About Me

Life With Piriformis Syndrome Pain

matt stehling

Matt Stehling

I suffered with Piriformis Syndrome from the ages of 35 through 39. In 2007, at the age of 34, I was running about three miles 3-4 times per week on a treadmill, as well as doing Yoga and Pilates. One afternoon while doing a Pilates stretch I suffered an injury to my groin,  in the vicinity of the piriformis muscle, only on the right side. The exercise I was doing at the time was an advanced variation of the Ball Roll. The variation calls for the arms to be placed inside the thighs, legs spread apart, with the hands clasping the outside of the shins. The illustration shown below is the standard Ball Roll.

As I was rolling forward (as shown in the image below) I felt acute and intense pain in my groin — but only on the right side. All of my flexibility in my groin’s right side vanished for 3-4 months. I slowly got it back over the course of the following year. However, gaining my flexibility back was meaningless.Around six months after the initial groin injury I had what felt like a pulled right hamstring. I stopped running for six months to give it time to heal, but continued stretching. Around 8-10 months after the initial groin injury I started noticing right buttock pain when sitting in my office chair (which I did 40 hours per week). A year after the initial groin injury I had my flexibility back, chronic right buttock pain when sitting, and a frequent sensation of a moderately pulled hamstring.

Ball Roll

Ball Roll

Chronic Pain Symptoms and Map

For the next five years, from the ages of 35-39 I woke up every day at a 2/3 on the pain scale. Sitting in an office chair or in a car would cause my  Piriformis Syndrome pain to rapidly increase from a 2/3 to an 8/9. When I say rapidly I mean around 30 minutes. My right buttock muscles would spasm randomly every day from one episode to multiple episodes lasting anywhere from 1 to 10 seconds. The spasms didn’t trigger painful sensations.

click to enlarge

Piriformis Syndrome Pain Map

Medical Imaging History

There were many failed attempts to try and find the cause of my chronic pain via medical imaging. All of the results came back as unremarrkable with respect to what could be causing chronic right buttock and frequent leg pain.

Findings: There is normal lumbar lordosis. No subluxation. Vertebral body heights and intervertebral disk space heights are preserved. There is normal marrow and lumbar cord signal. Conus medullaris terminates at T12-L1.

T12-L1 through L2-3: No central canal or neural foraminal stenosis.

L3-4: Diffuse disk bulge with far left focal protrusion resulting in mass effect on the exiting L4 nerve root. The right neural foramen is patent. No central canal stenosis.

L4-5: Mild eccentric leftward disk bulge resulting in left neural foraminal stenosis. The right neural foramen is widely patent. No central stenosis.

L5-S1: Minimal disk bulge. No central canal or neural foraminal stenosis.

Negative MRI of the right hip and hemipelvis.

Mild posterolateral disk bulges at L4-L5  which contribute to mild bilateral foraminal narrowing; Small broad-based posterior central disk protrustion without evidence of central canal stenosis or compromise of the nerve roots.

Normal uptake within the lumbar spine.

Negative MRI of Thoracic.

Medical Treatment History

From early 2008 through late 2011 I tried many different treatments to relieve my chronic pain. Here’s a list of treatments and results.

Relieved the pain for 6 months.

Relieved the pain for 3 months

Relieved the pain for 2 weeks

Temporary, sporadic pain relief

Relieved the pain for 2 months

2 days of pain relief

6/10/10 – 10/13/10
Never had more than one consecutive day of pain relief

2 weeks pain relief

No pain relief

No pain relief

No pain relief

2 weeks pain relief

6 weeks pain relief

9/6/11 – RF ABLATION of T-11 THROUGH L2
Buttock pain relief (not leg) for 1 month

12/2/11 – RF ABLATION of T-11 THROUGH L2
No pain relief

Chronic pain relief immediately; Situational pain relief after six months of recovery

Illustrated Timeline of Failed Piriformis Syndrome Treatments

Piriformis Syndrome Treatment


The articles and content of this website may not be construed as personal medical advice and are provided for information only. No action should be taken based  solely on the contents of this information. Readers should consult the appropriate health professionals on any matter relating to their health and well-being. The publisher of this website and its contents is not a licensed medical care  provider. The information is provided with the understanding that the publisher is not engaged in the practice of medicine or any other  health-care profession and does not enter into a health-care  practitioner/patient relationship with its readers. The publisher is not  responsible for errors or omissions.

  1. Natalia
    October 8, 2020 at 4:22 pm

    Hello, I would like to know if some of you know why Dr.Tim Tollestrup is not taking any type of health insurance anymore? I really want to go to Nevada, to meet him and see if he can help me, but I am concerning about it. Thanks.

    • December 6, 2020 at 11:44 am

      Dr. Tollestrup went out of network with commercial insurance last year and will stop taking medicare at the end of this year. He does continue to take Tricare for Veterans and I have heard that Tricare pays for the trip out there.

      You have to pay his fee up front but the surgery center and anesthesia does take insurance.

      Dr. T trained Dr. Eric Williams in Baltimore, Maryland to do his piriformis muscle removal surgery and recommends him for those who need to use commercial insurance. Currently Dr. Williams still takes insurance.

      More and more doctors are going out of network with insurance because they are paying less and less and they do not have the resources to fight for payment.

  2. Jeanne Hester
    July 27, 2020 at 10:46 am

    Thank you for this article. L5. S1 fusion left me with permanent sciatic nerve damage. As a result pain pops up about anywhere from waist down. This pain sounds like what you experienced. The pain goes from the lower back and down the leg with hip pain and to knee. Knee hurts and often feels as though it is is going to buckle. What type of physicion found and treated this condition? Really need your help. Neurosurgeon said that nothing could be done for sciatic nerve damage and you are left with the problem of finding out the possible source of pain and then finding out who can help. The SI has been dysfunctional several times leading to therapy then injections that sometimes help but for very short periods. Please reply. Thank you, Jeanne Hester

  3. September 4, 2019 at 5:34 am

    Difference in Piriformis Muscle Release (highly unsuccessful) vs Piriformis Muscle Removal surgery (Highly Successful)

  4. Bill
    July 21, 2019 at 4:29 pm

    I had the removal surgery with Dr Tollestrup. It did absolutely nothing for my pain. It didn’t worsen it other than post op pain for a few weeks. Dr. T is a nice guy and an excellent surgeon but you have to remember surgery is how he makes a living. I went through every treatment known to man and had every diagnostic test done including 3T MRIs from the most advanced imaging center in the world (HSS in NYC) and nothing could be found.
    Another member on this thread introduced me to the work of Dr John Sarno and his best selling book Healing Back Pain. This book, along with another book titled Back In Control by David Hanscom, saves my life. My pain is down significantly and I’m back to living my life. Do not have ANY surgery until you read these books and apply the principles. It took me many many months to apply these principles and there were ups and downs with pain but I’m significantly better. Most pain syndromes are not from a physical source, if you’re sick of going through the medical rotating door try and open your eyes do something else.

    • September 4, 2019 at 5:37 am

      Bill, do you think you just needed more time to heal from the surgery?
      I’m glad the book helped you through your healing. But I really don’t think the book itself healed you. I think you need to face the fact that the surgery did work.

      • Bill
        January 22, 2020 at 7:22 pm

        No I don’t think the surgery did anything. If I become stressed, worn down, frustrated, etc… my pain comes back. This wouldn’t happen if the surgery worked. Surgery is a business, surgeons make money of desperate patients…
        Read this: https://www.reliasmedia.com/articles/78526-piriformis-release-surgery-beware

      • January 23, 2020 at 1:25 pm

        In my case, if I hadn’t done extensive physical therapy post surgery I dont think I would have had such great success. Surgery was only part of the cure for me.

      • John McGary
        January 23, 2020 at 3:42 pm

        I’m not sure your link means anything other than PS surgery can be harmful. But we all know that. It’s true of all surgeries and especially true about back surgery, where you sign a form acknowledging medicine isn’t science and there may be side effects like damaged nerves. I think we’re all trying to find someone that’s experienced in this area but it’s difficult – Personally I wouldn’t choose a neurosurgeon for PS unless they specialized in peripheral nerve surgery and experienced with PS. Over time I’ve found that some of my doctors are now familiar with PS; they’re seeing more PS patients but it’s still rare. Before I had to go to NYC for Botox; now, I can get injections from a variety of doctors in Houston. In fact, I just had them two weeks ago. Hopefully PS surgery is getting more attention and becoming better recognized like Botox injections. And yes people don’t want surgery because it can have bad side effects but it may be the only option left.

      • Bill
        January 23, 2020 at 5:39 pm

        The link is an article from a neurosurgeon who is from of one of the most prestigious hospitals for neurosurgery (which is nerve surgery) in the world. He doesn’t even think this condition exists. I flew across the country to have these muscles removed and it didn’t do a thing except cause surgical pain. I’m not alone either, I’ve communicated with several patients who had these muscles removed and it didn’t do anything for them either. I’ve also been in contact with a few others who had others peripheral nerves operated and have had no relief.
        Surgery is not always the answer especially for a diagnosis that most neurosurgeons don’t think exists.
        I’ve had success with a mind body approach, it drug free, surgery free and costs nothing. Why not try it first….. just giving my experience

      • John
        January 23, 2020 at 10:04 pm

        The article is only a commentary; it’s simply an opinion abstract based on scant personal observations that consisted of 2 patients, some cadaver observations, and maybe another reference article. It doesn’t get much less scientific than that. Your personal experience, and others, is more informative than that. Of course there’s no way to know if the surgery or the books provided relief for you but the idea of conservative therapy is what most people prefer. Thanks for the reference on John Sarno. I’ve been using Jon Kabat-Zinn’s methods. The good news is that you’re doing well and surgery didn’t destroy you.

      • Bill
        January 24, 2020 at 5:56 am

        It’s obvious to me that the surgery did nothing. My symptoms come back during times of stress. I don’t have my piriformis muscles to press on my sciatic nerve any more but I still get the SAME pain at times. This is proof to me that the surgery to remove the muscle did nothing. When people are desperate they do desperate things like fly across the country to get surgery. I was there. Now I realize the stresses of my life put my nervous system on overload and triggered a pain syndrome. My life went from laying on my couch to doing intense cardio 6 days a week and back to full time employment. This wasn’t because of surgery. I was fed up with the BS medical system in this country which is driven by profit and not by helping patients. I said F it and started slowly and gradually working out and following many of the practices I learned about by reading mi d-body books. I’m not cured yet, I do still have pain, it’s better and I can function well but I am a 1000 times better off than I was.
        Also I specifically referenced this article because it was from a Dr. from Cornell, possibly the best Hospital in the world. I agree it’s a bit vague…

      • mysijourney
        January 30, 2020 at 3:39 pm

        If you had removal with Dr. T, Dr. A or Dr. W, and you still have pain “sometimes”, its a damaged peripheral nerve. You should reach out to them and see what numbing block to try. If you study the sciatic notch and pelvic area, you will see how many peripheral nerves there are. Unless you had this just a few short years and or didnt have an injury that damaged your muscle an nerves, theres a good chance its a damaged nerve. The majority of us that have PS or bad injury have damaged nerves. The pain overlaps. I know because I lived it. If its something you can live with, thats awesome! if not, you know who to call!

      • Bill
        February 25, 2020 at 5:27 am

        I did call Dr. T back and he got back to me quickly (he’s great with that) and told me it must be “another nerve involved” not the sciatic nerve (was told nothing could possibly be compressing sciatic) and he recommended diagnostic injections into other nearby nerves (which I wish he offered prior to me having Piriformis surgery) . I tried these injections and they didn’t do a thing. That’s when I had enough and started using a mindbody approach. It’s slowly working for me. Two others I have communicated with have not had success with Piriformis Removal Surgery. If anyone would like to reach out to me please send me an email at jwpdnyc@gmail.com and I’ll try and help you. You need to calm your nervous system.

  5. JE
    June 11, 2019 at 12:55 pm

    Matt, author of the blog, I just looked at your history detailed here showing that you had lumbar involvement, disk bulge protrusion in Jan 2008 and 2007 symptoms of groin/hamstring pain/tendonosis and later saddle pain. Lumbar Injections relieved pain for a while. And then you had a ton of treatments over time including Piriformis release in the end. The reason I bring this up is that some people don’t have any history or diagnosis of back problems but have PS. Then others like myself have:had some back problems, and PS. In the end PS became the pain driver. Just wanted to point this out that PS can be with or without lumbar/sacral activation/interaction. And most doctors don’t understand True PS much less PS with back issues. I was treated for both conditions, PT back/Piriformis and Botox which finally resolved it. If I hadn’t worked on the spine issues during that time I wouldn’t have gotten past it. Now I’m in a routine of back conditioning and stretches without PS. Very complicated. Hope this help others.

    • mysijourney
      June 17, 2019 at 7:45 am

      PS is a condition that goes in and out of remission. If yours comes back you should look into getting the muscle removed by Dr. Tim Tollestrup. He perfected the surgery for PS and the sooner you get it out, the less other damaged peripheral nerves you will have. This condition is more harsh on your body than it is documented anywhere.
      If you just had a tight muscle, streaching will help. But streaching only scars a piriformis muscle. Years of streaching can take you to the point of no return pain.
      Took me 6 years of going in an out of remission to reach that point of no return.
      Also check your leg length. I am seeing so many now with leg length issues. when the muscle is removed, that problem goes away.
      Keep in mind, those who have had total hip replacements the piriformis muscle is rendered useless. Its an assist muscle, the body doesn’t need it.
      If you live on the East Coast, Dr. T trained Dr. Eric Williams in MD how to do this removal surgery. Maybe you can get to him.

  6. Beata Maria Major
    June 10, 2019 at 7:12 am

    John, the illustrated Timeline of Failed Treatments is extremely helpful in understanding and planning treatments for myself. I am 4 months post coccygectomy and in sever pain coming from piriformis muscle spasms. I tried just about everything that was available and still didn’t achieve my goal of eliminating my sciatica pain. I am somehow disappointed and discouraged with the outcome of your Botox injections. I wonder how is your piriformis doing now? If you continue having this pain? Are you pursuing research in other treatments or a surgery? Best of Luck to you! Please, continue sharing your experiences with your fellow sufferer. It is a great resource for many of us.

    • John
      June 17, 2019 at 5:12 pm

      Not sure which John but the source of my problem was different. Botox and PT turned my problem around. It took 6 – 12 months plus a final steroid injection to get past it. Total time was 18 months but had steady and slow improvement. Hope that helps.

  7. John M
    June 9, 2019 at 2:53 pm

    Lots of interesting stuff here. Apparently there’s a lot of mixed outcome stories posted here, some of which relate to the method used: endoscopic release or “open” surgery typically used for hip replacements. I’m cautious of referencing medical papers since quantity can be high and quality low, for a variety of reasons. But the following reference may help those of us that are on the fence. At least the following paper discusses the endoscopic procedure and their outcome, although for a very small sample. Hope this helps and leads to further investigations and better choices. I’m still gathering. Thanks to all that have posted.

    • John M
      June 9, 2019 at 3:17 pm

      I forgot to point out the paper has other worthwhile references, in particular the study by Fishman,LM , who at least has a reputation among his peer group, and was slightly controversial with his early EMG studies.

