How to Heal Piriformis syndrome When You’ve Tried EVERYTHING else.

I personally suffered from piriformis syndrome for at least 5 years before finding long-term relief. You can guess how much time I spent online researching. I literally tried everything under the sun, read every single post and article online, did a ton of stretches and exercises, and tried every treatment or therapy I was referred to.

I’m writing this post to provide you with some alternative healing modalities that helped me heal piriformis syndrome once and for all. I haven’t had a flare-up in more than 3 years.

Now, you need to understand that in order for you to fix piriformis syndrome and get better once and for all, you’ll still need to fix the underlying muscle imbalances that have caused the pain in the first place. And I’ll show you how to do that later in this post. But for now, I want to provide you with a list of treatments that worked best for me…

Please stick around and read through this post. I want you to learn from my mistakes so you can heal piriformis syndrome quickly without wasting years in trial and error as I did.

This post is broken into two parts: the therapies and treatments I found the most success with. The second part will give you some suggestions to do at home to fix the underlying problems that have caused the pain in the first place.

Once you fix the underlying causes, you won’t need any symptom-focused quick-fixes. You’ll enjoy long-term relief.

I know you want that so please take some time to read the post fully. And if you have a question, post it below and I’ll do my best to help you. Let’s get started.

Typical Treatments For Piriformis Syndrome

I’m assuming you’ve clicked on this post because you feel you’ve done it all.

In part 1 to this post, I go step-by-step on how to heal from piriformis syndrome fast by identifying and fixing the root cause. You definitely want to read that post too.

Let’s assume you’ve tried at least 70% of the following treatments for piriformis syndrome and nothing worked.

Typical therapies and treatments to treat piriformis pain:

  • Physiotherapy
  • Athletic therapy
  • Massage therapy
  • heat/cold therapy
  • Acupuncture
  • Sitting on a ball
  • Sitting on a kneeling chair
  • Standing desk
  • Pilates
  • Yoga
  • Stretching 10 times a day
  • Chiropractic adjustments
  • Injections
  • Medications

I personally have done all of these treatments (except for injections) to try and fix my pain and relief was always short-lived.

Now I want to mention that I only found long-term relief shortly after I became a strength coach and started studying to become a corrective exercise specialist…

I understood better why I was having all this pain and committed to fixing the muscular and postural imbalances that contributed and were constantly triggering the pain.

Don’t worry you don’t have to also become a specialist in this to heal. That’s why this website exists. I want to show you how to do it too.

Recommended Program: Piriformis Control Program.

Now let me list the 3 alternative treatments I personally found success with. I highly suggest you give them a try as soon as possible.

How To Heal Piriformis syndrome – Alternative Therapeutic Treatment Modalities.

Dry Needling

You may think that dry needling and acupuncture are the same things but they’re not. I tried both and dry needling gave me faster and longer-lasting relief. Here’s the difference:

Acupuncture is focused on balancing the energy flow of the body. Acupuncture needles remain in place for about 20-40 minutes (or longer).

Dry needling is more focused on treating musculoskeletal pain. The best result I personally got was releasing the TFL (tensor fascia latae) – a muscle that flexes, internally rotates and abducts the hip and can get extremely tight – and the piriformis with dry needling. I found that this ‘gentler’ treatment did not result in more spasms and relief lasted more than just a few hours.

You’ll also benefit immensely from just relaxing and tuning into your body.  Stress can make the pain worse sometimes and just lying down for a few minutes to relax can also have a positive effect on the neuromusculoskeletal system.

Swimming

If you have a herniated disc or found that your piriformis pain is originating from a disc problem, you’ll benefit a lot from swimming and here’s why…

Movement is key when you’re trying to heal a disc or joint injury. Due to their structure, joints and discs rely on movement to draw oxygen and nutrients in.  Cell regeneration and tissue recovery become really difficult without proper movement.

When you’re in a lot of pain, it’s almost impossible to exercise or move. In fact, you shouldn’t be pushing through or placing additional load on your spine when you’re in pain.

Swimming is the ultimate solution. It also promotes the integration of the whole muscular system without isolation and without loading your spine and causing more disc damage.

The Study of Neuroplasticity

If you’ve never heard of neuroplasticity or brain plasticity, don’t worry, it’s not a very common word and most people don’t even realize the link between that and healing pain.

