touch the hamstring directly. Or when sitting on a couch that is low to the ground that doesn’t make contact with the hamstring, it doesn’t hurt. But if it is a high couch where it is pressing up against my hamstring, I can start to feel the pain pretty soon.
    What makes it better? Laying down, extending my legs, standing up, stretching.
    What is your range for the Hamstring Stretch Test? Full range, 90 degrees, no pain
    What is your range for the Pencil Test? 3 cm (or 1.2 inches) before there is space
    What is your range for the Touch Your Toes Test? Pass. Second knuckles touching the ground effortlessly. No pain, just feels like a regular stretch.

  • Dr. Chris
    Posted at 00:36h, 18 July Reply

    Hi Carolina, you definitely don’t have piriformis syndrome with 90 degrees of hamstring stretch range. Even though your MRI is clean, it’s most likely a disc issue “referring” the pain to the piriformis area and also causing hamstring/calf symptoms. I’d try finding a Manual Adhesion Release doctor wherever you live to help it. In the meantime, I’d take as much stress off your low back as you can.

  • Kane
    Posted at 17:43h, 31 July Reply

    Hi Dr. Chris,

    I just read your post and among the hundreds of post and research that I have read this post really made a point. I have been suffering for a back injury for more than 8 months. I’ve been to several doctors you name it you got it physical therapist, neurologist, etc they cant really tell what kind of pain I’m experiencing. I have CT scan than MRI which I think MRI can really tell what’s happening inside me. I had to say the doctors in the Philippines is not really that cool. Anyway I think I diagnose my self haha I think I have a Piriformis syndrome I am just not sure how did I get it. Maybe prolong hours of sitting at work, Too much exercise, I cant think of anything. Few months ago I was able to walk properly without any pain radiating from my buttock to inner calf. I didn’t want to have an operation because I think If I will undergo through that I would loose some parts inside me that will make me more inable to do things. That is just me not offending anyone else. I tried physical therapy session but it did do better on me. I researched some few ways on how I can be better so I saw this Chiropractic Doctor in Manila and I had several sessions with him. Thank God after my fourth session one day I started to notice that the radiating pain is gone. The reason why I am writing now in your post is a month ago I felt a lower back pain again. I dont know why I felt it again but I have been very careful about how I would move around not carrying heavy things regular stretching. I am observing myself to see if the radiating sharp pain will ever go back. Do you think I need manual adjustments again to ease the pain Im going through. Thank you and more power!

    • Dr. Chris
      Posted at 22:58h, 02 August Reply

      Hi Kane, I’m sorry for your troubles. The fact is, PAIN = too much stress on some body part. Even if you did a little bit, your body is saying “that little bit” was too much. If I were you, I’d find the best myofascial therapist I could find. This is your best bet to getting better.

  • Sarahi Rojas Reyes
    Posted at 05:22h, 08 August Reply

    Is feeling something hard in glute a sign Piriformis Syndrome.
    I cant sit on the toilet or in a hard chat because i feel I’m sitting on something hard on my right glute. + I have all the other symptoms

    • Dr. Chris
      Posted at 10:59h, 08 August Reply

      The symptoms you describe can be “piriformis syndrome” or a “disc”. You need more data.

  • Ben Hall
    Posted at 13:46h, 10 August Reply

    Hi Chris. Can you recommend anyone in Atlanta, or Georgia to see for stubborn Piriformis Syndrome? I’ve tried PT, Chiro and massage with minimal improvement.

  • Katy
    Posted at 17:08h, 19 September Reply

    How old are you? 33
    Any trauma to the area? No
    Where is the pain? Low back, both glutes which radiates down mostly the outer left leg to the ankle
    Describe what the pain feels like. Burning, deep ache
    What makes it worse? Sitting for long periods and standing
    What makes it better? Laying down, stretching the piriformis and hamstrings
    What is your range for the Hamstring Stretch Test? Good
    What is your range for the Pencil Test? C grade
    What is your range for the Touch Your Toes Test? Fail-high risk

    • Dr. Chris
      Posted at 11:21h, 20 September Reply

      Hi Katy, sounds like a disc. Focus any treatment you get there on low back.

  • Matthew Dwight
    Posted at 20:25h, 16 October Reply

    Hi Dr. Chris,

    My wife has been to 2 PTs, 2 Chiros, 1 pain management specialist and has had 1 injection done directly into the piriformis muscle, not to mention almost 8 months of PT, chiropractic appointments, MRIs, X-rays (both came up clean every time), stretching, and isolated strength training. She’s been dealing with pain for 2 years and we finally know for a fact it’s Piriformis Syndrome, as concluded by all the PTs, Chiropractors, the pain management specialist, and my wife. We’re here in Dallas, TX and after looking for doctors on https://integrativediagnosis.com/find-an-id-provider/ the closest I’ve been able to find is in Denver or St. Louis. My first question is, is it worth going to see one of these specialist or do you know someone in TX that might be closer? My second question is, would flying or driving to see one of these specialist and then returning home undo what the specialist did? I’m worried the length of time my wife would be sitting will cause more damage or discomfort. Thank you in advance for your help and your very educational article.

    How old are you? She’s 26 and has a lean body type.
    Any trauma to the area? Possibly? Not sure, She used to snowboard and now she sits all day at a desk (I think that counts as trauma)
    Where is the pain? In her butt and lower back, but mostly isolated to her right butt cheek.
    Describe what the pain feels like. She’d be able to tell you better than me.
    What makes it worse? Sitting for long periods of time, walking a lot, sometimes lying flat on her back
    What makes it better? she does a certain stretch that seems to help. Not sure how to describe it.
    What is your range for the Hamstring Stretch Test? good range, pain is isolated to right butt cheek
    What is your range for the Pencil Test? different PTs, different results but best result at the end of several months of PT was around 85%
    What is your range for the Touch Your Toes Test? By the end of PT she could just touch her toes

  • Daksha Patel
    Posted at 18:03h, 18 October Reply

    This really helps. any doctors in Ventura County California?

  • Theresa Schrock
    Posted at 22:02h, 21 October Reply

    Hi Dr Chris,

    I have been having pain in the left side deep in the butt area, and side hip, an occasional back pain not too often and have seen a Chiropractor for ART about 8 sessions each, and now seeing a PT that specializes in running, about 8 sessions so far, with dry needling and scraping so far. It is getting better slowly but not completely gone. I know the next time I go running or exercise it is going to flare up again, Can you recommend someone here in the Denver, CO area?

    How old are you? 49
    Any trauma to the area? no
    Where is the pain? left butt (deep), side hip and sometimes hip flexor
    Describe what the pain feels like. Feels like a chronic nagging pain, When I am sitting, I feel like I am sitting on a rock.
    What makes it worse? Distance running, Laying on the side, pain with specific exercises, such as side shuffles, Split stance lunges, jump squats, jump lunges, side plank toe touches.
    What makes it better? nothing so far.
    What is your range for the Hamstring Stretch Test? good
    What is your range for the Pencil Test? about 2-3 inches
    What is your range for the Touch Your Toes Test? green light, no issues

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