    • mysijourney
      June 27, 2019 at 8:14 pm

      John, I had a open release that made me so much worse. Dr. Tim Tollestrup is VERY close to publishing his removal procedure that he pioneered for piriformis syndrome. He has had a the highest success rate I have seen and he used to be a trama surgeon so he is very brave indeed. He does this surgery through a two inch incision. He gives his patients a cell number to stay in close contact. You should really check him out, I think you will be quite impressed.
      I did have him do revision surgery on me and he also fixed all my damaged nerves from having the condition so long and from my release.
      He has trained a doctor on the east coast, Dr. Eric Williams. to so this procedure as well.

      • Andrea
        June 27, 2019 at 8:54 pm

        Is he in Baltimore?

      • mysijourney
        June 29, 2019 at 10:14 am

        Dr. Eric Williams is in Balitmore, MD. Dr. Tollestrup trained him on his muscle removal procedure. Dr. Tollestrup is in Las Vegas.

      • Paige
        June 27, 2019 at 10:09 pm

        I wouldn’t say he’s “perfected” the surgery. I’m aware of a couple of people who are worse off after his piriformis surgery. I’m also aware of him removing the piriformis muscle of a patient even though when he got in there, there was absolutely nothing wrong with the muscle. Where are you getting your information that he was a trauma surgeon? That’s an interesting new take. There are some of us on this blog who had open piriformis removal with no issues by an actual researchable pelvic trauma surgeon in Texas. He is the best of the best and works with a radiologist who specializes in MRN’s and the condition. If you do your research you will find out that a cheap MRN in Las Vegas read by someone who doesn’t have the depth or training of the doctors in Texas, makes all the difference. I personally would recommend the Texas surgeon over Dr. Tollestrup any day. His billing practices are also questionable, but that’s a whole different bag of beans. I can’t respect a doctor that openly criticized other doctors as he’s done on some Facebook pages.

      • Paige
        June 27, 2019 at 10:26 pm

        Who is mysijourney on this site? Because based on the wording of the responses, it sounds like the poster is Dr. Tollestrup himself and the same rhetoric he posts on the Facebook page. Many people left that group as it basically turned into a page centered around him getting business. If you disagreed with anything or anyone, you got removed from the group. Matt’s blog was set up for patient to patient connections and stories, not doctor solicitation. Please do your research. Read old posts. There are plenty of people on here who had successful outcomes with other surgeons who understand the condition.

      • Hope
        October 26, 2021 at 4:22 am

        I am saving for surgery with him I have had this pain in my left buttock, back of hamstring and low back since 21 now 42. After all my research I believe I have both piriformis syndrome and snapping hip syndrome. If the snapping in the crevice of my groin stops after removing the piriformis. Than I’ll know it was the compressed piriformis causing it and not actual snapping hip. A lot of ppl I’ve read have had si joint fusions with no relief only to realize it’s more likely piriformis syndrome. Someone asked Dr Tollestrup why si joint fusion causes PS he said it doesn’t cause it it’s likely it was PS all along. The severe tight feeling I’ve felt in left buttock and highest top point back of hamstring feels like the skin could break. I think might be the reason for the crevice of my groin snapping 50 times a day and not actual snapping hip. I can’t wait for the surgery to see if it cures the snapping cause the snapping wears me down along with the pain and tightness. And the guy on here who said majority of pain isn’t physical I think is wrong just my opinion. I think most ppl it is physical and they need surgery but don’t end up getting the right one.

  8. Georgetta
    May 10, 2019 at 5:09 pm

    Has anyone tried dry needling? It sounds very painful, but trigger injections, Botox and cortisone were not effective and neither was PT and myofascial release. It’s really the only thing I haven’t tried before considering surgery. Thanks.

    • June 14, 2019 at 3:21 pm

      I have tried dry needling and it did nothing for me. You don’t really feel the needle but sometimes when it hits your muscle it causes it to spasm and that is not very pleasant. I’m surprised they gave you cortisone in your muscle? I was told by a doctor that it kills the muscle. Best of luck to you, I’ve been suffering for over 8 years and have tried everything and nothing has worked so far. I found swimming to be helpful for exercise as it really loosens everything up and is easy on your joints.

      • Francisjames
        June 16, 2019 at 7:48 am

        Regarding the piriformis: This muscle is prone to hypertonicity bc of it’s attachment from the sacrum and greater trochanter. Positional changes that deviate from ideal alignment of the pelvic and hip very often cause tonal changes to the piriformis…secondary to its low irritability threshold…thus, stretching or “pounding” the piriformis with some massage techniques will only add to tonal changes…a circular pattern that worsens. There are other muscles that are synergistic with the piriformis…gluteus Maximus, quadratus femoris, obtuators, and gemellis…external rotators of the hip. This means the piriformis may assist in hip ABDUCTION and EXTENSION. When the GLUTES are WEAK, the piriformis will become OVERWORKED…causing the piriformis (and it’s tendon to function abnormally at the trochanter.) to not perform correctly…affecting also the sciatic nerve…eliciting pain in the GLUTE MEDIUS and MINIMUS.
        Injecting the piriformis with Botox is not the answer. Dry needling and acupuncture will not change the aforementioned patterns…However, DN to that muscle and the surrounding muscles can accelerate blood flow to these muscles, causing the appropriate and expected “spasms.”
        The bottom line…make sure that all support muscles in the hip are equally “strong” and each hip muscles in balance. Not to be neglected are the multifidus muscles and lower back muscles. If the MAXIMUS muscles are weak or inhibite, the hamstrings will be overworked…especially the biceps femoris…which can imitate piriformis syndrome.

      • mysijourney
        June 17, 2019 at 8:56 am

        Its a assist muscle that the body doesn’t need. Someone told me, “if it offends thee, take it out”, best advice I ever had in my life.

        How are you doing Francisjames since your release? is your pain completely gone yet?

      • Georgetta
        June 17, 2019 at 10:39 am

        Thanks. I did try the dry needling and didn’t think it was so bad, but I agree not pleasant. I thought it was helping release some muscles, but I’m back to square one again. I’m not using my muscles correctly. Some are overcompensating for others. I wish I could find someone who could help me sort this out. There’s no point in getting all these injections if the muscles just tighten up afterwards and if this is because I’m not able to function right. I’m glad you are able to swim. I used to love it, but now my glutes hurt when I kick for do the breaststroke. I’ve had this for so long so I don’t know how I could possibly change any patterns that might be contributing to the pain.

    • Hope
      October 26, 2021 at 4:24 am

      Made pain so much worse and made the bursitis worse with more swelling. If piriformis is already compressed to me anything pressing or touching lile massage or dry needling just makes it worse.

  9. Sherry
    March 18, 2019 at 5:36 pm

    I’m so glad that I found this post. I’m a 69 yr old female. I’ve suffered from “piriformis syndrome” for over 5 years. It started right after labral tear surgery. I’ve been to over 6 ortho doctors (Duke University and Dr. Martin in Dallas) and had numerous PT and injections. Dr. Tollestrup is currently reviewing my records. I’m very interested in more reviews of Dr. T as well as Dr. Redmond. Thanks

    • Hope
      October 26, 2021 at 4:28 am

      I’m also saving to have surgery with Dr Tollestrup honestly none of us really know if it’s piriformis or SIJD until actually removing it. It’s kind of like process of elimination to find out what’s wrong cause so many things mimic each other. I’ve suffered this severe pain in left buttock, back of hamstring and groin for 21 years since 21 now 42. But I also have snapping in left crevice of groin not sure if piriformis causes that or do I also have snapping hip syndrome. I hate that so many conditions mimic each other leaving so many like myself to suffer for years. What I’ve read is piriformis release has a high failure rate so I’m going with removal and after researching Dr Tollestrup he seems like a very good Dr.

  10. Heather
    December 3, 2018 at 9:20 am

    I suffered a injury in September 2016 and have had horrible butt/hip/leg/back pain only on the left side. I have went thru hell and back with doctors/injections/RFA to SIJ/therapist. I am to my wits end! Please help with advice on the piriformis removal surgery. I want the good, bad and ugly reviews. I am scheduled to have the muscle removed. I’m so concerned the pain will be worse afterwards.

    • Jocko1
      December 3, 2018 at 10:31 pm

      I had it removed and I had no change in symptoms from the surgery. I waited 6 months to heal and still had no pain relief. Another member on this board introduced me to the work of Dr John Sarno and TMS therapy and it has helped me the most by far. The majority of people I’ve communicated with have not had relief from removal surgery. But I can say one thing, the surgery wasn’t too bad af all and you can’t notice missing the muscle at all. Most doctors do not believe PS even exists.

      • PLR
        December 24, 2018 at 12:22 pm

        Who removed your piriformis? What kind of pain were you in prior to removal?

      • John
        June 9, 2019 at 10:18 am

        Jocko . Did you have sacrum or lumbar problems before surgery? Maybe it’s coming from those nerve roots.

    • Francis
      December 4, 2018 at 6:57 am

      Heather: DO NOT have your piriformis muscle removed! The process is to have it RELEASED at the trochanter…the surgeon releases the tendon. After a time, the muscle itself will atrophy.
      I was injured June 21, 2011 on a DRX9000 traction machine because of an incompetent and corrupt “doctor” (Dr. John Sparks in Birmingham Alabama at Spine Institute. He was convicted later by lawsuits against him by others for fraud. He lost his license.)
      Anyway, I went 7+ years of pure hell because I had numerous injuries to ligaments, tendons, and muscles in my right hip and lower back. I went through 21 doctors, 17 physical therapist and so many tests that it would take me too long to list; believe me, I tried everything. Not even Mayo Clinic doctor’s (3) could find my problem. However, a Mayo Clinic doctor recommended Dr. John M. Redmond. On January 23rd this year I visited Dr. Redmond; who, after 7-10 minutes, and using ultrasound (which I had previously.) and his thumb and ROM test found my problem. I had an injured piriformis tendon which would not let the muscle function correctly and causing other muscles to not function at the proper time.
      Because of years of injury in the glute region and hamstrings, I had severe scar tissue and a inflammation in the glute bursa. I had an OPEN SURGERY on March 20, 2018. The right side piriformis muscle was released, bursa removed and scar tissue cut loose in two places that was attached to the sciatic nerve. The surgery lasted 1.5 hours and required being put to sleep. The surgery was successful and was performed as an out-patient. I immediately felt the release of the piriformis that was pulling on my right hip and lower back where the piriformis attaches to the sacral area. I could also feel that the nerve pain was gone when the scar tissue was cut away from the sciatic nerve.
      I am now at 8.5 months post surgery and I can tell you, the recovery was pure hell too. Not from the surgery but from the scar tissue that accumulated after so many years. It took 6 months for the “surgery pain” to subside. I was waking without a walker or cane after one month. I saw Dr. Redmond on the 3rd month, who did ROM checks on my right hip.
      Because of so much scar tissue from years past and the surgery, I had to do extensive PT because of my right gluteus maximus was weak and atrophied due to years of not exercising. My treatment for this included ASTYM and dry needling; which I had before numerous times. I am now riding a bicycle and still doing at home PT exercises for total strengthening.
      I would STRONGLY NOT RECOMMENDING ARTHROSCOPIC for surgery but OPEN SURGERY. The recovery time is the same regardless. In fact, Dr. Redmond told me he had performed another surgery on patients who had arthroscopic surgery performed by other doctors. If you have had your injury for sometime, you will definitely have scar tissue near or on the sciatic nerve or near arteries, other muscles, fascia tissue, etc. The open surgery is the only way to guarantee full acces to the peritrochanteric space. It is not just about the piriformis muscle…it includes the total buttock region. I was prescribed Tramadol 50 mg, which did stop the pain during recovery and PT exercises. Dr. Redmond is located in Jacksonville Florida at the Southeast Orthopaedic Institute and my surgery was performed at St. Vincent’s Hospital. I now have my life back after almost 8 years of extreme pain. In 2012 I attempted suicide because doctors told me there was nothing wrong with me and it was in my head. You cannot solely depend upon MRIs and x-rays and all the other worthless test. It takes a doctor for mayor with muscles. Dr. Redmond is a fantastic doctor and surgeon who understood what was wrong. He saved my life.
      Hope this helps.
      Francis James

      • December 4, 2018 at 8:04 am

        I had mine released at the sciatic notch.

      • Francis
        December 4, 2018 at 7:48 am

        Yes…Dr. Redmond accessed from glute-hamstring region up to trochanter (at piriformis) to sciatic notch, and through notch up to sacral region. He “lifted” the circumflex artery and other muscles and manually lifted the sciatic nerve for full access through notch and down to hamstrings. A PA assisted him in the sciatic nerve handling. Dr. Redmond knew exactly what had to be done. It was entrapment at nerve and piriformis.
        Francis James

      • December 5, 2018 at 7:05 pm

        Francis, first off, you realize you are high risk for other damaged nerves? You are 8 months post op and still rehabbing from what you say is your botched surgery. Release surgeries cause lots of scar tissue on the nerve.This takes months to happen. My pain didn’t quaduraple until this happened.

      • December 5, 2018 at 7:44 pm

        Francis, here is my concern for you. Yes, some doctors may relieve the pain down the leg and you may get somewhat better, but this pain you are rehabbing from is most likely damaged PFCN or LFCN if you have buttock and thigh pain. These doctors doing releases are damaging other nerves and or the Piriformis Syndrome is damaging other nerves from over compensating so many years or from other surgical procedures. Also you are truly at risk for your muscle reconnecting to the nerve with scar tissue. If your pain continues, gets worse or doesn’t go away. I suggest you see Dr. Tim Tollestrup so he can help you. Pain that lasts longer than 6-8 weeks after any procedure or surgery is considered peripheral nerve damage until otherwise proven that its not.

      • Tracy
        December 4, 2018 at 11:38 am

        I had open piriformis removal by Dr. Starr at UT Southwestern Dallas in Dec 2015. Dr. Avneesh Chhabra is an expert at reading the 3T Tesla MRI. He also is at UTSW. My surgery was success, Please don’t believe all the hype.

      • Francis
        December 4, 2018 at 3:13 pm

        Tracy…glad to hear another success concerning DGS…Dr. Redmond told me there people who are born without a piriformis muscle or partial fibers of the piriformis may actually be attached to another muscle. He explained this to me to alleviate my concerns (mostly fear). I know of a person 19 years old who had DGS and is very active and no problems. It depends on each individual and certainly the surgeon.
        Francis James

      • December 4, 2018 at 12:55 pm

        I agree with Tracy. My husband had open piriformis REMOVAL by Dr. Starr at UTSW/Parkland in Sept 2015. Dr. Starr is a hip trauma orthopedist, at the county hospital in Dallas, so he has seen a lot of hips. I cannot say this enough, I truly don’t believe EVERY piriformis condition is identical. In my husband’s case, Dr. Starr had NEVER, repeat, NEVER, seen a piriformis muscle adhered to the pelvic bone with the sciatic nerve being SMASHED behind it. Had Dr. Starr NOT done open surgery, no way he would have been able to see “this”. My husband will tell you he was 80% better after the surgery and then he had to work his “behind” off in rehab another year to get back to a new normal. Between a horrible back injury in 2013, total knee replacement Nov 2014, and this piriformis monster that started in Feb 2015, it took him five years to get back into golfing. But, he did. However, he’s not your “average” person, and will study, google on youtube, and figure out what he needs to be doing. Every single doctor he’s been to understands he isn’t their “normal” patient. He NEVER missed a day of work unless it was for doctor appointments and he basically stood everywhere. The only position he could get relief was laying down. When he sneezed, coughed, even when he sat on the commode, it caused electrical shocking nerve pain from his hip to his ankle. I was his advocate and found this blog, who led us to Dr. Starr. I’m not sure where we’d be today had we not found this blog!! My husband will tell you, that he understands why people harm themselves and end it!!

