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Piriformis Information
Answers to Questions About Piriformis Injury
What is the Piriformis?
How does the Piriformis Get Injured??
How Long Does Piriformis Last?
How Do You Reduce Piriformis Pain?
What Can I Do Now?
What is the Piriformis and How Can you Heal it?
The Piriformis is a flat muscle located deep in the buttock.
Its main job is to turn the leg outward or move the leg to the side.
The Piriformis attaches to the sacrum which is the bony part at the bottom of the spine just above the tailbone.
The other end of the Piriformis attaches to the upper part of the thigh bone called the trochanter.
It's a strong, thick, flat muscle that is wider where it attaches to the sacrum and narrower where it attaches to the thigh.
Because of its location, the Piriformis muscle can have an impact on the Sciatic Nerve
The Sciatic nerve is a major nerve and it carries most of the signals from your brain down to your leg.
The piriformis muscle passes right over the top of the sciatic nerve.
In fact, around six percent of people have a rare Piriformis muscle anatomy where the sciatic nerve actually goes straight through the piriformis.
If you have Piriformis Pain, often termed Piriformis Syndrome, it can be quite debilitating.
It can make life difficult, dealing with the pain, when just trying to move around and do basic life tasks.
But you can heal it.
You just need to know the right steps to healing Piriformis pain.
Hint: It's not 90 percent of the bad advice you find online.
Often websites recommend activities and 'treatments' that can actually make things worse.
Piriformis and Sciatica
Piriformis Syndrome is often called Fake Sciatica. The symptoms can be very similar.
But sciatica is usually caused by a bulging disk where the nerve root comes out of the lower part of the spine.
The close relationship between the Piriformis and the Sciatic nerve is the main reason that problems with the Piriformis can become so debilitating.
The Piriformis is directly on top of the Sciatic Nerve.
If the Piriformis is injured it will go through the same swelling and spasming that any injured muscle will experience.
But in this case, it will be right against the surface of the sciatic nerve.
It will narrow the space the sciatic nerve usually passes through and rub against the nerve whenever there is movement of the leg.
Every person's anatomy is different and some people have less space for the sciatic nerve to pass through.
Any spasm would then pinch the nerve where it passes through the muscle.
This makes it more likely in those cases for swelling or tightness in the muscle to irritate the nerve.
Irritation to this major nerve for the leg can cause weakness, "pins and needles", numbness, and pain.
You can see why this condition is often mistaken for Sciatica.
Common Symptoms of Piriformis Syndrome
Symptoms of Piriformis Syndrome can vary from person to person.
Your Piriformis injury is unique.
It will likely have some different symptoms from what you read and hear.
That is ok and normal. You can still heal it with the right steps.
The common thread in everyone's symptoms is pain in one side of the buttock.
After that, many people describe many different related pains that can range from the top of the hip to the end of the toes.
Usually, it is sensitive to pressure.
One quick Piriformis test is to press on the spot and it will hurt and may even aggravate symptoms for a while.
It can be dull pain or stabbing pain or may include that "pins and needles" sensation that comes with nerve pain.
Some people have numbness and pain down the leg.
That numbness will make it difficult to do many normal daily tasks.
Some people have trouble walking or going up stairs.
Sitting can be an issue. The prolonged pressure on the buttock can aggravate the Piriformis making pain worse.
Many people have weakness in the leg on the same side.
What Causes Piriformis Pain?
The cause of Piriformis pain can be from a specific incident and in other cases it can be from overuse.
Sometimes it stems from a sedentary lifestyle or just too much sitting.
Sometimes people doing a lot of running or cycling or some other repetitive motion with their leg can cause irritation to the Piriformis over time.
But in other cases, it can be from lifting something heavy.
Any one of those things can cause the initial injury.
When this happens, you will have pain from the muscle strain of the Piriformis tear itself.
But you will also have pain from the muscle swelling and spasming against the sciatic nerve.
Muscle Strain and Piriformis Injury
A Piriformis Injury is ultimately a muscle strain. This is what causes Piriformis Syndrome.
The strain can cause muscle tightness, swelling, spasms or other symptoms.
If the strain is severe enough there may be torn fibers in the muscle which can cause bleeding as well as the other symptoms.
