Introduction
The acute symptoms of piriformis syndrome can be alleviated by anti-inflammatory and analgesic medication. When the symptoms first appear, sporting activity should be stopped immediately and cooled. In addition, the attending physician can also achieve rapid temporary improvement directly on the piriformis muscle through targeted injections of a local anesthetic and possibly additional cortisone. However, this treatment only relieves the symptoms in the short term.
Conservative therapy for Piriformis Syndrome
Conservatively, the piriformis syndrome can be treated mainly 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 prolonged sitting in uncomfortable positions can alleviate the symptoms. In the long term, it is recommended to strengthen the remaining muscles of the lower back and buttocks by a mixture of physiotherapy and massages to such an extent that the piriformis muscle is relieved and can no longer irritate the sciatic nerve.
Trained physiotherapists can treat prolonged piriformis syndromes with targeted ultrasound waves 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) surrounding the muscle is specifically stimulated and thus relaxed, so that the inner muscle also continues to relax and no longer presses on the sciatic nerve. In most cases, analgesic and anti-inflammatory drugs for the acute symptoms as well as physiotherapy and special stretching exercises to eliminate the causes are sufficient to counteract a recurrence of the piriformis syndrome.
Manual therapy or physiotherapy is a first step in the successful treatment of Piriformis Syndrome. It is carried out by physiotherapists and/or osteopaths. The aim is to stretch and relax the entire musculature in the lower back and hip area.
To achieve this, the physiotherapist uses massages and stretching movements and often shows his patient stretching exercises for at home to keep the small hip muscles supple. Trigger point treatments are designed to find punctual tensions in the muscles and release them, for example, by applying pressure. A success should be immediately noticeable.
However, there is no scientific evidence of sufficient effectiveness. Therefore, every patient must try out for himself from which form of treatment he benefits most. For prevention and in the case of an existing piriformis syndrome, stretching of the muscle is an important part of the treatment concept.
By sitting or training the muscles for a long time, it shortens them. By stretching, a shortening can be counteracted. A helpful stretching exercise proceeds as follows: You lie on your back on the floor; the affected leg is bent at 90° in the hip and knee.
Next, the bent leg is slowly moved to the other side of the body so that it extends beyond the other knee. There should be a slight pull in the buttocks of the bent leg. Now you can additionally pull the knee further over with the arm and hand of the other side.
The feeling of stretching should now become stronger. You should remain in this state for about 30 seconds. After that the exercise for the opposite side is performed.
The exercise should be done about three times for both sides. In addition to this exercise, there are many 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 hip and knee prostheses should only do this exercise in consultation with a doctor or therapist. TENS stands for transcutaneous electrical nerve stimulation. Via TENS electrodes, which are glued to the skin, small stimulation currents are conducted through the skin into the tissue and muscles, 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 to relax the tense muscle. With TENS, the patient feels at most a slight tingling sensation.
In some cases, this therapy is also reimbursed by the health insurance. This should be checked with your health insurance company before starting therapy with TENS for Piriformis Syndrome. You can find more information here: ElectrotherapyTo treat Piriformis Syndrome, kinesio tape can be used in different techniques.In addition to prefabricated so-called “pre-cuts”, you can work with normal commercially available kinesio tape.
The affected person lies on his or her stomach and has the knee on the affected side slightly bent outwards (like a frog), so that the front pelvic bone lies freely in the air. A normal strip of Kinesio-Tape about 25cm long is cut into two equal wide strips until there is still a common base about 3-4cm long. The backing paper is removed at this base by bending 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 to the sacrum in an arched shape with tension, whereby the last part is glued again without tension. The same is done with the upper strip, so that both overlap on the sacrum.
A second method involves a strip from the sacrum to the greater trochanter major (large rolling mound / larger bony protrusion on the femoral head) which is glued horizontally under traction. In addition, two smaller tapes are crossed over the main pain point under full traction. If the tape causes pain, redness or signs of inflammation, it should be removed.
Acupuncture and acupressure can be used to treat the symptoms of Piriformis Syndrome. The acupuncture needles are placed in special acupuncture points for the muscles. This often loosens cramps in the piriformis muscle and the underlying ischiadicus nerve is not more or less pinched.
In the course of traditional Chinese medicine, additional remedies are often used to enhance the effects. Blockages and malpositions in the pelvis, hips and the lumbar spine area can cause increased tension on the piriformis muscle. This leads to cramps and increased tone, which causes the corresponding symptoms.
Through mobilization, treatment of the fascia and other techniques, osteopathic methods can also be used to treat Piriformis Syndrome. Corresponding exercises for stretching and mobilizing the gluteal region can also be performed at home on your own. A home remedy for piriformis therapy would be to massage the gluteal muscles independently with a tennis ball or fascia ball, for example.
To do this, one sits lightly on the ball and moves the buttocks in circular movements on it. In this way, the deep muscle layers up to the piriformis muscle are treated and massaged. Trigger points of the musculature are activated.
This can be quite painful. However, it should not be trained fully into the pain. The use of a fascia roller can also alleviate the symptoms.
Additionally, as described above, regular stretching of the buttocks to reduce the pain helps. In addition to the conventional medical therapy for Piriformis Syndrome, there is also the possibility of therapy using homeopathy. This can help to alleviate the symptoms of Piriformis Syndrome.
In homeopathy, for example, a mixture of Harpagophytum, Ledum, Rhus toxicodendron and Tartarus stibiatus is used, which are the ingredients of the drops available as Bomarthros Harpagophytum Complex. They are said to have analgesic and anti-inflammatory effects. Acidum nitricum or Echinacea can be used against the inflammation itself.
Whether homeopathy really helps is scientifically controversial, so that in the case of Piriformis Syndrome, a conventional medical opinion should still be sought. Some patients are helped by the self application of a tennis ball massage to relax the tense muscle and become pain-free again. The idea is that the tension is released through targeted pressure on painful areas.
For this purpose, the ball is placed on a chair. Then you sit down on the ball carefully until it is under the painful area. It is not necessary to use your entire body weight.
Instead, so much pressure should be exerted that the pain is noticeable but easy to bear. The massage begins with a light rolling motion. The painful area should be treated for half a minute.
Afterwards the ball can move on to massage other painful areas. This form of massage achieves the best results if it is applied several times a day. Botox, or botulinum toxin; is a nerve toxin produced by a bacterium called Clostridium botulinum, and is one of the deadliest poisons 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, making movement or physiotherapy painless. Health insurance companies do not necessarily cover the costs of treating the muscle with Botox. In some studies it has been proven that muscle injection with Botox is superior to injections with local anesthetics or corticosteroids.
Botox is sometimes injected directly into the muscle in several sessions. Mostly this is done under CT control to make sure that the needle hits the right muscle. Risks are injuries of nerves and vessels, the development of a hematoma and slight side effects of Botox. These include a general feeling of illness and temporary muscle weakness. Long-term side effects are not known if used correctly.
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