Piriformis syndrome and physical therapy

Good morning.  I have been diagnosed with piriformis syndrome recently after having MRIs done from my brain straight down through my pelvic region as well as an EMG which all came back normal.  Although I was complaining of butt and hip pain with pins and needle feeling in my butt and legs my family doctor basically told me it was all in my head and wanted me to do a psychiatric consult.  Told him this was not in my head it was in my butt and I refused the consult.  I asked him about my piriformis muscle and physical therapy and was told he didn't check that as he didn't think of it and refused to send me to PT.  I even explained to him that I can literally feel my muscle contracting and he still refused.  Needless to say I am looking at finding a new GP.

I went to see the pain doctor and explained my symptoms to him and after doing his exam of me he diagnosed me with "piriformis dysfunction" and ordered physical therapy.  I never once mentioned to him that I thought my piriformis was aggregating my nerve just told him my symptoms.

Anyways I have started PT three days ago and have been doing my home stretches religiously and I feel the nerve pain is getting worse.  Does anyone know if this is common?  I want to believe it is from the stretching and the sciatic nerve beginning to release and starting the healing process.  Has PT ever made your symptoms worse before getting better?  Thanks for reading and offering any advise.  May we all have a blessed day.



  • tjlazerttjlazer TacomaPosts: 121
    edited 04/13/2018 - 4:08 PM

    Why would it NOT be normal?  When you have an irritated nerve how is messing with it more not going to cause more pain?  PT is always thrown in as the first thing to do.  It boggles the mind how some clinicians and patients think it will help.  If you have a compressed nerve, take away the compressions to get relief.  With that said, there are psychosomatic things that can cause this!  Google TMS.  In essence being stressed out, having tight muscles, etc, can press on nerves giving lots of issues like Sciatica, pain, etc...  Try to relax and see if that helps.

  • It is my piriformis muscle which lays over your sciatic  nerve which is very tight causing the sciatic pain.  This has been diagnosed by both pain doctor and PT.  I was only asking if starting therapy was irritating the nerve more.  

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  • I agree with @tjlazer in that PT just aggravates an already agitated nerve. I can’t figure out why PT gets ordered in many situations. I’m not a fan of PT. I religiously did my exercises daily too, for months, and never got better. 

    I suppose for certain conditions PT can be helpful but there’s a whole lot of situations where it’s a total waste of time IMO.

  • But if the irritated nerve is caused by a tight muscle what can be done to treat it besides stretching the muscle

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  • Hi baycitygirl
    Piriformis syndrome is not fun and same thing happened to me with doctors thinking it was in my head. Plus all my tests came back normal except for the manual tests I found on Spine Health and convinced my doctor to do. I was diagnosed with both Si joint dysfunction and Piriformis Syndrome like you. Back pain has been my problem for over 20 years but after having an injection and gallbladder surgery I developed the worst pain/burning in my life. It was located in my butt, hip, groin, leg and big toe. I could not walk, sleep etc. life has not been the same so I understand where you are coming from. Does that sound like what you are dealing with or different.
    In recent years both are now being recognized more but still difficult to find a doctor or therapist who are educated, experienced and certified. That is not me saying that it was a 
    So may I ask what exactly did the Pain doctor do when he examines you like moving a leg a certain way? It is excellent that he diagnosed you with none of the tests were showing anything. The reason I say that is many doctors use MRI's etc. and if the tests don't show anything they give up or focus other places. I have lost count of the number of injections I had with no relief but so many have. 
    Therapy yes it will hurt I have had brutal pain from therapy but was getting better until I had to stop due to another problem. One thing I would do is talk to your therapist you have to communicate with him or her. You are in a team with this person and if they don't know you are suffering how can they change your exercises or explain why the added pain. 
    So can I ask you how you know it is the nerve pain that is causing the added pain. I sound silly but I always had a hard time knowing what was causing the pain when dealing with this problem. 
    I am really happy that you found a great doctor who that not only diagnosed you but has referred you to therapy and for sure find another GP.
    Let us know how the therapy goes or after talking to your therapist what they have to say about the added pain. 
    So hoping you get relief soon and come back let us know how you are doing. 
    Take care Sherri

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  • Sherri there are times when it actually feels as though the nerves are "dancing" in my butt.  Know it sounds funny but trust me it is not.  My therapists are having me do my stretching, they are doing the deep tissue massage, electric stimulation and moist heat.  I am so hoping that the increased nerve sensations are being caused by the muscle stretching and healing of the nerve.  I cannot tolerate medicine side effects as mine are severe and I cannot tolerate nuerontin or lyrica.  They do have me taking a low dose of pamelor which is anti-depressant to help with the nerve pain.  Hoping it works.  Will keep you updated on progress.

  • Sherri my pain doctor had me try different positions which increased the pain as well as palpitated the muscle to diagnose.  When went to therapy they also had me try different positions and muscle palpitations to confirm diagnosis.  I have also started using roller and exercise ball to home at my therapist suggestion.   I have never had back pain just hip and butt pain with sciatica down legs and butt.  Hope you find relief soon.

  • @baycitygirl

    Hi! I had a posterior lumbar microdecompression L4/5 on December 4, 2017, which included the removal of a bone spur. Pain was a constant burning 8 prior to surgery unless I was in bed. Now an aching/burning 3-4 most days at the same location down the back of my left thigh. Sometimes cramping in my left calf. I just started PT two weeks ago. I described the "grabbing" feeling of the muscle in my leg. My therapist said that in 20% of people, the sciatic nerve does not lie nicely behind the piriformis muscle, but runs more through the muscle. She thinks that is the case with me. The exercises that I do can be quite painful, especially the "roller" to the ilio-tibial band. My husband uses a rolling pin on the days that I do not have PT. I would like to use it on his head after that! LOL. 

    I have only had 3 hours of complete relief since starting the PT and the pain came back after that. I am hopeful that both you and I can benefit from PT. 

    Warm regards, 


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