      • mysijourney
        December 6, 2018 at 7:18 am

        Recovery doesnt have to be PURE HELL If you get a removal. You most likely have other damaged nerves. I healed from removal in 6 weeks. My scaitic nerve was fine and healed wonderfully that quickly with removal by Dr. Tim Tollestrup. Besides, the difference in removal vs release is, short rehab, no future problems with scar tissue reconnecting the hanging muscle that isnt doing anything to the sciatic nerve. Do the research, once the muscle is released, its rendered useless so why leave it in to cause problems?

        Any doctor will tell you the muscle doesnt work anyway after release, so why not get it removed ? Also orthopedics dont understand all the other nerves in the area, hence why Dr. Starr has some patients seeing Dr. T now because its suspected his retractors damaged them. Also Dr. T only does a three inch open incision. Go to youtube and see how bad it can get after release. Search his name and release. Worth a few min of your time.

      • Rachel
        February 3, 2019 at 9:37 pm

        Hi I am in the same situation. It’s been nearly four years that I have been in this pain. Finally got diagnosed with Piriformis Syndrome on both sides but my left side is where it started. The right side acts up on occasion and when it does it’s even worse then the left. I’m about to have the surgery and I am scared but I have also thought about ending my life because of the pain and endless doctors telling me they can’t find anything wrong. It’s been a nightmare. It’s changed the family and friends see me. Of course when the Drs can’t find answers the people in your life start to question if your pain is real. Plus they get tired of hearing about it but when you are in constant pain it’s hard to think about anything else. I pray that the surgery works for me. I also had a hard time finding a surgeon who even does this procedure. I’m glad to hear it worked for you and thank you for the tip on the open surgery. My surgeon didn’t really explain how the surgery would be performed but he did say he would ruin my bikini season so maybe it will be open. He said he would be cutting the muscle to relieve pressure on the sciatic nerve and that I had fibrous tissue in there. My back hurts all the time too. All the muscles are extremely tight but stretching aggregates the sciatica. I’m bummed to hear the recovery is so long but I will do anything to get my life back. My days are spent alone. My marriage was destroyed after 25 years as well. I feel like I have lost everything. All I want is to be able to function and then I can rebuild a life for myself. I wish more Drs would check for this condition so those who have it don’t have to suffer for years and years before they find an answer. It will drive a person crazy tone in constant pain without answers. So happy I found this thread. I forgot to ask…did you have it in both sides as well and what position did you sleep in after the surgery?

      • Francis James
        February 4, 2019 at 5:47 am

        Rachel: Before you have any surgery you should make sure the surgeon explains to you what he will do…You must be aware of what to expect. If you have arthroscopic Surgery there is a good chance that The surgeon will not have complete access to evaluate the sciatic nerve for any scar tissue that may be the result of any injuries or prolonged pain due to mobility issues. Depending on how long you have had the pain, whether it is on both sides, it will affect the function of the piriformis on each side as well as other rotator muscles in the hip region. I will tell you from personal experience which is too extensive to actually explain… But I will tell you if you have weak gluteus maximus muscles, it will overwork the piriformis muscles and not allow the piriformis tendon – muscle to function correctly. The average doctor and probably most surgeons are not aware of the anatomical functions of the muscles. I know this to be a fact after having seen 20+ doctors and unfortunately too many physical therapist, who always assume that it is due to just the muscle and not the tendon or ligaments. If possible, you should try to strengthen all of your gluteous muscles…Especially the maximus. An exercise that will immediately initiate the Maximus muscles Is a lunge routine whereby a person performs the routine by stepping out and lowering vertically to engage the aforementioned muscles.
        Again, I would recommend not having a piriformis release performed arthroscopically but to have an open surgery… The recovery time is the same regardless of each procedure. I can tell you I am glad that I had the open surgery even though it was painful. But… I had 7+ years of accumulated injuries and scar tissue that is generally not part of a persons problem with scar tissue. The surgery performed by Dr. John Redmond was 100% successful and after 10+ months post surgery I am so thankful that he performed the surgery. Your story is so much similar to mine that many times I considered suicide as I had no life And was in bed most of the time slowly slipping away… All my friends disappeared and it was a struggle for my wife as I had become mostly an invalid.
        I would strongly not Have the piriformis Muscle Removed but to have it released… After a time the muscle itself will atrophy… And if the surgery is performed correctly the muscle will not “flop” around as was stated in this blog. In fact, there are people who are actually born without the piriformis muscle and who have normal lives. I hope these few words help you in your decision… If you wish you may email me at fjc409@gmail.com to discuss. If you do I will give you my phone number and we can discuss as I could give you more in-depth information concerning your issues and your proposed surgery. I will tell you that Dr. Redmond would not do my surgery arthroscopically but only by open surgery… This is because he had to do recurrent surgery on individuals who had the release surgery orthoscopically because of the uncertainties as explained above. I am so glad I listened to him. I hope these few words help you. I know what pain and misery you have gone through… I wish I could speak to many other individuals to help them in any decisions. It took all my strength to find out what my problem was because the doctors that I saw had no clue about muscle issues… Most of their decisions Was based on MRIs, x-rays, etc. which were totally useless in detecting muscle issues.

      • mysijourney
        February 4, 2019 at 6:02 pm

        Francis James,
        I am not sure where you are getting your information from. But stop telling people you strongly don’t recommend piriformis muscle removal surgery when you have not experienced it. I for one had the release and ended up with reccurent piriformis syndrome along with the majority that have release surgery.

        So unless you have personally experienced the joy of piriformis muscle removal, and healed from that surgery within 6-7 weeks. don’t give folks false information.

        Its a assist muscle your body needs it about as much as it needs the appendix. Seriously, do some research. RECURRENT PS is REAL!!

      • Francis James
        February 6, 2019 at 11:07 am

        You are definitely opinionated and that your case is an all inclusive example, not to mention seriously biased.
        Having studied the anatomy and biomechanics of all the body muscle groups for approximately eight years I make no bogus suggestions or iinaccurate information. Your opinion on how the piriformis muscle, as well as the other muscle groups in the hip function is exceedingly narrow…to the point of infantile. You seem to think that the doctor that you so strongly advocate is the only doctor that has knowledge of the piriformis
        I will agree with you that recurrent DGS surgery is real…but the reason you had recurrent surgery is because you chose the wrong doctor and a doctor who only knows arthroscopic procedures. Your assessment of of muscle function and biomechanics is based upon the pablum your doctor fed you…thus, your understanding of the post surgery functioning of the deep six abductors and gluteals is totally erroneous. Specifically, your comments on how the piriformis muscle functions is absolutely ridiculous. So don’t tell me that the piriformis is just an “assist” muscle…you don’t see the complete picture. You have no clue of proprioceptive neuromuscular facilitation associated regarding intrinsic structures. Your surgeon should have explicitly explained all system functions prior to surgery. The surgeon I chose explained and demonstrated all these facts. My knowledge and understanding of the structural and functional pathology assisted me in my choice of surgeons. This in turn allowed the surgeon to understand my pain and function problems. While it is true that the piriformis muscle is and assist muscle that is not the full picture of its function, Whether it be released or removed. Your doctor should have explained to you that the remaining 5 rotators act more like local stabilizers while the piriformis acts like both a global stabilizer and mobilizer. You should have also received explanation of the gluteus Maximus function as well…released (non-function) or removed (parallel to individuals born without piriformis or piriformis fibers partially attached to gluteous Medius muscle fibers.)
        In regard to scar tissue post surgery release…your statements pure conjecture. Just because the piriformis was released, this has no bearing on whether a person will have scarring on the sciatic nerve or that the released piriformis will entrap the sciatic nerve. It does not take 6 months, 1 year, 2 years post surgery, for scarring to occur…it is immediate, regardless of methodology. Any internal or external scarring can be absorbed by Astym, post surgery healing.
        There again, the advantages of open surgery to that of arthroscopic surgery. I can tell you with proof that my surgeon has had to do recurrent surgeries on individuals who had arthroscopic procedures. And my surgeon is completely aware of the other “experts who invented the process of piriformis removal.” So…for you to suggest that your surgeon is the prima donna of DGS surgery is a absurdity.
        You have no basis on what to suggest for other individuals because of your failed initial surgery or pursuing the removal surgery. That should be left to the individuals who face that decision. We should hope that they would be fully informed and in close discussion with their surgeon(s).
        And please don’t post false statements as you did; stating that my surgery was botched… I never said such words and you are totally incorrect. I am 11 post piriformis release – open surgery and I am pain-free with no scarring nor nerve damage…another concern that was clearly explained by my surgeon and was clearly emphasized with open surgery being the optimal methodology. I have had two (2) post surgery ultrasounds of my right hip with no scarring, and the atrophied piriformis has retracted as was predicted by my surgeon.
        My complete familiarity of the optimal type of investigative procedures… ultrasound…and based upon my post surgery function and pain level… My surgeon granted my request for ultrasound.
        So don’t tell me to do some research. I did that long ago. However, I am completely prepared to answer your rebuttal I am sure it will be forthcoming.

      • mysijourney
        March 13, 2019 at 11:56 am

        I had an open release surgery, shows how much you are taking in what I have written. When you get tired of being in pain from your nerves and if your scar tissue reconnects and gives you more pain, you know who to call, Dr. Tim Tollestrup or Dr. Eric Williams. They can help you. This is not about us, its about the pain you are still dealing with. Face it, you are still having issues. Not as bad, but you are having issues.
        I have nothing else to say to you, ever, your body, its your choice to live in pain.
        I have no time for folks who want to argue about a Surgeon that is helping people.
        Mic Drop – BAM!!!

      • Francis James
        February 4, 2019 at 5:57 am

        Rachel: my surgery was on the right side and I had been sleeping on left side for almost 8 years. I am now able to sleep on both sides. Also I would remind you to use a pillow between your knees and sleep on your side but you can… This will keep your hip in line, left side and right side as well as keeping your spine straight and in line with your hips and neck. I hope this helps you… Again you must be told how the surgery will be performed And which side is actually causing your problem. If there is a problem with the piriformis on one side it can affect the other side as well… Not to mention all the other muscles as well… Even in the sacral location Where the piriformis and Maximus muscle attaches.

      • mysijourney
        February 4, 2019 at 10:33 am

        If you have a release surgery, please note, it is very unsuccessful. within the first two years, you will be high risk for scar tissue on your sciatic nerve.

        Removal surgery is the new and high successful way to cure piriformis syndrome. Its like removing the appendix, your body does not need it.

        Anyone who tells you its needed, doesn’t understand anatomy. Think of it this way, once its releieased, it is only there to cause problems, it doesnt work like it used to. So why leave it in to cause scar issues?

        Also, going to a orthopedic is like going to a dentist for eye surgery. You should really have a peripheral nerve surgeon and Dr. Tim Tollestrup perfected the surgery for this condition.

      • Bill T.
        March 17, 2019 at 12:20 pm

        Hi Misijourney,

        All you do is come in here and advertise Dr. Tollstrup. Obviously you are paid by him to spam the discussion boards. I’ve seen you doing the same in other boards discussing this topic. Stop spamming. You are hurting people who already have enough trouble.

      • Carol Butler
        October 20, 2019 at 6:56 pm


        My son is only 9 years old – he has had a sports injury and is suffering PS/back pain daily for 1.5 years now from a hockey injury. We are in the middle of tremendous slow progress along with misdiagnosis; and complacency to hear what we are saying by medics in Finland. It is so obvious to us what the symptoms indicate (even down to the duck feet orientation associated with the injury). Please can kindly provide the contact that diagnosed you to recovery (carol.butler109@gmail.com).

      • shawn
        September 9, 2020 at 12:23 pm

        The drx9000 table messed up my hip & piraformis too!!

      • September 9, 2020 at 8:49 pm

        How long ago did you have a release surgery? Give it time, it is high risk to grow scar tissue down your sciatic nerve. MStehling is the only person who hasn’t had this happen, not sure why, but I understand his surgeon isn’t doing this any more. It is the OLD way of surgery for piriformis syndrome. It should be removed the way Dr. Tollestrup and Dr. Williams do it through a two inch incision and should be done within the first two years of having this condition to lesson the chance of other damaged peripheral nerves.

      • Hope
        October 26, 2021 at 4:32 am

        Release has a high failure rate though and why Dr Tollestrup started removing it with high success rate. If release of Piriformis or removal doesn’t cure a person than it’s likely not the problem to begin with.

    • mysijourney
      December 5, 2018 at 7:57 pm

      Heather, there is a group on facebook, Piriformis Syndrome and Peripheral Nerve Solutions. Its focus is on the real solutions to PS. Its a very educational group and you can follow people having removal surgery.
      Do your homework. Release surgery is highly unsuccessful. Google Recurrent Piriformis Syndrome.

      • lifeoftracy
        September 18, 2019 at 2:49 pm

        @mysijourney. The FB page you’re referencing would be a good resource if you didn’t block people who had different opinions of yours. Let people share their journey. Just b/c someone doesn’t use the doctor you push, it doesn’t make their story less valuable. We all deserve to hear the good, the bad and the ugly.

      • September 18, 2019 at 9:10 pm

        There are plenty of people sharing there stories, some of which are trying to figure out their next step. The group doesn’t push a doctor, matter of fact, if you watch the video chat done with Dr. Tollestrup, he recommends the other doctors within the first 5 min. There are also several patients of the other doctors in the group.
        The group teaches people about the new field of treatment of surgery for chronic pain due to peripheral nerve conditions. The group actually recommends four surgeons that have dedicated their entire practice to this new field of treatment. The group doesn’t recommend any other surgeons because they do not use the same techniques as these four do.
        So you see its a group that is telling the truth about Piriformis Syndrome and peripheral nerves and expanding the knowledge about this new field.
        BTW, no one is forced to stay in the group. You can leave if you wish. Or you can stay and continue to follow folks on the journey to the healing side. There was a pretty amazing story just last week! Someone that was labeled with CRPS , used steps for the first time in 12 years! Pretty amazing stuff alright!

    • Bill T.
      December 7, 2018 at 1:57 pm

      Heather, there are 8-10 different things that can cause Piriformis pain, many of which have nothing to do with your Piriformis at all. That’s the problem, if you simply get your piriformis out, that may not do anything. That’s why you need to find a doc who really checks.

      In my case, I had the horrible nerve pain, horrible, and I called it piriformis pain. But then a doc said “wait it’s too low for piriformis”. Long story short, I have something called High Hamstring Tendinopathy, which causes the same problem…inflammation of muscles, muscles cramp and crush the sciatic nerve, which causes agonizing pain. In my case it’s the glueaus maximum and other small muscles nearby that are causing the pain, not piriformis. That is really far down on your butt, at the top of the thigh (which is how we found mine, by location).

      There are many locations in your pelvis that this can originate. Most doctors don’t believe it’s real because most doctors don’t want to be bothered to think about it.