But there is a huge benefit to learning and using neuroplasticity to heal piriformis syndrome or any muscle pain in general. This is even more important if you’ve been in pain for more than a few months or years.

I want to explain neuroplasticity in very simple terms… When we injure an area of our body or when pain is triggered for the first time, the brain will build neural pathways associated with that painful feeling. This is called pain-memory also. And this process is referred to as neuroplasticity.

Here’s an excerpt from an article from Spine University website (I’ll link the articles in the resources section at the end of this post)…

 …Where neuroplasticity comes in is when acute pain develops into chronic pain. Your body reacts to acute pain as it warns you that something is wrong. Usually, once the acute pain has been dealt with, either with medications or other treatments, the pain goes away and becomes a distant memory. However, over the course of a few weeks, months, and sometimes even years, your brain’s “wiring” may reorganize itself and tell your body that the chronic pain should be there and will stay there.”

Now the good news is…you can use the same process of neuroplasticity to build new neural pathways associated with the non-pain feeling and to weaken the existing neural pathways associated with the pain memory. I found the easiest way to do this is through mindfulness meditation and visualization.

There is nothing woo-woo to meditation. There is a ton of scientific studies that demonstrate the benefits of meditation on helping the body relax, heal and regenerate faster. So don’t ignore it especially if you’re under a lot of stress.

You can get my 3 custom 5-15 minute meditations to reprogram the nervous system through neuroplasticity here.

Here’s a tip for you to kick start this process. Try to focus for a few minutes on an area of your body that actually feels good or is completely pain-free.

This will help your brain break the cycle of focusing on the pain all the time.  This may be hard to do when you’re in a lot of pain so try to do it early in the morning or before going to bed when you’re the most relaxed.

Now start to expand that pain-free feeling to the other areas of your body. This will help you relax more and start reprogramming your whole body on feeling pain-free again.

When Piriformis Syndrome Won’t Go Away

Now I want to give you a few tips on fixing some of the underlying postural or muscular imbalances that have contributed to the constant piriformis pain.


If you already know exactly what’s causing the pain in the piriformis or your hips, and it’s related to a disc problem, don’t ignore this section. Let me explain why…


When you experience a back or hip injury, you start to move differently. For example, you’ll start using the opposite leg more to try to avoid pain. You’ll also experience what is referred to as relative flexibility. And here’s what it means…


It means that when a joint or an area of the body is hurt, strained or just very tight, the adjacent joint will compensate for that and become hypermobile. An example of this is…


If your hips are extremely tight, you’ll notice your knees are now compensating for that. Unless you pay close attention to this, you won’t notice it. This even happens at the shoulder level. Very tight shoulders and upper body will affect how the hips are moving.

The body is a kinetic chain so don’t ignore the other areas of your body when trying to fix any kind of joint or muscle problem.

Assess Hip Weakness Causing Piriformis Pain

Using one leg or hip more and compensating for the weaker (or hurting) hip will create muscular imbalances.

I have a simple exercise you can right now to test for hip weakness. This will help you get some clarity on why the heck you’re not getting long-term relief. You’ll be able to fix the weakness and the root cause.

Muscular Imbalances Test

You’ll need to film yourself with your phone from the front and the back as well.

Stand nice and tall, feet shoulder-width apart, feet facing forward (not rotated out or in). Raise your hands up (not flexed at the elbow).

Now complete 5 repetitions of the bodyweight squat. Don’t squat too low. Squat as if you’re going to sit on a chair. We want to assess any hip instability here. Some important notes:


Don’t look down or to the side (mirror) to watch yourself squatting. This is why you need to film yourself and then you can watch and review your form.

Here’s what to look for:

  • Do the feet flatten as you’re squatting down?
  • Do the knees cave in and internally rotate as you’re squatting down?
  • Do the feet and knees externally rotating instead?
glute weakness piriformis syndrome test
An example of the right knee caving in and internally rotating showing tight TFL (tensor fascia latae, and weak glute medius.
testing for piriformis muscle tightness
Right foot externally rotating – a good indication of an overactive piriformis muscle.

If you do notice that one foot (or both feet) is rotating out as you’re squatting down, the piriformis on that side is overactive. The piriformis muscle is a hip external rotator, so when overactive, it’ll tend to drive the foot and hip out during transitional movements like the squat.