Muscle strains come in three classes. Typically, they are called degrees or grades.
This is common to all muscle strains.
A grade 1 muscle strain is a minor overstretch of the muscle.
It can cause mild tightness and swelling and it usually heals quickly if you do not reinjure it.
You probably don't have a grade one strain if you are looking online for information since it is usually only mildly irritating.
Since you are online reading about Piriformis it's a good bet your strain is a grade 2 and maybe a grade 3 in some people.
A grade 2 injury is significant overstretching along with some tearing of the muscle.
This injury takes longer to heal.
You may have pain for a few weeks.
It is very easy to reinjure this strain so a plan to minimize reinjury is key for this one.
Grade 3 means you have a torn Piriformis with considerable tearing of fibers and in some cases your doctor may say it needs surgery to correct.
It takes much longer to heal from this type of injury.
No matter what type of injury you have in your Piriformis muscle, what makes it unique is how close it is to your sciatic nerve.
The location means any swelling or spasms will cause pressure against the sciatic nerve which will cause irritation and tenderness.
This is the reason that some people refer to Piriformis as fake sciatica.
Healing the muscle strain will stop the spasms and ease the swelling resulting in no more pain and numbness.
For an excellent, in-depth explanation about how an injury heals click here for our Tissue Healing Page.
Common Mistakes and What to Avoid
Your Piriformis needs your help to heal.
But it does not need you to just start randomly doing stretches and exercises you find on the web.
This is a great way to keep your injury going.
Reinjuring the muscle is the number one thing prolonging your healing time.
The piriformis muscle is one we use every time we get up and move around.
So, it does not get to rest, unless, you focus and make a point of resting.
Another complicating factor is that many people find that sitting irritates the Piriformis.
It is located right there in your buttock so sitting, especially for long periods, can make it worse.
You may need to either find a way to change your sitting position, so you alleviate pressure on one side of the buttock, or move frequently.
But obviously, if both sitting and walking cause irritation, it will take some planning to get some time to rest your piriformis.
At first, you want to focus on three things.
Reduce pain with cold compression not medication.
Avoid reinjuring the muscle.
Increase blood flow to the muscle to stimulate rapid healing.
Pain Medication
Pain reduction is important.
When the Piriformis hurts, you need to reduce pain so you can go about your day and do the things you need to do.
But masking pain with pain medication is not recommended because it can lead to you being unaware of the damage you are doing to a muscle.
This is a very common way people get caught in an injury and reinjury cycle.
Don't get caught in this loop.
Get some initial rest of the muscle and give it time to heal.
Find ways to protect the muscle from too much use during the early healing phase.
Use cold for pain during the day.
If you use do pain medications, use them at night for sleep.
Don't use them during the day since they greatly increase your chances of adding more damage to the muscle strain.
Some pain medications can help - if you use the right one at the right time.
Call us and speak to one of our trained treatment advisors about which pain relievers work best.
We are here to help.
Tens
TENS is an acronym that means Transcutaneous Electrical Nerve Stimulation.
The TENS machine is designed to overstimulate the nerves to relieve pain.
It deadens the nerves and that's it.
Yes, you want to reduce pain.
The pain with Piriformis Syndrome can be debilitating for sure.
But TENS machine over an injury is a very bad idea.
Tens causes your muscles to spasm during treatment.
That's bad.
Having your Piriformis pulse and flex uncontrolled will cause further tissue damage and slow down healing.
It will also cause the Piriformis to spasm directly against the sciatic nerve, which is exactly what is causing most of the pain with Piriformis Syndrome.
Avoid this treatment as it can make things significantly worse for this condition.
Isometric Strain
Continuous mild pressure on a body part when it is not moving can lead to an injury called Isometric Strain Injury.
If you are inactive for a long period of time, and your leg is held in a position where you are putting pressure or stretch on the injured area, you may be hurting yourself.
With Isometric Strain, you usually don't notice it when you're actually doing the damage.
You know how when you sit in a position for a long time, and then when you go to get up, parts of your body are stiff and a bit painful?
That's Isometric Strain.
You don't feel it when you're doing the damage, only later.
