The muscle can be manually stretched by applying pressure perpendicular to the long axis of the muscle and parallel to the surface of the buttocks until the muscle is relaxed. Another stretching exercise is to lie on the side opposite of the pain with the hip and knee of the upper leg flexed and adducted towards the ground while the torso is rotated so that the back of the upper shoulder touches the ground. Physical Therapists may suggest stretching exercises that will target the piriformis, but may also include the hamstrings and hip muscles in order to adequately reduce pain and increase range of motion. Patients with piriformis syndrome may also find relief from applications of ice which will help reduce inflammation and so may help limit pressure on the sciatic nerve. This treatment can be helpful when pain starts or immediately after an activity that is likely to cause pain. As the length of time progresses, heat may provide temporary relief from many types of muscle pain and will temporarily increase muscle flexibility. Local injections
Failure of conservative treatments such as stretching and strengthening of the piriformis muscle or a high level of immediate pain intensity may bring into consideration various therapeutic injections such as local anesthetics (e.g., lidocaine), anti-inflammatory drugs and/or corticosteroids, botulinum toxin (BTX, Botox), or a combination of the three, all of which have a well-documented effectiveness at relieving muscle-related pain. Injection technique is a significant issue since the piriformis is a very deep-seated muscle.
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.