      Some doctors who specialize in this problem will understand this. Dr. Hal Martin, in Dallas, is the one who wrote the book on this problem. Read a few of his papers on “Deep Buttock Syndrome”. You have to travel to Dallas to see him in person, that’s the only way he’ll do it. He gets patients flying from all over the world.

      I haven’t gotten any surgery since my tendon is the source of the problem, and there’s no way to fix that. Surgery would just inflame the problem worse. A surgeon in Finland named Lempainin is the world expert in THAT problem but he said I should do rehab instead.

      I took so much Motrin that I damaged my liver. No I can’t take any pain medicine AT ALL without damaging my liver further and dying. Yep.

      There are no quick fixes for this. You have to accept that. Don’t plan on going back to running marathons again. Think about what’s going to happen when you are 70 years old. Accept that high intensity exercise is out. The alternative is to stay in agony for the rest of your life. Sorry that’s what has been pounded into my 60 year old head the hard way.

      Very sorry for your pain, and good luck.

      • Francis
        December 8, 2018 at 5:37 pm

        Bill T.
        See my previous posts this site. 8 year story..I had your problem…injured hamstrings at ischial tuberosity, severe strain of glute Maximus at linea aspera, severe strain of glute medius and partial tear of glute Minimus. As well as other hip muscles, the 3 capsular ligaments, all dorsal ligaments in low back and dexoscolois sat Le due to pulled and injured thoracic ligaments and multifidus muscles, etc. I was a mess. Anyway, I had 2 1/2 years of prolotherapy, PRP, and BMA…A total of 16 sessions and over 1000 injections… Using my own blood platelets and bone marrow from my tibia. Everything healed except my piriformis tendon Had too much damage. However after reading your story you may be interested in pursuing “Prolo.” I had my procedure is done at caring medical in Fort Myers Florida and was performed by Dr. Timothy L. Speciale a DO Who evaluated me and found my problems by physical exam not by MRI or x-rays, etc. But there are other places such as REGENEXX Located in Tampa Florida. There is also a group I believe in Michigan and I think in the mid west. The correct way to do prolotherapy is by comprehensive… whereby, The muscles of the entire joint would be injected… This is because muscles do not act separately but our synergistic or antagonistic. Do not let anyone tell you that Prolotherapy is voodoo medicine or that it causes scarring. This is absolutely not true. However insurance does not cover prolotherapy because they claim it is experimental. Caring Medical has been doing prolotherapy for almost 40 years and is based on the Hemwall-Hacket method. This Is option 1 to consider.
        Option 2…ASTYM…A medical-science based Protocol that regenerates soft tissue such as ligaments tendons and muscles and Breaks down scarring. It’s result is neural. It is not the same as Graston Technique or ANY myofascial telease method Because they cannot be used on the tendons or ligaments. Insurance will pay for Astym. I received Astym After my surgery to break down scar tissue and to regenerate the gluteus maximus muscle and tendon as well as the tendons and muscles at the tuberosity. This is option 2.
        Option 3. Sinew Therapeutics. These are natural liniments and natural massage oils. They are not a scam but is based upon 3000 years of Chinese warrior solutions. I have used these products for over a year and use them as required. I used the chronic liniment 4 weeks after my surgery and I use the massage oil before I ride my bike and afterward. The Acute liniment is used for quick use after a pulled muscle or stressed tendon or ligament. The chronic liniment knocks down the sharp pain of injuries to tendons and the stinging of ligament laxity. This is Option 3.
        Option 4. Dry Needling (DN)…also known as electro-dry Needling. DN is NOT the same as acupuncture!!! I had DN performed on my glute Maximus to “kick start it” after 7+ years of atrophy. It works and helps healing of tendons and muscles by increased blood flow to injured area. Acupuncture never worked.
        I hope one of these can help you as I know what your pain is like. As you probably already know, muscles, tendons, and ligaments are “orphans” when it comes to doctors understanding these. I know…I went through 21 different type doctors and 17 different PT groups before my surgery. Many told me it was in my head. 2 doctors kicked me out of their office because I knew more than they did.
        I got up and walked out on one Orthopaedic sloth.
        Regards…hope you get better soon.

      • Georgetta
        December 9, 2018 at 10:24 am

        Thanks Francis and Bill T for your valuable information. I too suffered from the high hamstring problem on the right side and deep glute pain. PS was ruled out by Dr. Fishman, the specialist in NYC that has been mentioned in previous comments. After appx 5 years of trigger point injections and Botox in the glute, tons of PT, and a PRP in the upper hamstring, the right side improved but my problem all shifted to the left, which is why I’m being told I have SI joint dysfunction and pelvic instability that is causing my problems. But now, 5 years later, the left hasn’t improved despite doing basically the same things I did with the right with the exception of adding Posture Restoration exercises, A visit with a spine specialist and a lumbar MRI shows degeneration in the L4 L 5 discs which could be driving the pain. I’m going for my second facet joint injection to see if it helps and if it does, I’ll try ablation to burn the nerves. However, I haven’t tried Astym, which I hadn’t heard of or dry needling, which I had considered but didn’t do it out of fear of pain. There are places near me that do both. I am also interested in Dr. Martin to see what he might diagnose. I’m in the NYC area and you would think there would be people who could help figure out an answer to this endless battle.

      • Francis
        December 9, 2018 at 11:39 am

        Before you do ANY injections you might want do a complete evaluation of your hip muscles and lower back. There is a fantastic PT in NYC named Brent Brookbush. Also, I would recommend doing PRP into all your dorsal ligaments (a doctor who does Prolotherapy could do this…however I suggest not going to a typical doc in the box or a doc who does just single injections. I assume you did comprehensive “PROLO?” The doc must inject in a proper order…sacrotuberous first. I went through this…it was not my lower back or SIJ but sacrotuberous and sacrospinious.
        Also, you should make sure your glute Maximus is strong on each side as that muscle affects many other muscles even “across” to other hip.
        Dr. Tim L. Speciale is now in New York…her is a former PT and is a DO…25 to 30 years experience. He saved my life.
        Hope this helps.

      • Georgetta
        December 10, 2018 at 9:21 am

        Thanks Francis. I’ve had tons of injections but I feel like I should follow this L4 L5 path since nothing else has helped. With my luck, it will be just another nothing. My glutes are not strong at all since whenever I use them for anything, they hurt, left side especially. It looks like the one DOC you recommended isn’t near me at all unfortunately. I’ll reach out to the other PT specialist although it looks like he runs a training program for therapists. I’ll find out if he still treats patients.

      • Francis
        December 10, 2018 at 3:43 pm

        Georgetta…when you “prolo” (PRP, etc.) did you have all dorsal ligaments injected? Did you have your sacrum adjusted before “prolo?”
        Ordinary doctors (single office, “doc N box”) do not know to this but a DO would know before injections. I thought I had SIJ problems but it was weak glutes (after “prolo”) Prolotherapy does not strengthen muscles, only injuries to soft tissue. I was injured by a DPT in 2016 and caused a L2 fracture. Had to go back for PRP from Dr. Speciale. He is about 300 miles from you in Williamsville NY.
        You might want to look at Somatics Therapy…Check out their website…I did the beginners course ($47) and it was worth it. I assume you have not been injured so those exercises might be for you…they are gentle but effective…more about relaxing muscle instead of heavy strengthening…can help pinpoint what muscles need attention. If possible, don’t have back surgery…MRI’s are just a “picture” and does not represent your total spine or SIJ, etc.
        Hope this helps. Francis James

      • mysijourney
        December 9, 2018 at 12:13 pm

        I know a lot of fellow patients of Dr. Tim Tollestrup who removes the piriformis muscle. Everyone claims the hamstring issues and pull ligament pain stops when the muscle is removed.

        PS is the root cause of so many other problems. IT truly helps a lot of those issues if you get the muscle completely removed.

        After almost 9 years including a release surgery, my sciatic nerve healed in 6 weeks.

      • Francis
        December 9, 2018 at 9:18 pm

        How long after your piriformis RELEASE did the pain return? What type of pain…nerve pain or “muscle tissue” pain? Did you know suspect what was causing the pain? Who diagnosed your pain…primary care or going immediately to Dr. T? Once identified, did you have to wait long for surgery to remove piriformis? Did you travel a long distance? After removal did you remain in vicinity of Dr. T? Did you take pain meds before the removal surgery?
        So far, I’m not in pain but sometimes my hip feels “weird.” Hard to describe. If it happens I don’t want to wait a long time again before a surgery. I was told by 2 doctors that full recovery could be up to a year. Doesn’t seem reasonable. But I’ve met so many slothful doctors in the past.
        Any other thoughts would be appreciated.

      • December 9, 2018 at 10:30 pm

        I didn’t have a removal. I only had a release which was six years ago and have lived a pain free life since. I will say that a year for a full recovery doesn’t seem unreasonable.

      • Francis
        December 10, 2018 at 9:33 am

        Matt: A little confused here…in an earlier (12/06/18 @ 6:15 am post you stated:
        “My sciatic nerve was fine and healed wonderfully that quickly with REMOVAL by Dr. Tim Tollestrup.“
        So you had a removal then? I’m just trying to get a consensus of all who had either the release or removal. Since it has been 8.75 months since my release it would seem if any other nerves were damaged, the pain would have manifested by now? In Dr. Redmond’s surgery report he stated that he evaluated the sciatic nerve for any “hour glass” appearance, or inflammation, etc. There was none. He also commented about the other “to take care of no injury to arteries or PCNF nerve, etc. Dr. Redmond also cleared away all scattered scarring to investigate the glute medius tendons to make sure they were not torn…they were not. Same with Minimus.
        I had no choice for a surgery and I questioned him relentlessly before surgery on what he would do. The ultrasound definitely indicated a problem with the piriformis tendon. The tendon seemed longer than the muscle. He MADE me look at with the ultrasound. He told me my piriformis was small. I also questioned him the morning of my surgery. I felt confident that he knew exactly what to do. Earlier I had mentioned other surgeons (Hal Martin, Dr. T, and several others.) and he told me that he had done recurrent surgeries on patients who had seen those doctors. I don’t think he just said that because he is a no nonsense Dr. and very articulate. He was recommended by MAYO CLINIC where he used to actually be… And when I Met him three months after my surgery and then again at the six months I still had a lot of questions about a “free floating” piriformis… he said mine was not just free-floating because it was so short. So, that is where I am today. I still pondering this about a muscle not attached to the trochanter. Of course the human body just not Respond like we think it should and everyone is different. I’m just glad that your surgery was successful and it gives me a positive outlook. Dr. Redmond is a modern Technological doctor with the skills to use the latest surgery tools. He did tell me that it was not necessary to see him for the one year revisit. I pray that it will be so. This past 7+++ years has been a life changing event. PS, in my opinion is up there with many diseases because for me, the pain and feelings were horrible. Many people think that DGS surgery is a simple “muscle fix.”


      • December 10, 2018 at 11:58 am

        Maybe that was a different Matt. This is Matt, the creator of this blog.

      • Bill T
        December 10, 2018 at 10:57 pm

        Hi Francis,

        Thanks for the writeup. Very kind of you.

        I have always heard “PRP doesn’t work” but, as somebody who has studied platelets in my real life, I have always said to myself “there’s no way that a few treatments could work. You’d have to get dozens of shots over weeks to get enough platelet growth factors to make any difference.”

        So when you say you got 1000 injections, that actually sounds more realistic!

      • Francis
        December 11, 2018 at 7:22 am

        Bill T.
        Yes…I had numerous severe injuries and each session entailed doing my right hip, low back (SIJ’s), thoracic spine, and left hip because of residual pain. Each session about 2 hours. I started out with 15% solution with Prolotherapy and then 25% which was painful in the remodeling process. Because of severity Dr. Speciale switched me to PRP and then BMA. The number of total injections was greater than 1000 because the treatments had to be comprehensive since muscles do not act independently (muscle slings). The PRP and BMA were induced with zinc and ozone…natural elements of the body. One aspect of “prolo” is to have a good diet, not smoke, nor alcohol, etc. Thus platelets multiply more rapidly. Even so, I was somewhat of a slow healer. I had severe laxity in major ligaments in all joints and now healed. Prolotherapy is not voodoo medicine and injections for most part are made using ultrasound so as to reach osseus junction.

      • Georgetta
        December 12, 2018 at 7:42 am

        Hi Bill, I had 1 PRP injection quite a few years ago now for the upper right hamstring and it helped. I was told that it’s common to get 2 or 3. This was PRP, not PROLO. Insurance doesn’t cover PRP unless that’s changed. In the NYC area, it was $1,000 a shot. I think my hamstring might have improved because I also had to stop doing yoga because of all my glute problems. Stretching like the downward dog made it worse. I’m still dealing with glute issues on the left side and just had my 2nd facet joint injection of the L4 L5 which the spine docs think could be the source of the problem. I guess if I feel somewhat better in a few days, then they could be right. The PT people are still telling me I have SI joint instability and a number of alignment issues, weaknesses and over compensations that are causing the problem. They say I need a full year since I’ve had this so long. After 6 months with one of the better places, I don’t feel any improvement.

      • Hope
        October 26, 2021 at 4:43 am

        I’ve wondered if what you mentioned is actually my issue and not PS. Because the tight feeling and pain is also at the top highest point of back of hamstring. I believe it’s called proximal hamstring tendon but I also have pain and severe tightness right smack in piriformis. But than I also have severe snapping in the crevice of my left groin with inner tight pain/soreness a tired feeling in the inner thigh. Also the inner knee has pain and swelling and bottom of foot hurts ankle pops a lot plus hip bursitis. I wonder is it the actual hamstring, piriformis or snapping hip syndrome or both PS and snapping hip syndrome. It feels the snapping in the crevice of groin comes from that tight part at the highest point of back of hamstring. It sucks how so many things mimic each other making diagnosis so hard and leave ppl suffering years. I’ve done a lot of PT, stretching ect it only makes it worse and causes bursitis to flare and swell more. Im desperate so I’m removing this thing and hoping for the best of groin crevice still snaps. I’ll have the internal snapping hip surgery with bursectomy I can’t take the pain and tightness anymore. Oh and I can barely wear clothes or underwear anymore cause they make pain in the butt, hip, hamstring and groin worse.

    • Hope
      October 26, 2021 at 4:29 am

      Same been to at least 100 Drs I’ve suffered since 21 now 42 ruined all my dreams hoping removal with Dr Tollestrup cures me.

  11. October 13, 2018 at 3:20 pm

    To BARB that sent me this email below. I replied but your aol email is not working. No one should get a release anymore. The removal surgery is very successful. And quick to heal from. Please don’t get surgery with Dr. Keppler.

    You need to get the muscle removed, it is the latest, best treatment for PS.
    Surgery is way to risky with anyone else.

    Name: Barb

    Email: barrrobb@aol.com


    Comment: I saw your post that you saw Dr Keppler
    For piriformis Release , did he perform the procedure on you? And if so, how was the outcome? I am scheduled this month to have the procedure done in Cleveland at St Vincent’s Charity Hospital, and wanted to know if that is where he did yours, and how you were treated?
    I have searched 5 years to find someone to do this, have been through hell, having surgeries, injections, SCS implant and nothing has helped!
    Praying someone has good news to share in regard to Dr Keppler, and this procedure.