When you're injured through isometric strain, you might not even notice it right away after moving.
Often you notice later that you are having a flare up and are not sure why.
With Piriformis this will most commonly happen with sitting or sleeping positions.
Sitting can be a real issue since many of us have jobs that require extended sitting.
The main thing for sitting is to notice if you are putting pressure on the buttocks.
If you can feel pressure in that painful area of the piriformis, you may be straining the tissue.
Or, if you are putting stretch into the area for extended periods, you may be straining the tissue.
Either way, this can cause irritation to the strained piriformis muscle and make it worse.
You may need to try a sitting pillow or find a good foot rest to get just the right sitting position.
But it is not just sitting.
Be mindful of any time you are stationary for an extended period and how you are positioning your leg on the injured Piriformis side.
Notice any pressure or stretch, and move to a more neutral position to avoid isometric strain.
Sleeping Positions
One common mistake is not considering how you may be straining the Piriformis Muscle while you sleep.
You may need to find a sleeping position that does not stretch or pressure the area.
Strain could be caused by positions where your leg is pulling to the side, or by pressure on the buttocks.
Most people find sleeping on their back relieves most of the pressure.
You may need to experiment to find just the right position for you.
You can try on your side with your leg supported by a pillow.
Or you might find that sleeping on your back is best, but only with a pillow slightly elevating the knees.
It is definitely worth taking the time to find a position that minimizes the strain at night.
Stretching
No doubt, you have seen all the recommendations online for specific stretches to do.
They claim it will be a quick fix, once and for all, "if you just do this stretch".
But this is mostly Misinformation.
Yes, if the Piriformis is spasming, it can cause pain.
And yes, stretching is one way to get a muscle to relax.
But not too soon.
Stretching a muscle already suffering from an overstretch injury or tear is a really good way to get it to spasm, swell and cause more pain.
Bottom line: if you stretch too early you will find yourself causing more injury.
Wait until you are later in the healing process when most of the pain is gone.
Even then you want to take it slowly and listen to your body.
A better way to get a muscle to relax is to work on healing the muscle fibers with increased blood flow and rest.
Massage
Many people ask about Piriformis Massage.
This is another area where timing is important.
If you have a fresh muscle strain with some torn muscle fibers in the Piriformis, you are looking at a good chance of making it worse with premature massage.
Massage can help to relax a muscle later when it is more healed.
This should be much later in the process, ideally when most of the pain is gone.
If you get a massage and it causes pain or does not feel right, stop it immediately and wait until a later date after more healing.
This includes deep tissue, trigger point, etc.
Exercise
For a piriformis injury, exercise falls in the same category of things that might be right at a later point.
You do not want to exercise a muscle with a recent strain.
If it hurts a lot, then rest it.
Give it time to heal.
Some sites online recommend lifting weights or even doing things like squats with weight to heal.
That's really bad advice.
If you just tore your Piriformis muscle recently and you go and do something like this, it could easily cause the injury to become worse.
Understanding that this injury is a muscle strain should help you understand why you should not lift weights or do other exercises until you are healing.
Later, after you are healed, strength exercises and stretching can be a great way to protect yourself from future injury.
But during the first few weeks of your healing stay away from this kind of thing.
If you have any doubt about whether you are healed, give it more time.
When to do Physiotherapy
Physiotherapists and doctors recommend stretching and strengthening exercises because it helps to promote blood flow through your injured buttock.
Remember, it's the motion in our muscles that causes the interstitial fluid to circulate.
When we are injured though, we need to reduce our activity, and that leads to a weakening of the muscles called Atrophy.
In the early days of recovery, it is only the motion that we need to pump the joint.
We don't need to bear a lot of weight on the leg.
Really, as long as you don't feel pain, whatever activity you are doing is probably okay.
So, in the early days of recovering, the early days of PT, the key is motion, not exercise.
Physiotherapy is also intended to help strengthen the surrounding muscles to rebuild that lost muscle once you are on the mend.
But it can be harmful if heavy stretching and exercises are started too early.
Your injury first needs to stabilize, and in order to stabilize the injury you need to rest.
If you still have significant injury, any physio you do should start off very light.
