What is the role of physical therapy in the treatment of piriformis syndrome?

Updated: Sep 16, 2020
  • Author: Milton J Klein, DO, MBA; Chief Editor: Ryan O Stephenson, DO  more...
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Answer

Once the diagnosis has been made, these underlying, perpetuating biomechanical factors must be corrected.

Consider the use of ultrasound and other heat modalities prior to physical therapy sessions. Before piriformis stretches are performed, the hip joint capsule should be mobilized anteriorly and posteriorly to allow for more effective stretching. Soft-tissue therapies for the piriformis muscle can be helpful, including longitudinal gliding with passive internal hip rotation, as well as transverse gliding and sustained longitudinal release with the patient lying on his/her side. Addressing sacroiliac joint and low back dysfunction also is important.

A home stretching program should be provided to the patient. These stretches are an essential component of the treatment program. During the acute phase of treatment, stretching every 2-3 hours (while awake) is a key to the success of nonoperative treatment. Prolonged stretching of the piriformis muscle is accomplished in either a supine or an orthostatic position with the involved hip flexed and passively adducted/internally rotated.


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