Hi Mel,
I had a number of treatments once the piriformis element/cause was diagnosed, also by a PT btw, starting with piriformis stretches; see here
http://www.spine-health.com/video/sciat ... rome-video
These exercises can often help release a tight piriformis muscle caused by piriformis syndrome and even cure classic piriformis syndrome. I would ALWAYS start with the very easiest and not overdo it, especially at first and especially if nerve pain (shooting, burning etc) is involved. These exercises really do help with a tight p muscle but can sometimes cause a flare of nerve symptoms. Some pathologies involve the sciatic nerve passing through instead of under the muscle so these people are more prone to a nerve flare when the muscle is stretched through these exercises.They are also more prone to sciatica of course if the muscle is compromised.
Do stop any stretch if there is any pain or the pain escalates.
Experimentation is the only way to find out if this will help at all, remember that there can be some delayed pain so stick to a few reps in the beginning. For me they can bring some buttock pain relief for a while, some people find total relief once the muscle is relaxed.
Myofascial release/piriformis trigger point massage with a PT who knows about this area, can also be tried, sometimes followed by heat treatment. A competent physiotherapist may also be able to identify if the muscle does have any painful trigger points or is problematic (sorry think you already have this info as reported 'tight').
Non of this had any lasting effect for me so I had dry needling, acupuncture and acupuncture with feathering. The needles were very difficult to get in and then were almost impossible to remove so at least this did indicate a muscle in spasm.
After this I was referred to a pain consultant who is PN aware and was given a steroid shot into the muscle. This did nothing after the initial anaesthetic had worn off and I was given a botox injection again into the muscle. That was the only thing that had any lasting effect. I only had one side (worst) done so could tell how much better that side was as the other side became painful through the day. It didn't do anything for the nerve pain unfortunately and it is presumed that the scar tissue in the muscle will need to be removed before There can be any improvement . The muscle pain relief continued for around 2 months, although gradually diminishing I could still feel a slight benefit up to 4 months later.
Another thing to add, if you try acupuncture and it is painful DON't try the feathering technique where the needle is 'pulsated' up and down. This was excruciating and in the end did no good either. The piriformis injections were equally as painful but that was just for a short while by comparison so worth trying if all else fails.
Personally, given the resources I would now like to try the shockwave therapy by Dr Andrew in Cornwall, Canada but until I hear someone local to me can do a similar treatment, decompression surgery will be my next step. Hope the above helps you long before you get to that stage
I take it that you haven't any lumbar spine problems? I would also take a look at the SI joint, pelvic misalignment with your PT, labral hip tears and maignes syndrome. They have all been covered in posts on this forum. Any ordinary pelvic mri scan can also determine if there is any asymmetry with the muscles especially if unilateral symptoms. MR
N scan will sometimes be able to see nerve involvement but it is not always conclusive as this imaging still needs some development.
Hope this helps
Take care,
Helen