Our advice is, don't start Physical Therapy until your condition has stabilized.
When you start, if you feel pain during or after PT, speak up!
Your clinician can't feel what you feel, so it is very important to advocate for yourself during physio.
Let them know how it feels at each stage so they can use that as a guide to treat you properly.
PT is not supposed to hurt and if it does you may be re-injuring your piriformis.
Never drive through the pain.
If your physio recommends you work through the pain you should consider a different therapist.
When you rest, your blood flow slows down which doesn't help your injury heal.
This is why BFST® is so important to start early on in your recovery.
The BFST® will increase blood flow when you can't exercise and stretch aggressively.
This enables exchange of nutrients and waste with the interstitial fluid - to promote the healing process.
So, with BFST, you can have increased circulation for hours even though your actual motion of your joint is quite light and that is invaluable to your piriformis.
BFST stimulation also helps prevent reinjury when you become more active.
Giving your buttock BFST before any activity triggers the muscle circulation as though there is significant exercise going on.
Think of it as a warm-up lap for your muscle before you actually start the exercise.
That warm-up is invaluable in preventing reinjury, particularly if you were fairly immobile before hand.
Start BFST early. The earlier the better!
Use the BFST® to warm up your injured area before PT and before any other heavy activity.
This will help prevent further injury as a result of the PT activity.
At the beginning of your injury, even before the injury has had a chance to stabilize and long before you start physio, the ColdCure® Wraps will help keep the pain and swelling under control.
Cold compression is highly recommended to stabilize a fresh injury.
And when you are active, invariably, you're going to aggravate your condition to some degree.
If you're very active, you may aggravate it a lot!
After any activity where you may have aggravated your injury, use cold compression to minimize the negative impact and stabilize your piriformis muscle.
Always use your ColdCure® wrap after any heavy activity and after PT.
The KB Support Tape™ should be applied every morning and worn all day long to help prevent re-injury, including to PT.
It protects you when you move.
KB Tape is armor for your injury.
For many people, King Brand® products, used in the comfort of your own home, are all that is required without having to attend and pay for Physical Therapy appointments.
Because you don't have to move to use them, the King Brand BFST® and ColdCure® Wraps can be started any time in your recovery process.
How Long Does Piriformis Syndrome Take to Heal?
There are 3 Key Factors:
1. The severity of your injury.
2. The amount of reinjury you do.
3. Proactive treatments you apply.
What people really want to know is, "When will the pain be gone and I can return to normal life?".
That's very different than when your tissue is actually fully healed.
Long before the Piriformis strain is fully healed, you will be doing most of what you could do before.
If it's a very minor tear and you really protect it to not reinjure it, the pain can subside in 3 weeks.
Once the pain is gone, you can start to slowly go back to normal life.
If you do it carefully, you will probably be doing what you did before the injury within 2-3 months.
Even though you return to normal activity and have no pain, the tissue is still healing underneath and it probably will be doing so for an additional 6 months after that.
So, for a minor tear, pain gone: 6 weeks, Normal life: 12 weeks, tissue as-good-as-new: 1 year
If it's a moderate tear and you really protect it to not reinjure it, the pain can subside in 12 weeks.
Once the pain is gone you can start to slowly go back to normal life and be doing what you did before within 4-5 months.
Fully healing the underlying tissue to good-as-new in about 12 months.
For a major tear and you really protect it, the pain can largely subside to almost nothing in 6 months.
Once the pain is gone, slowly go back to what you did before within 10-16 months.
Fully healing the underlying tissue to good-as-new in about 2 years.
You've just digested a lot of information!
At this point, people want to know what they can do to speed up the process.
You can be proactive, but what's most important is to avoid the things that will slow down the healing process or prevent it all together.
The short-list of things to avoid are to not drive through the pain, avoid using painkillers, and avoid exercising and stretching that can make the situation worse.
As long as you are still in the painful stage, stretching is bad, not good.
Physiotherapy is also for after you get past the painful period - it's good then, but it can be damaging if started too soon.
If you aren't happy with the best case healing times, don't do things that are going to drag out the injury and be proactive about healing.
Proactive Treatments
What You Should do When You Have Piriformis Pain?
