With that said, piriformis syndrome is often diagnosed based solely on buttock pain and palpable tenderness along the course of the piriformis that is associated with pain upon sitting or with activity. So with that said, a great initial start is physical therapy
, ice and nsaids
. However, not all physical therapy is created equal. The best approach is to strengthen the gluteus medius and piriformis to build endurance, and to stretch with dynamic stretching techniques. Often piriformis syndrome is a result of over training, and the muscle becomes fatigued. So the best pt approach is to strengthen the muscles and build endurance. So if your pt was mostly comprised of e-stim, riding a bicycle and stretches, you didnâ€™t fully address the problem. Your physician should be able to re-examine you and determine if the muscle strength has improved. Other approaches that can be successful are massage
. If despite these treatment strategies, your symptoms continue, i would reconsider the diagnosis. Did you actually tear a muscle, etc? Perhaps an MRI
would be helpful. Lastly, if an MRI is normal, and pt, acupuncture and massage have all failed, then nerve
studies (EMG) could be helpful to prove the nerve is entrapped. In that case a Botox
injection into the piriformis muscle may alleviate the pain. Good luck.