    • October 13, 2018 at 3:24 pm

      Sorry, forgot to put surgeons name. Dr. Tim Tollestrup. Google him, then go to youtube and search his name. He has a video of what the release surgery is doing to people.
      Plus it grows scar tissue down the sciatic nerve. This release surgery needs outlawed it is highly unsuccessful!

      Dr. T perfected this surgery. Please don’t put yourself through the horror I have been through.

      • Francis
        December 4, 2018 at 10:31 am

        To “my journey”
        Your comments are exaggerated and not based upon actual historical data. The comment “it grows scar tissue down the sciatic nerve” has no basis in historical facts and is a mere false statement. There is no basis for your statement that the surgery should be outlawed. The basic premise is that one must find the appropriate surgeon to do this type of surgery. Also, Dr. T did not not “perfect” this type of surgery. There are surgeons equally qualified; namely my surgeon, Dr. John Redmond. The difference in “open” surgery to that of arthroscopic surgery is completely opposite. Only by open surgery can the surgeon fully access the piriformis AND the sciatic nerve with scar entrapment. Scar tissue adhered to sciatic nerve is scissor cut, eliminating additional surgical cutting. This technique is performed manually by the surgeon. This can not be fully performed arthroscopicly. I had only one incision and it healed completely with no adverse problems. I am 8.5 months post surgery.

      • December 5, 2018 at 12:09 pm

        Yes there is documentation. Go to Youtube. Key in Dr. Tim Tollestrup release. Watch the and learn. Also google recurrent piriformis syndrome and read the published reports. Do the research before you make claims.

  12. Vipp
    October 9, 2018 at 4:52 pm

    From Piriformis Syndrome to Deep Gluteal Syndrome
    Once an uncommon controversial diagnosis, piriformis syndrome is now
    understood as a sciatic nerve entrapment neuropath

    By Stuart B. Black, MD, FAAN
    Chief of Neurology
    Baylor University Medical Center at Dallas

    Click to access PN0918_ST_Piriformis.pdf

  13. John
    June 25, 2018 at 8:13 pm

    Go to a doctor ASAP. Classic lumbar spine problem.

  14. Nicky
    June 21, 2018 at 7:28 am

    Hi everyone.
    Has anyone suffered for loss of bladder and bowel control with piriformus syndrome?


    • Lillian Nash
      June 26, 2018 at 6:21 pm

      That’s a new wrinkle. I have heard of people having loss of bladder control after having hysterectomies. But not the loss of bowel control.
      I hope you will find some help soon.

      Sent from my iPhone

      • Nicky
        June 27, 2018 at 4:23 am

        Thank you. I am totally house bound to scared to go out anywhere. Because it does happen any where and anywhen. No triggers

      • L
        June 27, 2018 at 6:56 am

        We will keep you in our prayers.
        Perhaps “Depends” or some other adult diaper will help ?

      • Georgetta Morque
        June 28, 2018 at 7:19 am

        Have you seen a pelvic floor specialist? Perhaps they can help?

      • Nicky
        July 11, 2018 at 1:02 pm

        Hi Georgetta,
        I have got pelvic floor exercises to do yes.

  15. Georgetta Morque
    June 8, 2018 at 11:59 am

    I remember someone posting about L4 & L5 in the past. After 10 years, I am having this issue addressed. I’ve been injected in the piriformis, glute, hip, SI joint – both sides and hamstring and I still have pirformis and glute pain and tight hamstrings and I’m unable to do much physically. None of these treatments have led to the source of the problem. Now the latest is to inject the nerve at L 4 & 5. Has anyone had this done? Thanks. Georgetta

    • L
      June 8, 2018 at 12:50 pm

      I have had injections into the L4, L5, SI with absolutely no relief, also into the piriformis muscle of which I got relief for one week only.
      After two years of searching after my pain began I finally found Dr. Tim Tollestrup in Henderson/LasVegas Nevada. He is a peripheral nerve surgeon, of which there are only a handful of them in the United States. Many of his patients that are Piriformis muscle syndrome, and have seen orthopedic surgeons prior, and having surgery for tendon release, which has caused major other problems, Dr. Tollestrup has perfected the surgery to correct any damage done and remove the Piriformis muscle and scar tissue.
      Your issue may not have anything to do with the piriformis muscle. – – however, After visiting Dr. Tollestrup, and having my Piriformis muscle removed , I still had some of the other issues prior to surgery. So, as instructed by Dr. Tollestrup, I went to pain management and they injected a block (not steroids but numbing block only – – not steroids ) to see if that was the issue – – sure enough, injection into the (SCN) superior cluneal nerve — relieved all pain in my sacroiliac area. Also, injection block into the (LFCN) lateral Femoral cutaneous nerve, relieved all pain on my right hip area, I could walk with no pain – – which all other Doctors said was the bursa – – NOT — the pain I felt feeling like the ligaments were being torn from my groin. Also injection block into the (PFCN) Posterior femoral cutaneous nerve – this pain affected my sitting bone big time — and the pain was gone – – this tells the surgeon, Dr. Tim Tollestrup, where the problem is.
      Next week I am returning to Dr. Tim Tollestrup (surgeon) to have disconnection of the SCN & LFCN.
      I swear by this doctor – – he has helped so many people, and a Peripheral nerves surgeon is much much gentler than an orthopedic surgeon which cuts through the Glut big time and you are in horrible pain afterwards.
      Just Google Dr. Timothy Tollestrup Henderson/Las Vegas and read his website – – also, give them a call and tell them what your problems are and they are happy to help you – – I was scared because I was afraid they did not except my insurance, Medicare – – it does not say on his website but he does except whatever insurance pays

      • Georgetta Morque
        June 8, 2018 at 3:39 pm

        Thanks so much for all of this. The pain doctor I’m seeing mentioned some type of block as well. I’m going to see a spine specialist to see what he says. I don’t have piriformis syndrome but I have pain there. Once there’s one problem all the muscles react. I don’t have any lower back pain but I guess this new theory for me is that the L4 and L5 are maybe causing pain down to the glutes. It’s so frustrating as you know

      • L
        June 8, 2018 at 3:51 pm

        Please !!! They all wanted to send me to a spine specialist also – – my back never hurt – – all the x-rays, MRIs, MRN’s never revealed anything wrong with my back – – if you go to a spine surgeon and they see any kind of little fuzzy stuff on your x-ray, they will want to open you up and explore —- they all wanted to send me to a spine specialist also – – my back never hurt – – all the x-rays, MRIs, MRN’s, never revealed anything wrong with my back – – if you go to a spine surgeon and they see any kind of little fuzzy stuff on your x-ray, they will want to open you up and explore !!! Please, call Dr. Tim Tollestrup office and explain – – I would hate for you to be cut open unnecessarily also big-time glute which will be very painful for you later.
        You’re in my prayers.

      • Ronald Joseph Goldberg
        July 29, 2018 at 12:05 am

        I just got connected with Tollestrup and am excited to get my Piriformis Syndrome solved. Need to get a MRN scan of the pelvis and a piriformis injection. Injection of pain med into piriformis and sciatic nerve, above, below and under piriformis. To verifiy that the sciatic pain is originating at the piriformis. 18 years of lazy doctors. Haven’t sat comfortably since summer of 2000. Im going to Nevada!! I can see the light.

      • Lillian Nash
        July 29, 2018 at 9:28 am


        I hope you get this it does not go to your junk mail.
        Glad to hear you’ll be seeing a Dr. Tollestrup soon.
        Please keep me updated on your progress.
        We will keep you in our prayers.


        Sent from my iPhone

      • L
        July 29, 2018 at 9:31 am

        I hope you get this it does not go to your junk mail.
        I also replied to your email so if you wish you can email to my email address
        Glad to hear you’ll be seeing a Dr. Tollestrup soon.
        Please keep me updated on your progress.
        We will keep you in our prayers.


      • Lillian Nash
        August 6, 2018 at 8:41 pm


        Just wondering how you were doing, have you made it to Nevada yet ?
        Please keep me posted on your progress.


        Sent from my iPhone

      • Hope
        October 26, 2021 at 4:57 am

        So do you continue to need to constantly get blocks or is it one time thing. Does this mean that it wasn’t your piriformis after all or it was you just had other issues. And why did you have to go to pain management doesn’t Dr Tollestrup do blocks being he’s a nerve surgeon. Sorry so many questions I’m not sure if I understood all your comment just want to make sure I understand correctly. I am saving up for removal of piriformis with Dr Tollestrup praying it cures me. But I also have snapping in the crevice of my groin not sure if piriformis can cause that. I suspect I either have PS with snapping hip syndrome or possible proximal hamstring tendinitis. Dr T said it is possible that I have PS by my symptoms and snapping hip syndrome. If the removal or piriformis doesn’t stop the snapping than I’ll have the snapping hip surgery with bursectomy. I forgot to ask Dr T if he does bursectomy cause the bursitis is also brutal. I’m sad he doesn’t accept ins I’m trying to save and figure out a way to get the money. So sad that so much of my life has just wasted away it’s affected all my relationships. 😢

  16. Ashly Dean
    June 4, 2018 at 12:18 pm

    Wow! That’s really admirable. Congrats on patience and achievement. My story is incredibly similar to yours. I had surgery. My pain went away but re-training my hip muscles has been tough. This gives me hope. Thank you! I am so happy you are pain-free! 😘

    • Patti
      June 4, 2018 at 9:09 pm

      Who did your surgery? Did you have the muscle removed?

      • Ashly Dean
        June 4, 2018 at 10:51 pm

        Dr. Hugh West in Utah. He studied with Dr. Hal Martin. I was his first. I was desperate. No, they just put a slit in it to stretch it out. My pain in now related to lack of space in other areas of my hips, an IFI; however, we are hoping with time and more PT it will open,

      • Lillian Nash
        June 5, 2018 at 12:28 am

        I had my Piriformis muscle removed by Dr. Tim Tollestrup In Henderson/Las Vegas Nevada. He has perfected the removal of the piriformis muscle. After surgery you walk out full blooded wait. There are only a handful of Peripheral nerve surgeons in the United States and he trains them.
        My surgery from the removal of the Piriformis muscle has healed, but I have other issues with some nerves which he will also do surgery on.
        Google his name and read his website, he excepts what ever your insurance pays. He is amazing and I know you will be happy with him.
        Dr. Tim Tollestrup Corrects many surgeries that have been botched by surgeons who only clip the tendons – – thus, leaving it to flop around and causing major scar tissue. Orthopedic surgeons will cut through Glute muscle causing you major major pain afterwards. Dr. Tim Tollestrup Has different techniques so you will be in far less pain.
        I strongly advise you to check it out.
        I have visited with many other patients, they do well after surgery.
        Sent from my iPhone


  17. Bill T.
    June 3, 2018 at 8:28 pm

    Hello here’s an update. I’m still pain free. My strategy was not to get surgery (for various reasons I couldn’t) but instead to focus on a long period of 100% rest and zero sitting.
    When I say zero, I mean, I have not sat at all, not even once. No running or walking up hills, only gentle exercise in a warm therapy pool or hot tub. I had one steroid shot which helped the whole area cool down and stop spasming. I am slowly retraining my hip muscles. So far so good. No pain at all for the past 6 months, this was after years of pain. Most important of all I avoided surgery.

    • Hope
      October 26, 2021 at 5:03 am

      You must not have kids there’s no way to do what you have done when you have a family to care for. Plus most ppl need to shop, wash ect it’s not just sitting that’s unbearable but walking, showering, laying (haven’t slept in 20 plus years.) And sex is painful which is also a symptom of PS in women including constipation and wearing clothes and underwear hurts a lot too.

  18. JD
    May 16, 2018 at 6:22 pm

    Dr. Tim Tollestrup removed my right Piriformis muscle 6 weeks ago. It was previously operated on by Dr. Hal Martin in Texas who totally botched the job. Dr. Martin created a ton of scar tissue through a large open incision and he did not address the issue causing my pain, he made things much worse. With Dr. Tollestrup’s surgery there was minimal pain in recovery compared to Dr. Martin’s procedure. For me it has not been an instant fix, there have been ups and downs, but overall I feel I’m improving and I have hope again. I am able to move around a lot easier.

    Unfortunately, I am one of the few who have this condition bilaterally. I had the muscles on the left side removed recently. I say muscles because I happened to have 2 piriformis muscles on the left side (an anatomic variation) with part of the sciatic nerve going between them.

    I urge everyone to join the new Facebook page titled “Piriformis Syndrome & Peripheral Nerve Solutions” for accurate information.

    Also, If anyone has been operated on by Dr. Martin and is worse off, please send an e-mail to me at jwpdnyc@gmail.com

    • Francis
      August 7, 2018 at 10:49 am

      Dr. Hal Martin is supposed to be the guru Of all piriformis release Surgeries; however, I have read other statements concerning his procedures and it sounded like the results were negative. For myself, I had an open surgery back in March of this year. my surgeon, Dr. John Redmond, did a super surgery. In my case the tendon of the aforementioned muscle was anatomically injured and would not function correctly. I have spent 7+ years trying to find doctors that can find the problem… Most of the doctors or either lazy, or just headnote clear. It to Dr. Redmond about 7 to 10 minutes to find my problem using ultrasound and his thumb And not more MRIs or CT scans. At first he was considering Endo scopic surgery but after reviewing the ultrasound; open surgery was the procedure to go with u and not more MRIs or CT scans. At first he was considering Endo scopic surgery but after reviewing the ultrasound; open surgery was the procedure to go with. This is because the doctor wanted for access to the sciatic nerve and the hip Bursa. During the procedure the piriformis was released, and then full attention to the sciatic nerve from his originating point and into the Sciatic sciatic notch and then down to and then down to the gluteal sling at the hamstring insertion. The sciatic nerve had several locations where scar tissue was adhering To the nerve. When this is completed the doctor than removed the bursa and then afterward to the nerve. When this is completed the doctor than removed the bursa and then afterward checked the tendons of the medius muscle for any tears. Luckily, there were no tears. Initially I question the doctor as to why he was wanting to do open surgery… He was quick to tell me that other patients who had had endoscopic surgery for the same problem headcount to him for revision surgery. So, even though it was painful, And still is, I’m glad I had the elephant surgery. Today marks my 20th week and I have completed 11 sessions of physio-massage, physical therapy for strengthening and stretching, topped off with Class 4 LightForce laser treatments. I will say, and since it was an open surgery, there were two incisions creating significant scar tissue. I will say, and since it was an open surgery, there were two incisions creating significant scar tissue The physical therapy but self would not have helped for the case of the scar tissue. It was the physio-massage by the physical therapist using ISTM tools and manual. it was the stainless steel tools that made the difference, which also found trigger points in my right leg and near my right knee both inhibiting my hamstrings. According to all information That I have read it takes six months for complete healing… Whether it is endoscopic or open surgery. I have six weeks to go to the six-month point. I still have to use ice packs several times a day and I’m down to taking one 50 mg Tramadol every 18 to 24 hours, which is pretty good. I am still limited In my walking. I did have to make one visit back to the surgeon because I had inflammation in the posterior tendon as a media’s muscl in my walking. I did have to make one visit back to the surgeon because I had inflammation in the posterior tendon as a Medius muscle… but this was probably due to too much massage with the ISTM tool. Overall, it has been a nightmare because one is limited to what they can do. Dr. Redmond is located in Jacksonville Florida and I live about 100 miles from Jacksonville. This is a stressful situation because if you have problems you cannot go to the emergency room or another doctor… Because they have no clue as to what deep gluteal Syndrome surgery is…Much less, that of piriformis release surgery. I attended a great physical therapy center and they two were not aware of this type of surgery. One must be very proactive in stating information and being careful of what another doctor or physical therapist would want to do. I hope if anyone reads this that it might help them. I can emphatically state that continuous injections into the piriformis muscle or L4 L5 will probably continue as a vicious circle. If this is the case, one might also want to look at if they have spinal stenosis Or similar.


