What is the best therapy for piriformis syndrome?

introduction

The acute symptoms of piriformis syndrome can be alleviated with anti-inflammatory and analgesic drugs. As soon as the symptoms appear for the first time, physical activity should be interrupted and cooled immediately.

In addition, the attending physician can also achieve a rapid temporary improvement directly on the piriformism muscle through targeted injections of a local anesthetic and possibly additional cortisone. However, this treatment only relieves symptoms for a short time.

Conservative therapy for piriformis syndrome

The piriformis syndrome can be treated conservatively with specific exercises from physiotherapy, such as stretching exercises. Furthermore, myofascial relaxation exercises and massages, but also the avoidance of triggering stimuli such as excessive walking and long sitting in uncomfortable positions can alleviate the symptoms.

In the long term, it is recommended to use a mixture of physiotherapy and massages to strengthen the remaining muscles of the lower back and buttocks so that the piriformism muscle is relieved and can no longer irritate the sciatic nerves.

Trained physiotherapists can treat piriformis syndromes that have persisted for a long time using targeted ultrasound waves, which are intended to relieve muscle tension and thus prevent irritation of the sciatic nerve.

In addition to this, a myofascial trigger treatment can also be carried out, in which the sac (fascia) that surrounds the muscle is specifically stimulated and thereby relaxed so that the inner muscle is also further relaxed and no longer presses on the sciatic nerve.

In most cases, pain relievers and anti-inflammatory drugs for the acute symptoms as well as physiotherapy and special stretching exercises to remove the causes are sufficient to counteract a recurrence of piriformis syndrome.

You might also be interested in: Trigger point therapy

Physiotherapy for piriformis syndrome

Manual therapy or physiotherapy is a first step in successfully treating piriformis syndrome. It is carried out by physiotherapists and / or osteopaths. The aim is to stretch and loosen all of the muscles in the lower back and hips. To do this, the physiotherapist uses massages and stretching movements and often shows his patient stretching exercises to do at home, which are supposed to keep the small hip muscles supple.

Trigger point treatments are intended to find punctual tension in the muscles and release them, for example, by applying pressure. Success should be felt immediately. However, there is no scientific evidence of sufficient effectiveness. Thus, every patient has to try out for himself which form of treatment he will benefit most from.

You can find a lot more information under our topic: Physiotherapy for piriformis syndrome

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Stretching in piriformis syndrome

For prevention and in the presence of a piriformis syndrome, the stretching of the muscle is an important part of the treatment concept. Sitting for long periods of time or exercising the muscles shortens them. A shortening can be counteracted by stretching.

A helpful stretch is as follows:
You lie on your back on the floor; the affected leg is bent at 90 ° in the hip and knee. Next, slowly move the bent leg to the other side of the body so that it goes over the other knee. You should feel a slight tug in the buttocks of the bent leg.
Now you can also pull the knee further over with the arm and hand on the other side. The feeling of stretching should now get stronger.
You should remain in this state for about 30 seconds. Then the exercise is carried out for the opposite side. In total, the exercise should be done about three times for both sides.

In addition to this exercise, there are a number of other stretching exercises that can be used to counteract piriformis syndrome. It is important in all exercises that you do not stretch into the pain. In addition, people with prostheses in the hip and knee should only perform this exercise after consulting a doctor or therapist.

Read more on the topic: Piriformis syndrome stretching exercises

Transcutaneous electrical nerve stimulation (TENS)

TENS stands for transcutaneous electrical nerve stimulation. Small stimulation currents are conducted through the skin into the tissue and muscles via TENS electrodes that are glued to the skin, which should lead to pain relief. In piriformis syndrome, TENS is successfully used as a therapy in some cases.
The pain is reduced and the stimulation current can help relax the tense muscles. With TENS, the patient may feel a slight tingling sensation.

In some cases this therapy is also reimbursed by the health insurance. You should inquire about this with your health insurance company before starting TENS therapy for piriformis syndrome.

More information can be found here: Electrotherapy

Kinesio tape

Various techniques can be used to treat piriformis syndrome with kinesio tape. In addition to prefabricated so-called “pre-cuts”, normal commercially available Kinesio tape can be used.

The affected person lies on their stomach with the knee slightly angled outwards (like a frog) on ​​the affected side so that the front pelvic bone is free in the air. A normal strip of kinesio tape about 25cm long is cut into two equal strips until there is a common base about 3-4cm long. The backing paper is removed from this base by kinking it and left to stick to the rest of the tape.
This base is glued to the front pelvic spine without tension. The lower strip is glued in an arch shape with tension down to the sacrum, the last part being glued again without tension. The same is done with the upper strip so that both of them overlap on the sacrum.

A second method involves a strip that is glued horizontally under tension from the sacrum (os sacrum) to the greater trochanter (large rolling hillock / larger bony protrusion on the femoral head). In addition, two smaller tapes are crossed over the main pain point with full tension.

