Some clinicians recommend formal physical therapy, including soft tissue mobilization, hip joint mobilization, teaching stretching techniques, and strengthening of the gluteus maximus, gluteus medius, and biceps femoris to reduce strain on the piriformis. More advanced physical therapy treatment can include pelvic-trochanter isometric stretching, hip abductor, external rotator and extensor strengthening exercises, transcutaneous electrical nerve stimulation (TENS), and massage physiotherapy of the piriformis muscle region. One study of 14 people with what appeared to be piriformis syndrome indicated that rehabilitation programs that included physical therapy, low doses of muscle relaxants and pain relief medication were effective at alleviating most muscle and nerve pain caused by what the research subjects had been told was piriformis syndrome. However, as this study included very few individuals and did not have a control group not receiving treatment (both serious methodological flaws), it provides no insight as to whether the pain in the piriformis would have simply dissipated on its own without any treatment at all, and is therefore not only uninformative, it may actually be misleading. The injury is considered largely self-limiting and spontaneous recovery is usually on the order of a few days or a week to six weeks or longer if left untreated. Stretching
Most practitioners agree that spasm, strain, or pain in any muscle can often be treated by regular stretching exercise of that muscle, no matter the cause of the pain. Stretching is recommended every two to three waking hours. Anterior and posterior movement of the hip joint capsule may help optimize the patients stretching capacity.
Piriformis syndrome is a condition which is believed to result from compression of the sciatic nerve by the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. Often symptoms are worsened with sitting or running.Causes may include trauma to the gluteal muscle, spasms of the piriformis muscle, anatomical variation, or an overuse injury. Few cases in athletics, however, have been described. Diagnosis is difficult as there is no definitive test. A number of physical exam maneuvers can be supportive. Medical imaging is typically normal. Other conditions that may present similarly include a herniated disc.Treatment may include avoiding activities that cause symptoms, stretching, physiotherapy, and medication such as NSAIDs. Steroid or botulinum toxin injections may be used in those who do not improve. Surgery is not typically recommended. The frequency of the condition is unknown, with different groups arguing it is more or less common. Signs and symptoms
The signs and symptoms include gluteal pain that may radiate down buttock and the leg, and that is made worse in some sitting positions. Etiology
Causes of piriformis syndrome include the following

Anatomic anomalies, present since birth:Bipartite piriformis muscleSciatic nerve course/branching variations with respect to the piriformis muscle: In over 80% of the population, the sciatic nerve courses deep to and exits inferiorly to the piriformis muscle belly/tendon.