      • Andrea
        October 13, 2018 at 3:39 pm

        Francis, Can you please email me at andrea s bihari @ yahoo (dot) com?


    • Hope
      October 26, 2021 at 5:06 am

      It’s horrible how drs refuse to train well and either leave ppl to suffer for years like me 20 to be exact. Or they do botched surgeries I’ve had one before for endo I can’t believe this is the America I live in.

  19. Andrea
    April 22, 2018 at 9:55 pm

    Hello, friends. I’m at the end of my rope. I’ve been dealing with PS and sciatica for months. I haven’t slept more than 2 hours a night for 5 months now. It has taken a toll on me in every way. I have no quality of life. The limitations on my life and this pain make me suicidal. I have no insurance and don’t qualify for Medicaid here in central Florida. I tried acupuncture and have been going to a pain/physio/chiro clinic for about 3 months, with no relief. I need to know there’s hope. I know that, if you are here, you know what this feels like.
    Thank you so much!

    • John
      April 23, 2018 at 8:18 am

      Symptoms? Activity or inactivity before symptoms? Back pain (never or not)? Sciatica symptoms – lower limb to foot – how far down, present with PS symptoms always or not? One side or bilateral? Sitting? Standing?

      • Andrea
        April 23, 2018 at 6:22 pm

        I was pretty active right before the symptoms started; in fact, I was going through everything in my house, just before moving to Florida last fall. At the time, I felt a twinge in my back, reminiscent of my previous bout with sciatica, but I never expected it to progress like this, with PS thrown in.
        My sciatica and PS are on the left side, only. The sciatic pain goes from lower back to left foot. The sciatic and PS pain are always there and I would rate both as 8/10. Sitting increases the pain within a few minutes and standing is a little easier, pain-wise, but I’m too exhausted to want to stand. When I get out of bed, everything is pretty much screaming in pain and is locked up. It takes a couple of hours to straighten out and feel a bit better. Whether I’m sitting, standing, or lying down, there is no comfortable position that alleviates the pain. It takes several hours to fall asleep and I either sleep a few minutes here and there, totaling a very small amount of sleep, or sleep no more than 2 hours, then the pain wakes me up and I can’t get back to sleep. I am going insane from the lack of sleep.
        I had sciatica before, 25 years ago (onset in 8th month of pregnancy). I waited 10 years to have surgery, which immediately relieved 100% of the symptoms. I had fusion,L5-S1, and a recent x-ray shows spondy at L5. I also had cervical spine surgery around 15 years ago, but I don’t think that area’s relevant at this time. I did not have PS at that time. This is the first time I’ve ever had it, and it is what keeps me from sleeping and limits my life much more than the sciatica at this time.
        Thank you for listening!

    • Lillian Nash
      April 23, 2018 at 8:48 am


      I hope you will check your junk mail and find this.
      I know exactly what you’re going through, as I
      was in the same situation for 2-years. I had injections, dry needling, chiropractor, PT, different medications and all with NO RELIEF. However,
      I accidentally found out how I could get some Temporary relief. Margarita with a double shot, I drink it as fast as I could and I got instant relief.

      My pain was so bad I was having the electrical spasms looking like I was being struck by lightning. Are you that way too ? I am not trying to get you to become an alcoholic but it double shot I believe it’s better than medication – – and it works until you can find out exactly what you need to have done. It allows you to get to bed at night. It allows you to sit down and rest. It will last, maybe up to four hours. – – Until the alcohol wears off. Like you, for two years I was up all night doing laundry, cooking, washing dishes, cleaning floors, anything to keep me on my feet because I could not sit down or lie down. Until I found tequila !!! I eventually got really tired of tequila and could not drink it, so I switched to vodka with Gatorade and 7-Up – – 🙂

      Whatever you do, don’t let them do a tendon release, because down the road you will be much worse and it will have to be corrected.

      I have blogged for about two years until I found reference from other bloggers a doctor that can really help you. I had surgery last month by this doctor and I am so much better now !!!

      His name is Dr. Tim Tollestrup and he is in Henderson\Las Vegas, Nevada. He is miracle doctor. Many times he has corrected what other doctors did trying to fix the problem and then he did what needed to be done, removing Piriformis muscle. Many doctors wanna tell you that you will not be able to function with that leg anymore – – wrong wrong — my leg functions perfectly and I can do much more than I did previously, while I am still healing.

      Other doctors Will cut through the Glut muscle and you will be in severe pain. Dr. Tim Tollestrup uses different techniques, this is done on an outpatient basis, and you walk out full-bodied following surgery. You don’t have to go back for follow-up check up. You communicate with him through text, and he will text you right back.

      I knew that flying to Las Vegas seems totally out of the question. (Money factor) That is exactly how I felt. But I knew I had to do whatever I had to do to get my life back, and I did !!!

      I suggest you Google and read about him, find his phone number and call, his staff is very helpful in answering your questions. There is a number of things that needs to be done before he will perform surgery, to merrily to rule out any other reason.

      Andrea, I hope I will hear back from you and I hope this has been some help for you.


      Sent from my iPhone

      • Andrea
        April 23, 2018 at 6:30 pm

        Hi, Lillian –
        I added more details in response to John’s questions, in case you want to read that.
        As for flying to Las Vegas, I don’t think I can do that right now, with work and pets, but mostly because I don’t have insurance to pay for any procedures. I’m so glad you found this doctor and you’re doing better and that you’re reaching out to help others. Thank you for that!
        I have the “electrical jolts,” yes.
        I have been trying wine and beer (no hard liquor, yet) to at least get me to fall asleep, but they don’t seem to help. Maybe I’m different from you, but alcohol has always seemed to magnify any ache or pain I have.


      • L
        April 23, 2018 at 7:47 pm

        Thanks for your reply. I am so sorry you’re in so much pain and I do understand. But with all my blogs and research I found out I needed a Peripheral nerve surgeon. They are much more delicate with nerves than your orthopedic surgeons.
        Dr. Tollestrup has perfected the surgery. I hope Xmas pray you will at least contact him and hopefully in the future you will find a way to see him.
        I know you said you did not have insurance – – he is the type of doctor that really cares for his patients and except whatever insurance pays. I know he would make other arrangements of payment for you.
        I did read the other blog.
        Andrea take care and please keep me posted and if you do find help.
        Dr. Tollestrup said there are only a handful of peripheral nerve surgeons in the US and I believe he trained them. Perhaps Dr. Tollestrup could tell you where a closer peripheral nerve surgeon is at near you.

    • L
      April 23, 2018 at 11:36 am


      I hope you will check your junk mail and find this, as I sent this to your email also.
      I know exactly what you’re going through, as I
      was in the same situation for 2-years. I had injections, dry needling, chiropractor, PT, different medications and all with NO RELIEF. However,
      I accidentally found out how I could get some Temporary relief. Margarita with a double shot, I drink it as fast as I could and I got instant relief.

      My pain was so bad I was having the electrical spasms looking like I was being struck by lightning. Are you that way too ? I am not trying to get you to become an alcoholic but it double shot I believe it’s better than medication – – and it works until you can find out exactly what you need to have done. It allows you to get to bed at night. It allows you to sit down and rest. It will last, maybe up to four hours. – – Until the alcohol wears off. Like you, for two years I was up all night doing laundry, cooking, washing dishes, cleaning floors, anything to keep me on my feet because I could not sit down or lie down. Until I found tequila !!! I eventually got really tired of tequila and could not drink it, so I switched to vodka with Gatorade and 7-Up – – 🙂

      Whatever you do, don’t let them do a tendon release, because down the road you will be much worse and it will have to be corrected.

      I have blogged for about two years until I found reference from other bloggers a doctor that can really help you. I had surgery last month by this doctor and I am so much better now !!!

      His name is Dr. Tim Tollestrup and he is in Henderson\Las Vegas, Nevada. He is miracle doctor. Many times he has corrected what other doctors did trying to fix the problem and then he did what needed to be done, removing Piriformis muscle. Many doctors wanna tell you that you will not be able to function with that leg anymore – – wrong wrong — my leg functions perfectly and I can do much more than I did previously, while I am still healing.

      Other doctors Will cut through the Glut muscle and you will be in severe pain. Dr. Tim Tollestrup uses different techniques, this is done on an outpatient basis, and you walk out full-bodied following surgery. You don’t have to go back for follow-up check up. You communicate with him through text, and he will text you right back.

      I knew that flying to Las Vegas seems totally out of the question. (Money factor) That is exactly how I felt. But I knew I had to do whatever I had to do to get my life back, and I did !!!

      I suggest you Google and read about him, find his phone number and call, his staff is very helpful in answering your questions. There is a number of things that needs to be done before he will perform surgery, to merrily to rule out any other reason.

      Andrea, I hope I will hear back from you and I hope this has been some help for you.


    • Lillian Nash
      April 24, 2018 at 5:12 am

      Please send to me your email address so I can send you pictures of what I do, hopefully will help you.

      Sent from my iPhone

      • Andrea
        April 24, 2018 at 6:59 am

        My email is andrea s bihari @ yahoo (dot) com. (Put it all together w/o spaces; I’ve “encoded” it so that it can’t be mined by spammers.)
        Thank you!

      • Lillian Nash
        August 6, 2018 at 8:36 pm

        Thinking of you and how are you doing ?
        I hope this will give you some “hope”. I heard of a girl in her 30s who needed her piriformis muscle removed, she was in Canada and there are no doctors around up there to do this and she did a “Go Fund Me”. She went to the news station, and they told her story and she got it done !!!
        Please reply, look forward to hearing from you.
        Sent from my iPhone


    • Francis
      August 7, 2018 at 10:53 am

      Andrea…see my post. I know what your going through. Francis

    • Hope
      October 26, 2021 at 5:07 am

      Try 21 years been like this since 21 now 42 brushed off by every dr have had every type of imagining you can think of. Hope you finally were cured it’s horrible to be left like this I know.

  20. Bill T.
    April 14, 2018 at 3:01 am

    I had what I thought was Piriformis syndrome, but as it turned out, my hamstring tendon (high hamstring tendon) is damaged (tendinopathy) which causes inflammation and scar tissue buildup nearby, including the sciatic nerve which is nearby. When the tendon is super inflamed it causes all of my pelvic muscles to spasm and that causes further crushing of the sciatic nerve (i even lost the use of my foot for a while). Horribly painful as you all know.
    No surgery can fix this, even the piriformis surgeons say so. I can’t take NSAIDs because of liver damage. So for me it’s warm therapy pool yoga and slow attempts to strengthen the hamstring. I never sit in a chair, only lie or stand, since sitting triggers the spasms and it takes weeks for them to subside.
    Best of luck to all.


    • *W*
      April 14, 2018 at 8:13 am

      Bill T., hi. I thought I had piriformis syndrome as well. I even went to see Dr. Starr/Dr. Chhabra and had a botox injection into my piriformis muscle and sciatic nerve. It never kicked in. I thought I had it nailed. I didn’t. After my flight to Texas, I collapsed in the airport as I had been unknowingly pinching my sciatic nerve during the flight. So humiliating. I left my job because I could not walk from my car to my office, nor sit there all day. 2+ years later after my trip to Texas, it turns out that I have “hamstring syndrome” as well. Horribly painful as you say and as you all know. The thing is that my docs here knew this all along. L4, L5, S1, SI joint, trochanteric injections, PRP, prolotherapy, drugs, physical therapy, acupuncture, dry needling, etc.I find it baffling that no one can get to the bottom of it – which is why we have to be our own advocates. Anyway after 6+ years of pain and searching for answers, I am going outside of the states to see a specialist in Finland. It appears to be the same sort of open procedure that is performed. I also have a bone spur in addition to the tendinosis which they think may be the true cause of the sciatic nerve compression, but we shall see. Both the tendinosis and the bone spur were found via ultrasound (3+ yrs. ago!). The bone spur shows up on x-rays and the tendinosis on MRI’s. I suggest doing a search on hamstring syndrome and Finland and see what you come up with. Another suggestion is to look into ionic magnesium supplementation and see if that is up your alley. I understand your pain, feel for you and hope that this can help you in some way. *W*

      • Patti Sanghwan
        April 14, 2018 at 12:37 pm

        Did the doctor in Finland diagnose and treat you? Are you any better? Our stories are so similar. I’ve been doing prolotherapy, platelet rich plasma injections on and off since 2014. In 2017 I travelled toBellevue Washington to get stem cell, platter rich plasma. I’ve had 3 Botox into the piriformis. Everything except surgery as some doctors say L4,L5. Others say so joint and others say piriformis. So it’s pretty hard to agree to have a surgery when no one can tell you which one would be best. Additionally I would have to leave Canada for any surgery. Nothing is offered here.

      • April 16, 2018 at 2:13 pm

        Patti, Just because the injection doesn’t give you relief, doesn’t mean you don’t have PS. I had two injections into muscle and I didn’t get relief either. But when Dr. T did removal surgery, he found I had two piriformis muscles compressing a split siactic nerve. If you join the piriformis Syndrome group on facebook, we have a flow chart in the pin post to diagnoise PS. It was written by Dr. T, the doctor who understands this condition the most. he removes the muscle which can give you instant relief. And no, removing the muscle doesn’t affect movement. Even when a release surgery is done, the muscle never works again anyway, so why leave it in there to cause problems.


      • Frank Crisp
        April 16, 2018 at 11:01 am

        Go see Dr. John Michael Redmond at the Southeast Orthopaedic Center Jacksonville Florida. Not even Mayo Clinic could identify my problem but Dr. Redmond. Not only was my piriformis muscle and tendon affected but also at the hamstring because of all the scar tissue in this area and around the sciatic nerve. I had this surgery four weeks ago. I had a complete piriformis release, bursectomy, complete sciatic neurolysis, and scar tissue removal at the hamstring and gluteal sling. The surgery was 100% successful. Dr. Redmond is the best…took him 10 minutes to determine my problem…without MRI, etc.