Should pain from the tape; If redness or signs of inflammation occur, this should be removed again.

also read: Kinesio tape

Acupuncture for Piriformis Syndrome

The symptoms of piriformis syndrome can be treated with acupuncture and acupressure.
The acupuncture needles are placed in special acupuncture points for the muscles. As a result, cramps in the piriformis muscle are often released and the underlying sciatic nerve is no longer or less pinched. In the course of traditional Chinese medicine, other remedies are often used to enhance the effects.

Find out more at: Acupuncture

Osteopathy in piriformis syndrome

Blockages and misalignments in the pelvis, hips and the lumbar spine can cause increased tension on the piriformis muscle. This leads to cramps and increases in tone, which cause corresponding symptoms.

With mobilization, treatment of the fascia and other techniques, osteopathic remedies can also be used to help with piriformis syndrome. Corresponding exercises for stretching and mobilizing the buttocks region can also be carried out at home on your own.

You might also be interested in: Osteopathy

What home remedies help with piriformis syndrome?

A home remedy for piriformis therapy would be to massage the gluteal muscles independently with a tennis or fascia ball, for example.
You sit down lightly on the ball and move your buttocks in circular motions on it. This results in a treatment and massage of the deep muscle layers up to the piriformis muscle. In doing so, trigger points of the muscles are controlled. This can be quite painful. However, it should not be fully trained in pain here either.

Using a fascia roll can also relieve symptoms. In addition, as described above, regular stretching of the buttocks helps to reduce the pain.

Learn more at: Fascia training

Homeopathy for Piriformis Syndrome

In addition to conventional medical therapy for piriformis syndrome, there is also the option of therapy using homeopathy. This can help to alleviate the symptoms of piriformis syndrome.
In homeopathy, e.g. a mixture of Harpagophytum, Ledum, Rhus toxicodendron and Tartarus stibiatus, which are the ingredients of the drops available as Bomarthros Harpagophytum Complex. They are said to have a pain relieving and anti-inflammatory effect.
Acidum nitricum or Echinacea can be used against the inflammation itself. Whether homeopathy actually helps is scientifically controversial, so that a conventional medical opinion should be obtained in the case of piriformis syndrome.

Treatment with the tennis ball

For some patients, self-application of a tennis ball massage helps to loosen tense muscles and become pain-free again.

The idea is that the tension is released through targeted pressure on painful areas. To do this, the ball is placed on a chair. Then sit carefully on the ball until it comes to rest under the painful area. It is not necessary to use the entire body weight. Instead, enough pressure should be applied so that the pain is palpable but easy to bear.

The massage begins with light rolling movements. The painful area should be treated for half a minute. The ball can then move on to massage other painful areas. This form of massage gives the best results when used several times a day.

Treatment with botox

Botox, or botulinum toxin; is a nerve toxin made by a bacterium called Clostridium botulinum and is one of the deadliest toxins in the world.
In low concentrations, it inhibits muscle contraction for up to six months, so that the muscle relaxes during this time.

Thus, the pain caused by the tense piriformis muscle should also disappear and make movement or physiotherapy possible painlessly. Health insurance companies do not necessarily cover the costs of treating the muscle with Botox. Some studies have shown that muscle injection with Botox injections with local anesthetics or corticosteroids is superior.

The Botox is sometimes injected directly into the muscle in several sessions. Most of the time this is done under CT control to make sure that the needle hits the right muscle. Risks include injuries to nerves and blood vessels, the development of a hematoma and minor side effects from botox.
These include a general feeling of illness and temporary muscle weakness. Long-term side effects are not known when used correctly.

Further information can also be found at: Side effects of botox

Illustration piriformis muscle

Piriformis muscle

1. Pear-shaped muscle -
   Piriformis muscle
2. Iliac scoop -
   Ala ossis ilii
3. Posterior sacrum holes -
   Foramina sacralia posteriora
4. Sacrum -
   Sacrum
5. Great Rolling Hill -
   Greater trochanter
6. Small rolling hill -
   Lesser trochanter
7. Femoral shaft -
   Corpus femoris
8. Ischium -
   Os ischii (ischium)
9. Fifth lumbar vertebra -
   Vertebra lumbalis V

You can find an overview of all Dr-Gumpert images at: medical illustrations

Surgical therapy for piriformis syndrome

In addition, in individual cases the symptoms can also be improved by an operation, especially if the sciatic nerve does not run under the piriformism muscle due to congenital anatomical changes, but through it.

Surgery to treat piriformis syndrome is still rare. There are special cases in which the sciatic nerve does not pull into the legs below the piriformis muscle, but rather through it. Then appropriate exercises for stretching and loosening are not helpful because the nerve is further compressed. This anomaly occurs in up to 15% of all people.

But this does not cause problems for everyone. If this condition exists and the symptoms cannot be remedied in any other way, then an operation can be started.
The exact course of the sciatic nerve is determined in various preliminary examinations. During the procedure itself, the tendon of the piriformis muscle is severed. In most of all cases this will give satisfactory results.

Due to the proximity of the sciatic nerve to the operating area, this method should only be used after conservative options have been exhausted.

Also find out about: Cure for Piriformis Syndrome

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