Explanation of Diagnosis

Piriformis syndrome occurs when the piriformis muscle (located deep in the buttocks) compresses or irritates the sciatic nerve, leading to buttock pain, numbness, tingling, or radiating pain down the leg. It is often caused by overuse, prolonged sitting, poor posture, or muscle imbalances. Symptoms may worsen with walking, running, sitting for long periods, or climbing stairs.

Specific Work Modifications

• Use an ergonomic chair with lumbar support to reduce hip strain.
• Avoid prolonged sitting; stand and stretch every 30-45 minutes.
• Use a seat cushion or wedge to reduce pressure on the piriformis.
• Modify tasks to limit repetitive squatting, bending, or prolonged standing.
• Apply heat or ice (15-20 min, 3-4 times daily) to reduce pain and inflammation.

Specific Activity Modifications

• Avoid high-impact activities like sprinting, jumping, or deep lunges.
• Modify workouts by switching to low-impact exercises like swimming, cycling, or yoga.
• Stretch and strengthen the hip muscles before and after activity.
• Use proper form during exercises to prevent muscle strain.

Recommended Supplements

• Magnesium (300-400 mg daily) – Helps with muscle relaxation and reduces cramping.
• Collagen peptides (10 g daily) – Supports muscle and soft tissue healing.
• Omega-3 fatty acids (1000 mg daily) – Reduces inflammation and nerve irritation.
• Vitamin D3 (1000-2000 IU daily) – Supports nerve and muscle function.
• Turmeric (500 mg twice daily) – Provides natural anti-inflammatory benefits.

Recommended Nutrition and Hydration

Diet Recommendations:

• Anti-inflammatory foods: Fatty fish (salmon, sardines), turmeric, berries, walnuts, and olive oil.
• Muscle-repair foods: Lean protein (chicken, fish, eggs), Greek yogurt, and legumes.
• Collagen-boosting foods: Bone broth, citrus fruits, and bell peppers.
• Limit processed foods, sugar, and alcohol, which can increase inflammation.

Hydration Tips:

• Drink at least 2–3 liters of water daily to keep muscles hydrated and reduce stiffness.
• Limit caffeine and alcohol, which can contribute to muscle tightness and dehydration.

Home Exercise Prescription

Focus on gentle stretching and strengthening. Avoid aggressive movements that increase pain.

Phase 1: Pain Relief & Mobility (Days 1-5, Reduce Tightness & Improve Movement)

1. Ice or Heat Therapy

1. • Apply ice for acute pain or heat for muscle relaxation (15-20 minutes, 3-4 times daily).

2. Seated Piriformis Stretch

1. • Sit upright, cross the affected leg over the opposite knee, and gently press down.
   • Hold for 20-30 seconds, repeat 3 times.

3. Figure-4 Stretch (Lying Down)

1. • Lie on your back, cross the affected leg over the opposite knee, and pull toward the chest.
   • Hold for 20-30 seconds, repeat 3 times.

Phase 2: Strength & Stability (After 5-7 Days, Once Pain Improves)

4. Glute Bridges (Hip & Core Strengthening)

1. • Lie on your back, bend knees, and lift hips while squeezing the glutes.
   • 10 reps, 2 times daily.

5. Clamshells (Hip Abductor Strengthening)

1. • Lie on your side with knees bent, lift the top knee while keeping feet together.
   • 10 reps per side, 2 times daily.

6. Pelvic Tilts

1. • Lie on your back with knees bent, tighten your core, and flatten your lower back.
   • 10 reps, 2 times daily.

Phase 3: Return to Activity (After 2-3 Weeks, If Pain-Free)

7. Standing Hip Abduction

1. • Stand tall and lift one leg sideways without tilting the torso.
   • 10 reps per leg, 2 times daily.

8. Single-Leg Balance Exercise

1. • Stand on the affected leg for 15-30 seconds, increasing time as tolerated.
   • Repeat 2-3 times per leg.

Avoid deep squats, prolonged sitting, and sudden twisting movements until fully healed (typically 4-6 weeks).

Helpful Books

1. "Rehab Science: How to Overcome Pain and Heal from Injury" – Tom Walters, DPT
2. "The Sciatica Relief Handbook" – Chet Cunningham

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.