      • *W*
        April 18, 2018 at 7:55 am

        To Patti Sanghwan – Hello, yes we sound very much the same and we have tried the same treatments as well. I’m also unsure as to the reason we have been passed around to different specialists without an answer to which course of action would be the best. It’s super frustrating. I have not gone to the Finland doctor….yet. I have all my ducks in a row to go at the end of June. It was suggested I try 3 more things before I make my final decision – 1) a device called Avazzia – supposedly a super duper tens machine, 2) a brace for the leg that hyperextends which will “stop” the constant pull on and damage to my hamstring at the ischial tuberosity, 3) consult with a Functional Neurologist. It was suggested to give it 3 more weeks. I will let you know what I decide. I also found Frank Crisp’s response enlightening and going to research Dr. Redmond as well. *W*

      • Frank Crisp
        April 18, 2018 at 12:04 pm

        ‘W’… first of all, Dr. Redmond did a open surgery which we discussed. After seven years of dealing with this and studying many medical journals books and so forth I was able to talk with Dr. Redmond using medical jargon… So our discussion was unique. The open surgery was required for full access to the sciatic nerve and visualization of the piriformis muscle and it tendon at the attachment at the anterior sacrum and insertion. Naturally this required general anesthesia and I was asleep… The operation itself lasted a little over an hour. First, he made an incision into the maximus muscle to have access to the piriformis; first by releasing the Tendon of the muscle. Afterwards he turned his attention to the sciatic nerve at the proximal location of the piriformis tendon and then under the muscle and then into the sciatic notch. Afterword, who then turned his attention distally at the hamstring at its insertion and released the sciatic nerve back through the notch. He ensured that the sciatic nerve was not tethered to any scar tissue Or myself. Afterwards he then turned his attention to the bursa where he did a complete bursectomy, removing the bursa and consequently checking the Medius muscle and tendon. He also checked all remaining rotators and to check the medial circumflex artery. And then the area was checked again to make sure that homeostasis was assured and then the incision was closed by the physicians assistant. When I first went to see Dr. Redman he looked at one of my MRIs from MAYO CLINIC and and told me that I had fluid in the bursa and that it would require removing. He immediately found the problem with my piriformis muscle tendon. The tendon at the insertion was elevated above its designated location consequently pulling on my sacrum. He use ultrasound and his thumb and showed it to me. After dealing with 21 other doctors in the past and physical therapist and other types of modalities I knew immediately that Dr. Redmond was the answer. I met with him two times before the surgery… The second visit was an explanation of what would be done. Even though it was an open surgery I was released that afternoon and stayed in a nearby motel in case there were any problems. The only protocol post surgery is to walk as tolerated. Dr. Redmond did my surgery at the St. Vincent hospital in Jacksonville and they supplied me a walker. All my symptoms that I had were immediately relieved. The only pain that I have is basically the surgery pain which is not too bad and I use tramadol 50 mg every 6 to 8 hours.
        Just for information to anyone reading this, I did 2 1/2 years of prolotherapy, PRP, BMC which helped with other problems but could not and will not fix a piriformis tendon that has actually been structurally altered. Based upon my seven years of study I can tell you that stretching of the piriformis well at one point structurally change the tendon at the insertion. No amount of Prolotherapy, massage, Botox injections, physical therapy, stretching, Chinese herbs Or acupuncture will work. When I went to see Dr. Redmond, I told him that I need a surgical intervention and it was true. The cost of the surgery from what I understand will be about $30,000 but this is nothing compared to that absolute hell that I have been through this past 7+ years… One thing I found Is that most doctors don’t understand the link between the hip muscles in the lower back muscles and most physical therapist do not understand the relationship of the muscle to that of the tendon and associated ligaments. I go back for a post surgery at six weeks. I am told that recovery will be from three months to six months. I can add That if a person’s problem is due to the abductor that person should first condition the remaining muscles to make sure that all muscles are equal strength and balanced, front to back, side to side. I would also suggest a high-protein diet, vitamin C, magnesium, potassium, and leafy green Vegetables. This will help with the healing time and at the time of surgery.
        One final note concerning Dr. Redmond… I questioned him extensively at our second meeting and he informed me that he has had to do repairs of patients who had other doctors to do a piriformis release any work with the sciatic nerve. The people that had those done and had to have additional surgery were usually people that had the arthascopic procedure… My recommendation, is the open surgery… That way, the surgeon has full access to all the tissue to be investigated. Yes, recovery time will be longer. When Dr. Redmond explained this to me I knew with confidence that he was the one. I hope this helps anyone reading.


      • *W*
        April 18, 2018 at 8:14 am

        To Frank Crisp – Hello and thank you for yet another option to research with Dr. Redmond. Certainly a lot closer than Finland. I have a bunch of questions for you – hoping that you would be willing to help. Was your surgery open or minimally invasive? Were you awake for the surgery – did he use anesthesia? How did the appointments go with Dr. Redmond – did you have to travel for consult AND surgery or was it all taken care of in one appointment/set of appts.? How did he discover your problem without the MRI – was it based on your symptoms? Does he check all areas during surgery – obviously he did with you – hamstring, piriformis and bursa? How long was your hospital stay? How are you feeling after 4 weeks – are you walking, up and about, pain levels, etc.? Follow up appointments, PT, pain meds, etc.? A big question is the cost associated with the surgery – after some research it appears that surgery in Finland is comparatively less than in the US. I’m thankful that you have responded and so happy that your surgery was a success. I’m elated to hear that yet another MRI may not need to be done. I am going to start glowing with all these radiological tests, etc. *W*

      • John
        April 18, 2018 at 8:31 am

        Hi. I’ve posted here before so I don’t want to repeat details of symptoms and recovery from PS. The tendinitis symptoms at the Hamstring IT origin can be driven completely by nerve irritation upstream (l5 etc) – feels like you pulled the tendon from functional movement like a severe overstretch. It’s a classic symptom of back problems. You can also get the same type of symptoms in the adductors and quads. I’ve had all of these symptoms and couldn’t walk for months; the pain was relentless and wouldn’t resolve like a strained tendon. After 10 years I finally determined the source of problems, found methods to correct it and prevent chronic episodes. The same was true of PS (that lasted 3 years), which was a mixed source problem involving the back, and not just the PS muscle. It took about 6 years to figure this out – lots of money, time, specialists, and education.


      • *W*
        April 18, 2018 at 10:41 am

        Hi John – So glad that you are feeling better and have found the root cause of your problem – seriously you have more patience than I. I thought 6 years was bad, 10 is a long time. How did you finally rule out the piriformis muscle and hamstring and route it back to your spine? All studies have indicated that it is not upstream in my case. I am a trainwreck physically with progressive scoliosis, SI/hip/knee problems, etc. all stemming from a horrendous MVA, but “they” insist it is not my spine that is the problem and is not causing the impingement. If you don’t mind me asking what did you find was the source of all your problems? I know we are all unique and your source may be completely different from mine, but it may help with another avenue to research. Thanks.

      • john
        April 18, 2018 at 5:06 pm

        Hi W. The consensus now is that all symptoms were triggered from nerves coming off the lumbar spine. We are fairly certain the source is at L5-L4 and believe all symptoms are mainly due to foramina narrowing in that region. We believe the piriformis involvement is due to lumbar nerve irritation where nerves upstream activated the muscle and then constricted the sciatic nerve, which later became chronic PS. To explain our conclusions, I’ll provide a brief history (sorry this is a bit long but maybe helpful for others). Originally I had severe tendinitis at the hamstring origin without applying physical stress to the muscle – I simply extended my leg back while in a pointing dog position. Snap. I couldn’t walk for 2-3 months. This happened two or three times within several years. During that time I had multiple meniscus tears and was diagnosed with overly tight hamstrings. Later, I went into the pointing dog position ( I didn’t learn my lesson) and SNAP – my back and pelvis snapped and I developed SI dysfunction. After about two months after the SI problem, I developed PS. Then I developed hamstring, groin, adductor, quad, and some other tendinitis problems that would last months while I had PS. Later, the tendinitis problems moved to the calves, ankles, and feet. Years later, I received Botox which helped relieved PS. About a year after the bilateral injections, I received a steroid injection which enabled me to walk and sit more. Then I started performing back flexion exercises. That significantly reduced my PS. But five months later I had another hamstring and groin tendinitis episode. So I started back extension exercises. That eliminated the chronic tendinitis and PS. Over the years, I have correlated all my symptoms from the pelvis down to my toes with back flexion and extension stretching maneuvers requiring adjustment in intensity, direction, degree of motion, and repetitions. It’s a subtle process requiring detailed attention to my symptoms and activity. A couple of items to note are that I had lower limb problems with and without PS symptoms – originally we thought the lower limb problems were strictly due to PS, which they might have been at that time but I have those symptoms without PS. I also have buttock pain without PS which is controlled through the back maneuvers. So the bottom line is (1) problems associated with the lumbar spine are responsible for all of my lower limb pain and symptoms including PS, (2) PS was masked by lumbar nerve irritation and generated by lumbar nerve irritation, and (3) flexion and extension exercises affect the symptoms from the pelvis down and require time though trial and error to understand how to control the symptoms. Hope this helps.

      • Bill T.
        April 19, 2018 at 3:30 am

        Wow these are tremendously informative posts. I didn’t think I’d see this many!

        W, yes I also have researched Finland, Dr. Lesse Lampainen at a clinic there. They focus specifically on high hamstring tendinopathy, which is a condition caused by chronic destruction of the hamstring tendon at the ischial tuberosity. In my case I’ve had it for 20+ years…completely chronic. It started as a mild pain in the ass and year by year, it’s gotten worse and worse. About 8 years ago I stopped sitting at all, since it was too painful. Built a special cushion for the car so I could sit on one side only and not the other. Stopped flying except when I can stand in the plane. I walk and hike a lot, always have, but only on flat ground without pain. Going up any hill trigged the problem.

        Then I got a new painkiller and started hiking again. Unfortunately I was hiking one day and something happened…probably a partial tear of the hamstring tendon the doctor says. In retrospect I realize that the painkiller didn’t fix the underlying problem, which was that my tendon was damaged and weakened by scar tissue. So I was hiking harder than usual and tore some tissue somehow.

        That tear triggered massive bouts of inflammation that caused my entire pelvic area to spasm and harden like a rock. Glutes, everything, spasming for weeks. That in turn crushed my sciatic nerve leading to loss of sensation and weakness in my foot, plus of course, the most hellish pain. Eventually lose use of leg completely and muscles disappeared. 8 months that way. Finally got a steroid injection that quieted the inflammation process and spent about a year building the muscles again in my leg and foot so I could walk (with a cane). Used a warm therapy pool 3x a week to do that.

        I am unlikely to ever get surgery, since I can’t use painkillers due to liver damage from the 20 years of Motrin taken for the hamstring.

        Its a rotten story, basically, but oh well.

        Dr. Lempainan gave me a exercise regimen from some folks in the UK that emphasizes isometric exercise of the hamstring The goal is to try to get the hamstring to “remodel” itself. Over the years I’ve not been disciplined enough to keep that hamstring strong, it has gotten weak, and now I have to try to grow it back again, but must do this without over stressing it and causing inflammation death spiral like I had before.

        Not sure if any of this will work, but all I know is, I’ve been trying for 2 years and still struggling with it. Never give up though.

        My piriformis does not seem to be involved at all. It’s all hamstring tendon for me.

        Hope that is not too much detail. Good luck to all.

        W, would like to correspond by email if you are up for it. janeturn22@hotmail.com

      • Hope
        October 26, 2021 at 5:16 am

        I’ve been in this pain 21 years since 21 years old severe pain and tightness in left buttock where piriformis is with severe pain and tightness and proximal hamstring. But crevice if my groin also snaps 50 times a day so not sure if I have snapping hip syndrome with PS. Or PS that is causing the snapping all I know is pain is severe. My symptoms are severe burning and tightness in area of piriformis, upper highest point of back of hamstring, snapping in groin, inner thigh severe soreness, inner knee pain and swelling with hip swelling also believed to be bursitis. It’s sad how so many issues mimic each other I feel like a car that mechanic can’t solve the problem. I’m desperate so have Dr Tollestrup remove the piriformis hopefully that will cure me. If the snapping continues I will seek out surgery for that with bursectomy. Seeing another hip sports surgeon who specializes in snapping hip to see what he thinks. Ive seen so many drs I’ve lost count and have had many MRI’s, xrays and CT’s but keep being ignored when I ask for ultrasound. Dr T said he will likely send me for an MRN also having another lumbar MRI cause he said he needs to see a new one. Can you tell me how you are and if you have been cured I hope so by now take care. 🙏🏼

    • Georgetta
      April 14, 2018 at 9:39 am

      Hi Bill, I have had a similar situation. I don’t have true piriformis syndrome but I have real piriformis pain. I had the high hamstring problem too and had a PRP injection there that helped. I still have to be careful stretching though. However, now all my pain is on my left side as opposed to the right, which indicates a biomechanical and/or alignment issue and over compensation of muscles. I still haven’t gotten it sorted out and it’s been years. I’m now considering PRP of my left glute. I do think the PRP helped my hamstring though. Insurance doesn’t cover it sadly.

    • jeremy voligny
      April 21, 2018 at 11:12 am

      google carnitine + sciatic – just an idea – use prescription levocarnitine though because it’s fresh and undegraded – prescription levocarnitine seems to have healed up my PS and I wondered about you

      • *W*
        April 22, 2018 at 10:10 am

        Hi Jeremy, I remember reading that you were helped by L carnitine and to use the blister packs. What was the brand and dosage you took and are you still taking it? Bill T, John and Frank, your replies are all so thought provoking and I’m still processing all the information. Bill T, I will be another guinea pig with L carnitine and let you you know about results. At first glance it appears to help with liver function which may help yours!

      • jeremy voligny
        April 22, 2018 at 12:26 pm

        It is called Levocarnitine and is “distributed” by Hi Tech Pharmacal and it comes in 330 mg tablets and I take 990mg two times a day.

  21. Barbara O'Connor
    April 11, 2018 at 2:36 pm

    Hi, Seven weeks out from open piriformis release and still feeling sciatic-like pain down back of leg and sometimes knife-like pain when sitting. Still have to take meds to sit. Has anybody had similar experiences or can anybody offer encouragement? Thanks, Barbara

    • Lillian Nash
      April 11, 2018 at 3:39 pm

      Hi Barbara,
      You may also be suffering from a lot of gluten pain.
      I have been communicating with several people with PS. on this blog site. Many many of them that got the tendon release ended up with major scar tissue needing to have more surgery – – I recently went to Dr. Tim Tollestrup in Henderson/Vegas Nevada – – he has perfected the removal of the Piriformis muscle he does not cut through Glut muscle – – patients walk out from surgery full body.
      However, I did not walk out, they had to wheelchair me out afterwards but I have other issues also – – I had previously fell onto a marble floor landing on my tailbone. But following surgery on March 13 today, April 11, I am able to sleep all night – – no more sciatic pain – – no more feelings like I am being electrocuted – – I do use ice pack especially before bedtime and I sleep all night. there are a number of patients that have returned to Dr. Tollestrup or the correction of their previous surgery – – just google Dr. Tim Tollestrup. Henderson/Vegas NV.
      His help in the staff are happy to answer any questions you may have.
      I hope this will give you some light on what to do.
      Sent from my iPhone


      • Barbara O'Connor
        April 11, 2018 at 4:48 pm

        Lillian, Glad to hear you’re feeling better. I keep hearing about Dr. Tollestrup and am thinking a trip west might be in my future. I’m so glad that there’s another option out there! Thanks for telling me about him and your experience!

    • Mitch
      April 11, 2018 at 4:17 pm

      Can we ask who did your surgery? I think everyone’s symptoms are slightly different. But I have heard of many people struggling post op in the first 3 months. Whether they improve seems to be variable.

    • Tracy
      April 11, 2018 at 4:23 pm

      Also remember that the nerve heals at 1-2mm a day. It’s a slow process. I too had open piriformis removal on Dec 14,2015 and it took several months to simmer down. Please relax and understand that everyone heals differently. Be patient.



      • Barbara O'Connor
        April 11, 2018 at 4:57 pm

        Tracy, Thanks. Surgeon who did the release was excellent but he didn’t promise results. (He said about 3/4 of his patients got relief.) So I was focusing on the other quarter, I guess. Thanks for the advice—patience is NOT one of my virtues!