There are things you can do to speed up your healing.
Stabilize the injured area and protect from Reinjury with KB Support Tape.
Use ColdCure® to reduce pain.
Use BFST® to bring blood flow to the area and speed healing.
For a little while - not forever - it is really helpful to give your Piriformis a rest.
In many cases, resting your Piriformis for a few weeks will give it time to heal to a point that your body gets ahead of the healing / reinjury cycle.
It's important to realize that once the pain and any swelling go away, your underlying injury will not be healed completely, so take it easy.
Go back to regular life gradually, once the pain and swelling are gone.
Rest & Use Conservative Treatments
If you want your Piriformis injury to go away as quickly as possible, you need to rest the affected area.
Avoid any physical activities that could cause further injury.
Do your best to avoid the activity that caused the tear in the first place.
Do regular ColdCure® treatments to control the pain and swelling.
You can also focus on healing the strain with regular BFST® treatments.
This combination will work to accelerate the healing process.
Around the 4-6 week mark - not before - you can start doing some light stretching and strengthening exercises.
Slowly work your way back to your regular level of activity.
Continue doing BFST® treatments long after the pain and any swelling disappear to maintain the healing you've done.
Do a ColdCure® treatment if you experience any flare-ups of pain and swelling and after any significant activity.
Surgery is Only For a Major Injury to the Piriformis Muscles
You don't have to undergo surgery in order to recover from most Piriformis Injuries.
Most tears will heal with conservative treatments.
However, it's possible that your situation does require surgery but do get a second and maybe third opinion as surgery is a big step and not all doctors will agree that it is needed.
If surgery is your only option, make sure your post-surgery recovery goes as smoothly as possible by using BFST and ColdCure.
Use a ColdCure® Back and Hip Wrap to reduce the inflammation and relieve the pain for the first few days following surgery.
Once the inflammation has gone down, promote blood flow to the injured area using a BFST® Back/Hip Wrap.
This will improve your circulation and help you heal faster.
Always get an opinion from more than one Orthopedic Surgeon before committing to surgery.
Consider what each one has to say.
Dealing With Pain:
Dealing With Pain - Consult with us for Free!
Meniscus Injuries can be so painful and debilitating that it causes us to rely heavily on pain killers.
But honestly, pain killers are not your friend.
It is understandable that you are looking for the relief from pain.
Remember, though, the pain is there to stop us from hurting the area further.
The pain is your body saying please stop doing that!
While pain killers are a welcome relief, they can be dangerous to take when you're active.
Pain killers can completely block the pain signal, making you unaware of any further damage you could be doing to your knee.
Pain killers should be restricted to times of rest.
When it comes to pain killers, some products are much more effective than others.
Some can actually help your injury when used correctly and others will only make it worse.
According to the National Institute of Health, our own government body tells us that Acetaminophen overdose is the leading cause for calls to Poison Control Centers (>100,000/year) and accounts for more than 56,000 emergency room visits.
And acetaminophen (Tylenol) won't help you get better one bit.
It only puts you at risk of more injury.
If you want help choosing the right pain killer and want advice on how to use it more safely and correctly, give us a call at 1-844-672-9440.
We will give you excellent guidance.
No charge.
No purchase necessary.
To maximize healing and minimize pain and swelling, complete a BFST® treatment right before bed.
We can give you advice on medication you can take to reduce the pain and help you heal while you sleep.
The BFST® treatment will work towards healing while you sleep, and the medication will work to relieve the pain and inflammation so that you can experience restful sleep.
During the day, ColdCure® treatments are the best choice to continue to reduce inflammation while you are active.
Our medical grade injury tape, KB Support Tape™, is excellent for reducing reinjury and pain when you need to be active as well.
If you're in pain, give us a call now for free advice 1-844-672-9440.
There's no doubt about it, for healing most tissue injuries in the body, blood flow is the most critical element in rapid recovery.
The blood flow brings the building blocks for new cell growth.
It carries away the waste and damaged tissue.
It brings antibodies to protect against infection.
Your blood flow supplies the cells in your body with everything it needs and removes much of what needs to be taken away.
While your heart ensures a sufficient supply to your body as a whole, in the individual parts of your body there are a lot of factors that determine how much that area receives.
