Piriformis Syndrome: How were you diagnosed and what helps?

I believe the symptoms of Piriformis syndrome and back problems are quite different. My symptoms right now are clearly Piriformis symptom. I have no back pain. My pain is in my butt, down the thigh and leg to my ankle. I can't sit or walk without pretty bad pain. I just had a steroid injection 2-days ago into the Piriformis muscle ---- I got no relief at all. This is the 2nd steroid injection I've had in less than one month. I'm not going to have any more. They don't work for me and I'm not going to waste my time getting any more injections. I need a new MRI (Pelvic MRI) to firmly diagnose Piriformis syndrome and my physician needs to come up with a treatment plan that works or refer me to another physician who can help me with this pain which I believe is a combination of Sciatica and Piriformis syndrome.

I am very interested in this subject, though I've never heard of piriformis before. Lately I've been having pain (aching and sharp pain both) that radiates from my back around where my kidneys are, down my buttocks to my legs. Sitting or laying in bed makes it worse; if I get up and move around it sometimes helps. I haven't been to the doctor yet. It just seemed to come on all of a sudden. No falls, no strains, no injuries. Help! Where should I start?

I've had piriformis syndrome, diagnosed by my PCP, and Physical Therapy fixed it.

So you didn't go to an orthopedist? Why? And how can they tell the difference between piriformis and sciatica?

I did not go to an orthopedist. My very experienced & knowledgeable PCP at the time diagnosed it and recommended PT. In just 6 sessions it was resolved.

@lesb0298, what leads you to believe it is not osteoarthritis? What next steps does your doctor suggest?

Funny you should ask, after letting my mind think outside the piriformis box, found out it was my left hip and since has been replaced. Now need my right one done, but due to cardiac issues, cardiac doctor says, no more surgeries. So now stuck in wheelchair. My fault I allowed myself to stay on that piriformis track.

Thanks for all this Sue. I have done massive extensive research on piriformis syndrome. I can’t walk; in a wheelchair and sleep in a recliner. I’ve been through PT and then was told that was the worse thing I could have done; the piriformis should not be stretched; it just causes more pain, PT never relieved me of any pain, I’ve also done numerous injections; none of which helped the pain for more than 2 days. That’s what the piriformis syndrome is, but in reverse of how you stated; the sciatica nerve actually presses on the piriformis muscle. The doctor did show me the X-ray and the MRI and it’s not that I don’t agree that I could have a bad hip, but no one is looking or has the ability (right equipment-which is “diagnostic ultrasound”) to focus on what I need to know. I’m on a FB forum for piriformis syndrome and have gained a lot of knowledge about this muscle from that page. There are only 5/6 doctors in the US that have experience in removing it, and they don’t take my insurance. If a “release” is needed, I think Mayo may do that which is what I’m trying to find out. Yes I’ve been to 2 ortho’s. I’m not a bit reluctant to undergo surgery again, I just want it to be 100% the right surgery.

Hi! I've had Piriformis Muscle problems for quite a few years. When it first came on I had many massages & that helped but only temporarily. I've also had steroid injections that last a little while. You're right, you cannot do stretches for this, it only makes it worse. When it flares up I try to massage it myself using arnica cream or Motrin Gel (asprin). When it gets real bad I push on it ( i use something that has a small ball on the end) it does hurt but
then it feels good too.
That usually settles it down some. Then I also have pain going down the outer side of my leg. I always thought it was my IT band but it could very well be my hip especially since I have osteoporosis.
Another thing I do to help with the pain with both of these is a heating pad.

I first had Piriformus Syndrome when pregnant 22 years ago. Have gone through 3 bouts since. I am active and had some "bad" exercises in classes that seem to tip me into it-- too much pressure on pelvis, or injury to sacrum from a fall.
What solved it? Rolling and certain stretches. Much like Loreliks above. Seemed to simple to be true. the technique also worked for some fellow exercise buffs who were finding it difficult to even walk, sit or stand-- we were ready to quit a dance class.
Stretching and some gentle movement in the muscles around the hip warm the area up. The then rolling took out the knots in the piriformus muscle. I first used a soft 6" roller at the Y; I now have a denser knobby one.
For right side: sit with your buttock on the roller. Have the roller at a 45-degree angle to your thigh, lateral side toward the foot and inner (left) side behind you. Keep left knee bent to help you move. Lift your right foot so your leg is straight and about 3" off the ground (may need someone to gently support it). Put your hands on the floor or therapy table behind you for gentle support. Slide slowly forward a few inches, letting the roller roll over the sore piriformus-- you will wind up leaning backward some; then slide back (push with your left foot) so the roller again goes over the sore point and to a spot just below your "sit bone" and you are upright. Repeat 5-6 times as you can tolerate. Twice a day is often enough.
Key seems to be having the roller at the angle to your leg so it hits some pressure points in and around the piriformus. Some of the stretches I learned involve not just back muscles, but loosening the hip flexors and the IT band down the side of my thigh. The time I discovered the roller technique, I was healed in less than a week. Now at the first twinge, I take the time to do the warm-up and rolling and have had no more full-blown incidents. I also remember to walk with my knees and toes forward instead of pointing out to the sides (the movement the piriformus does).

I totally feel for you suffering this! Try the rolling if you can, or get an exercise / Physical therapist to help you try.