Correct Muscular Imbalances

If your feet flattened as you were squatting down. Then you definitely want to start at the base and fix that imbalance. Imbalances at the base (feet) will have an effect on the adjacent joints (knees and hips) so you need to be releasing the peroneal muscles and strengthening the posterior and anterior tibialis.

If your knees started caving inwards as you’re squatting down (with or without your feet flattening), this is an indication of an overactive TFL (tensor fascia latae), adductors and a weak glute medius.

You should NOT be stretching the piriformis here. Clearly, it’s lengthened and weak. Stretching it will only lead to more weakness and tightness.

Click here to watch a video tutorial on how to release the TFL muscle.

Recommended Program: Piriformis Control Program.

If the opposite happened and your feet or knees started to externally rotate, then you should spend some time releasing the piriformis muscle.

As you can see, we don’t just stretch the piriformis for the sake of it, you need to assess first and there needs to be a need for stretching.

As you release the piriformis muscle, you should also activate and strengthen the glute medius and glute maximum to help stabilize your hips and re-awaken these muscles so they’re firing up when needed.

Fixing piriformis syndrome isn’t going to happen if you don’t fix the muscular imbalances that caused it, so please don’t ignore these steps. The treatments I mentioned, in the beginning, will help you get relief but they won’t fix weak muscles that aren’t working properly.

To get long-term relief, you should check out Piriformis Control.

I hope this post was helpful.

Don’t forget to also refer to my guide: how to heal from piriformis syndrome quickly… I explain the location and functions of the piriformis muscle, how to fix the underlying muscular imbalances and mistakes to avoid flare-ups and setbacks during your recovery.

Resources:

how to heal piriformis syndrome when it won't go away
  • Thanks for the info, after more than a year of pain I think I have piriformus issues. It’s been a very long year with many unsuccessful or temporary fixes. I would caution people about going to a chiropractor, because for me that’s what made my issues worse. But I also found a good chiropractor that has helped me along this journey. My problem was many things, my pelvis had an up slip, but then after that was corrected it would rotate so when a chiro would just adjust when rotated it would cause worse pain. Really good advice you gave in your blog though. Another good book is The Brains Way of Healing, by Dr. Norman Doidge. Best Wishes for good health!

    • Hi Willette,

      Thank you for your comment. You know, I 100% agree with you. I think finding the right chiropractor takes time. I went through the same thing with physio. After the adjustment, I feel worse. I felt like they were practicing on me on every treatment. So I discontinued it all together. I used that website rateMDs to finally find a good qualified chiro, and I had to look the reviews to make sure he had a lot of success healing this particular issue because it is one of those mysterious chronic injuries that tends to linger. Up to this day I still feel soreness every now and then I have to be very careful working out. I believe it is something that needs our continual care for sustainable long term healing. Thanks a lot for the book recommendation, I will certainly check it out 🙂

  • Hi Sofia

    I 24 and suffering from piriformis syndrome for about 6 months now . I believe the root of my problem was because i was training Jiu Jitsu which is a very tough sport on the joints and muscles. One day i woke up out of bed with a very stiff lower back . After a few days the pain moved to my left buttock and shooting down my leg . I paid a visit to the doctor and he said it was piriformis . I went to some physio sessions and acupuncture therapy which temporarily relieved my pain . And i found the acupuncture most effectictive . I do daily stretching and light mobility exercises to focus on building back up the hip muscles and lower back. But right now is my hamstrings , calves and glutes seem to be getting stiffer each morning only on the left. . And its becoming difficult to bend in the mornings and night when i am more relaxed as i work 8 hours a day moving about . I am sick of taking painkillers and they are making me loose my appetite . Am i over doing it by stretching and exercising each day . Should i rest more ?

    Thanks

    • As a general rule, I was told. It is O.K. to work through muscle pain but don’t exercise and rest when it is nerve pain.

  • I have had ps for 6 years. I walk, water walk, yoga. Stretches in morning and night. I’ve been seeing drs this whole time with no relief. Why do I have to keep suffering? I’ve had back surgery. I’ve had injections. I’m at my wits end.

  • Hi, I’ve had piriformis problems in both sides for the past two years and I could really do with some help as I’ve exhausted everything else!!

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