Motion in local tissue can play a significant factor in blood supply but when you are injured, that motion is less and so is that trigger to bring blood to the area.
People often don't understand that motion is enough and that doesn't mean putting a heavy load on your joint.
When you swing your leg gently and with limited range that's enough.
Adding the weight of your body or doing stressful exercise doesn't improve the motion and the added loads can end up resulting in reinjury.
Find light gentle motions that you can do with no pain at all and do those several times each day.
If you're using crutches the swinging of your leg through the day is enough, you don't need to add more load.
Diathermy is a medical process to promote blood flow in tissue that is at rest.
Diathermy is a process by which energy is sent deep into the body to stimulate blood flow in tissue far below the skin.
An example of diathermy are ultrasound treatments that people get when they go to physiotherapy.
The challenge with ultrasound is that all diathermic treatments are effective for up to 4 hours whereas people go to the physio clinic once every couple of days.
Also, ultrasound is an older more risky process that can damage subdermal tissue so it needs to be performed by a technician - you can't do it at home.
The good news is that you have an option to ultrasound.
BFST™ devices from King Brand are diathermic devices that people can buy to treat themselves at home.
With a home diathermic device, you can treat yourself multiple times each day and significantly improve your blood flow and the healing process.
And they're more powerful too.
An Ultrasound device is very focused and the effective area can be less than 1 square inch in the underlying tissue.
That's why it needs to be constantly moved around, both to cover the whole injury and to prevent the tissue from burning.
BFST devices have massive coverage areas, treating up to 70 square inches without needing to move it around.
They are typically up to 10x more powerful than ultrasound too - and completely safe.
Blood Flow Stimulation Therapy™ (BFST®) gives your Piriformis the blood flow it needs to heal quickly and completely.
BFST® brings extra oxygen and nutrient-rich blood to the injured area - a requirement for the body to heal itself.
With a King Brand®BFST® hip Wrap, blood flow can be stimulated in the area of injury while you are at rest.
With improved blood flow and without physical activity and the risk of re-injury, you can recover from your Piriformis injury at a surprisingly rapid rate.
For proactive treatment advice click here for our Recommended Treatments page.
I have piriformis so bad I can't sit and my stand time is limited.
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For flat packs these are just absolutely insane. My skin's not getting damaged, it stays at the correct temperature - you can sit on them.
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Robert from Arizona - ColdCure Back - Aug 02, 2023
I am telling you, that BFST works so well! I'm 64.
Nothing would help the piriformis syndrome for six months, maybe longer.
I thought my life was over and I'd be an old man before it healed.
Yesterday I walked a mile and a half, I rode my bike for two and a half miles, and went swimming.
It is a miracle little thing.
Michael from Florida- - BFST Back|ColdCure Back|Wide Roll Tape - Nov 06, 2022
I just wanted to tell you, oh my gosh, I'm mad because I didn't find you sooner.
I have been having trouble with my piriformis muscle and into the sciatica.
I had it almost a year and I am now getting relief because of the products that I bought from you guys recently.
I mean the pain was so bad I couldn't even roll over in bed. I am doing the cold and then also the BFST treatments.
I had the pain so long but the first first day I got the cold treatment I got so much relief.
I wasn't feeling the sharp shooting pain from the nerve going down my leg.
That was amazing!
And now I have just been doing the BFST treatments four times a day. I no longer have the nerve pain going down my leg.
I do computer work so I sit a lot, because of this, I try to move around and not stay stagnate so I even stand up next to my desk.
Every once in a while I'll still get the numbness, but it has gotten, oh my gosh, 80% better!
At first I started by going to the gym because I was reading online and doing all this stretching.
But it was crazy because after 3 months of stretching one day I woke up and I was stretching and I'm thinking "it's hurting more then it did yesterday.
I must not be doing the right thing" so I just stopped. Then I read about resting so I rested for a while and it just didn't seem to be getting any better.
Then I tried some chiropractic but it still wasn't getting it.
I mean, I have been trying for months, but nothing has really helped until I found these products.
I am so thankful.
Teresa from Florida - - ColdCure Back|BFST Back - April 06, 2021
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