After the diagnosis is made, the treatment options can include physical therapy anti-inflammatory medications either by mouth or topically applied, ice and/or heat therapy, therapeutic ultrasound and stretching, and even yoga.
When these conservative therapies are ineffective, the next option is to try and inject the muscle and reduce some of the spasms and inflammation.
The procedure is often done either under ultrasound guidance or fluoroscopic x-ray guidance. The latter method relies on a fluoroscope and injected x-ray ink also called contrast in order to identify the picture of the piriformis muscle appearing as striations.
Ultrasound guidance is another unique localizing technique and has some advantages, and that is there is no radiation.
Regardless of the technique once the muscle is identified a small amount of steroid mixed with a combination of local anesthetics is injected into the muscle and often provides immediate relief.
Recovery is rapid although on occasion patients may feel numbness down the leg, which can happen in some of the local anesthetic spills onto the underlying sciatic nerve.
Postinjection ice is often the next day followed by gentle stretching and resumption of physical therapy.