  22. Georgetta
    April 2, 2018 at 7:05 am

    Has anyone tried a PRP injection of the piriformis? Or glute medius? Both of mine have been ongoing problems for 10 years. I’ve had trigger point injections in both areas – only temporary relief and PRP in upper hamstring which seemed to be somewhat effective although not 100%. I’ve also had Botox.

    • Barb
      April 2, 2018 at 8:25 am

      I tried PRP, temporary band aid. My muscle had to be removed for instant and long term relief. I wasted so much money trying this and that. After nine years removing the muscle was the only way. Dr. Tim Tollestrup also removes the scar tissue that built up.

      • Georgetta
        April 2, 2018 at 11:50 am

        I’ve spent a ton of money too on years of PT that doesn’t work. I’ve had SI joint injections too. I’m in the New York City suburbs where we are supposed to have experts. But so far, I haven’t found anyone.

  23. jeremy voligny
    April 2, 2018 at 6:25 am

    Strangely enough my piriformis syndrome cleared up after I was put on prescription levocarnitine for an unrelated reason. It was fairly persistent before hand and I didn’t have a lot of luck with stretching and rolling on a tennis ball. I had actually taken over-the-counter L-carnitine in the past without any such observation but the prescription levocarnitine comes in blister packs and is fresher – the over the counter tended to degrade – expanding and getting brown spots on it.

  24. March 5, 2018 at 8:08 pm

    Dear,Sir,I have had like you multiple steroids injections to try to allvieate my chronic back pain to know avail??!! I had back surgery in 11-24-16 to retry to deal with spinal stenosis but it was a FAILED BACK SURGERY I have searched around the Chicago area looking for a doctor to help me from going lame I have been promised then refused surgery because the doctors claimed it will make it worse but now my feet are burning every day with a pinched nerves in L-5 and I am almost lame and I am contracting cauda equine Syndrome that will seal my fate ?!! I have approached Lazer Spine Institute to see if they can help me but it is hard to find dudes to all my doctors appointments because I can’t drive !! I am pleading does anybody know of a back specialists that can operate and relieve this compressed nerve so I can walk again or I would settle for being lame as long as I can go to the bathroom if anyone can help me please contact me Michael S O’Brien 316 Highwood Ave Highwood,Illinois 60040 My phone number is 847-502-5236 Thank You Michael O’Brien


  25. February 10, 2018 at 2:08 pm

    To anyone who is reading this. Please know I have learned from Dr. Tim Tollstrup, if you have surgery pain lasting longer than 6-8 weeks, you have peripheral nerve damage or compression until proven otherwise. NONE of us should be rehabbing nothing but muscles, not from pain.
    If you have ANY pain that is not explained in tests, you need to search this surgeon. He does know a few others that can do this too. If you fill out the contact form on his website he will get with you and tell you what tests/type of doctor you need to see if he doesn’t think he can help you. This doctor is not like any other doctor I have ever met.
    Good luck to you all!


    • Jack
      March 16, 2018 at 3:55 pm

      Did Dr Tollestrup do a revision surgery on you?
      Does he accept insurance? How long after a consultation did you have to wait for surgery. How big is the incision?

      • March 16, 2018 at 5:57 pm

        Answer to Jack, Yes Dr. T did my revision 10 months after release by an orthopedic. the incision is about 3″. I started talking to him via email (started with his contact form on his website) early last November and my surgery was on Dec 12th. I was completely healed up and by 7 weeks doing aggressive exercises. he has perfected the surgery for PS by removing the muscle. releasing the muscle flings the muscle and tendon back around the sciatic nerve. it doesn’t work and folks have pain long after release surgeries. Join the piriformis support group on facebook. He is in the group. there is a flow chart now how to get a diagnoses for sciatica pain. The flow chart is in the support group pin post.

      • March 16, 2018 at 5:59 pm

        Jack, I had the release done by Dr. T. Join the piriformis support group or check out his web site. Several folks are getting revisions done by getting their muscles removed.


      • March 16, 2018 at 6:01 pm

        Jack, I am sorry. Dr. T did my revision by removing the muscles. Join the fb support group or go to this web site. Removing the muscles is the greatest best treatment now for PS. Releasing is the old way that is not successful. Contact him through the contact form on his website.

    • Jason V
      April 4, 2018 at 9:42 am

      Did you live in Neveda where Dr. T practices? If not did you fly in for a consult? I’m in the process of trying to get an appt and was curious as to how you worked out the logistics?

      • April 4, 2018 at 4:36 pm

        I used the contact form on his website and he emailed me back. that is the best way to connect with Dr. Tollestrup. He is doing more and more successful Piriformis Muscle removal surgeries every week. He is also fixing damaged nerves from orthopedics doing release surgeries. go to nevadanervesurgery.org. I am from Ohio and had to fly out. Very much worth the trip for getting the right surgery and instant relief. His office has hotels that give discounts. Or you can use Airbnb since its a vacation area, lots of rooms for rent.

      • Jason
        April 5, 2018 at 9:12 am

        Thank you. How late mg after your initial visit with DR. T did u have the surgery? Did you MRI show anything, all mine came back normal for my age.

      • April 5, 2018 at 4:31 pm

        Jason, my MRI were negative. Dr. T responded from his contact form within a few days with questions via email. He will direct you in diagnoising. I do know you need a lumber MRI, pelvic MRI to rule out other propblems. Then you need to get a diagnostic injection in the prifiromis muscle with Marcaine by a pain doctor or interventional radiologist. This may or may not show anything. MY two injections only helped with numbing. If you join the Piriformis syndrome support group on facebook (there are two, the one with 3k memebers) we have a flow chart to help diagnoise PS that Dr. T wrote. It explains it all. Also go to youtube, he did a 2 1/2 hr video chat explaining everything about PS. Just look for his name on youtube. He is doing this surgery now almost every week and has been successful with everyone. He is also finding those of us that had release surgery done some of us have nerve damage, he is fixing that too. It took me about 4-6 weeks to get in and get my muscles removed.

      • Jason
        April 6, 2018 at 5:34 pm

        Much thanks! I have watched the video and made contact with his office. Lumbosacral plexus MRI schedule for Monday (to go along with the 3 other pelvic, lumbar and spine MRIs I had this year). Had my 3rd Piriformis injection yesterday with lidocaine (2 other Piriformis injections with steroids within last 6 months) just made my butt numb no relief. This is in addition to 6 spinal epidurals, Ischial tuberosity injection, posterior femoral cutaneous nerve block, hip bursa, injection , sympathetic nerve block, Labral tear/FAII cam impingement surgery, 5 biopsies, false diagnosis of ALS…crazy.. Trying pudendal nerve block Tuesday (I’m a human pin cushion) 1 year of PT, dry needling, every nerve drug possible and 100 plus doctor visits and every blood panel known to man..lol. I truly appreciate you responding to me and helping me out as I continue this struggle and journey !!!

      • April 6, 2018 at 8:09 pm

        Wow Jason, you have been through so much! There are serveral folks in our Piriformis syndrome support group that had fai laberal tears. I am glad you got that fixed first. You should join the support group on facebook. you have a lot in common with so many of them. Glad you made contact with Dr. T. I am going there next week to get my hopefully last damaged nerve fixed superior cluneal nerves. That orthopedic really messed me up. But I am starting to see other folks with superior cluneal nerve damage that didn’t get the release. So I am starting to wonder if that is the nature of the beast (PS) . Those who have had it so long end up with damaged nerves.

        Good luck to you, you are in good hands with Dr. T!

  26. Barbara
    January 21, 2018 at 3:08 pm

    I am in Indiana and need to know how to begin
    to find a doctor that preforms Piriformis Release.
    I mimic your experience, although from what
    I read, it looked like you had 9 injections, I had
    14. I have been going through this journey for
    4 years. The pain is constant.
    I am 8 weeks Post Op from having the Spinal
    Cord Stimulator implant (told that was the last)
    resort. It took me three years to give in and accept
    that, however, no relief!
    I am willing to undergo the Piriformis Release
    Surgery as I cannot live with this pain!
    I have spent hours trying to find a doctor closer
    To me to get this done, no luck! There has to be
    One in Indianapolis, nothing coming up?
    Houston is the only information coming up for
    A doctor that does it!


    • JD
      January 31, 2018 at 9:18 am

      You had a spinal cord simulator implanted and have no relief? Did they at least give you a trial first prior to implanting? And if so did the trial produce relief? I’m told if trial does not work then there is no sense to implant. I’m considering this since I had surgery with no benefit. I have been told this technology has become a lot better in the last year.


    • January 31, 2018 at 12:49 pm

      There is a nerve surgeon that has perfected this surgery. He removes the muscle and you have no movement issues. It makes for quicker recovery and no recurrent piriformis pain.
      Dr. Tim Tollestrup, Henderson NV.


    • L
      February 1, 2018 at 3:59 pm

      I hear you regarding the pain. My pain is from different reasons but it has been EXCRUCIATING for 2-years. I also have searched and searched to find a local doctor, they are just not around. I will be traveling to Nevada to Dr. Tim Tollestrup. Yep, travel will be expensive, but, it is the rest of my life. Here is some information regarding where some doctors are at. But from what I have heard, Dr. Tim Tollestrup is the BEST. Attached is information including chat video with Dr. Tim Tollestrup answering questions and also his website. The video is 2-hours, but a MUST see and answering questions.
      Youtube chat session – its over 2 hr long, but a must see!! https://www.youtube.com/watch?v=gOS0TPX6UOI
      Dr. Tollestrup website – good info there too. – even notes for your doctors to help them understand – https://nevadanervesurgery.org/


      • Barbara
        February 9, 2018 at 7:34 pm

        Thank you! I will be looking into this for sure! Please let us know how it goes for you too!

      • Barb
        February 13, 2018 at 8:49 pm

        Oh, am I watching this site to see what your trip to Nevada, and Dr Tollestrup turn out!?

        I had a cortisone injection into the Piriformis muscle last week that gave me 3 days of a NORMAL life! 3 whole days!

        I just came from my Pain Management doctor that scheduled for a Botox injection to, hopeful that I will see at least a 3 month relief from the visit with “Hell” I have been if for the last 3 years!

        If I get relief from this, he agrees that getting
        The Piriformis surgery done is a go! Now to find the doctor, and learn how to get this done when I’m in Indiana, and need to get to Nevada for the surgery, recovery, and check ups?

        That’s were you come in! Please could you email me, to walk me through your journey and help me get there too?


    • February 1, 2018 at 4:25 pm

      Dr Adam Starr, UTSW/Parkland, DALLAS Tx, hip trauma orthopedist surgeon understands PS and gave my husband his life back with open PS surgery Sept 2015. He went to therapy for probably 12-15 months after surgery and for the first time in five years, was able to golf in 2017. Want to know more about “our” journey through this debilitating condition you may email me at srewop77@gmail.com


    • Judy
      February 10, 2018 at 12:10 pm

      Dr, Barbaro Indianapolis. He’s a neurologist. I just googled him.

      • February 10, 2018 at 1:01 pm

        Judy, please save yourself, there is a surgeon in Nevada that has perfected this surgery by modifying the retractors and removing the muscle. This is an assist muscle you don’t need it for movement. I had a release and been through pain for almost a year before I found Dr. Tim Tollestrup. He is a peripheral nerve surgeon. He fixed me and it healed in 6 weeks. He has trained two other surgeons. This is the new method, do not get a release or you will be sorry. Very rarely do folks heal 100% from the release. you have to get them removed for full relief. Goggle this doctor he has a web site with a lot of info on it about this condition.

        I cant stress this enough. I know it seems like you shouldn’t have to travel , but its worth it!
        You can follow others that are seeing him in a facebook support group, Piriformis Syndrome.

    • Martin Alvarez
      March 5, 2018 at 1:26 pm

      I live in the Houston area, which Dr did you find for PS in Houston ? I’ve been searching with no luck.

      • March 5, 2018 at 2:56 pm

        Dr. Tim Tollestrup has perfected the surgery for piriformis syndrome. He removes the muscle. Heals within 6 weeks. I know its sounds crazy to travel so far for surgery, but release surgery is the old way and very tough to recover from. Also when I had my release done, the orthopedic damaged nerves. So I had to have two surgeries to fix what the ortho did, I have a total of 5 incisions now. But its your choice. get it done the new way which is highly successful, or do the release and risk problems with continuous pain, scar tissue on siactic nerve and possible damaged nerves.


      • Jack
        March 6, 2018 at 7:55 am

        Does Dr. Tollestrup take insurance. Did you stay overnight in hospital. I’m thinking about seeing him.

      • John
        September 16, 2019 at 8:08 pm

        Did you find anyone in Houston? Dr Kim claims he does on his bio.

    • March 16, 2018 at 6:04 pm

      Yes, he takes insurance. There is also three other surgeons he has trained to do this. Go to youtube, search his name and you will see a 2 1/2 live chat he did on PS. He tells the other doctors name. There are only four in the US doing this surgery by removing the muscle. Do not get a release. you may get more nerve damage like I* did.


      • Lillian Nash
        March 18, 2018 at 9:47 am

        To Whoever in Indiana :
        I saw Dr. Tim Tollestrup and I am here in Las Vegas now —- I flew in from Texas — – I had surgery last Tuesday to remove my Piriformis muscle. I am already MUCH better than prior. Prior, I had seen 17 different medical professionals and NONE of them could help me. It is MUCH MORE than just removing the Piriformis muscle — Dr. Tollestrup has different techniques. GO FOR IT.
        I Think I have sent you emails before – – always be sure to check your spam box or junk box.
        Feel free to contact me at:

        Sent from my iPhone

      • sharon
        March 18, 2018 at 2:24 pm

        Not sure accuracy of “only four…removing the muscle”, as I know Dr. Adam Starr, hip trauma surgeon in Dallas, removed my husband’s piriformis.

      • Tracy
        March 18, 2018 at 6:20 pm

        Dr. Starr removed mine as well. 😊

      • March 19, 2018 at 6:55 am

        Dr. Starr is no longer seeing patients outside of Texas, and he is an orthopedic so it takes longer to heal from his surgery than a peripheral nerve surgeon. They are more delicate and less bloody. Matter of fact, I’m not sure when Starr did his last removal surgery. I’m going by what I hear in the support group.

      • Tracy
        March 20, 2018 at 12:12 am

        Interesting. My surgery was Dec 2015.

      • srewop77@gmail.com
        March 18, 2018 at 6:48 pm

        Dr. Aaron Filler’s (neurosurgeon in CA) youtube is how my husband self-diagnosed his PS. Dr. Aaron Filler is also the one who developed the MR Neurography. Resource for those living in the CA area: https://youtu.be/DuxclPpwTLQ

      • Jack
        March 18, 2018 at 7:01 pm

        Fillers reviews are frightening.

      • sharon
        March 18, 2018 at 8:13 pm

        no endorsement on Dr. Filler, other than his youtube video was spot on in what my husband was experiencing, and no other physicians (internal med, PM&R, neurosurgeons[3]) in Dallas or Temple, TX had been able to diagnose him. I appreciate Dr. Filler’s video, as it pegged my husband’s condition to the “t” and he was then able to approach his treating PM&R physician, who BTW “listened”, and she began treatment (PT) for piriformis syndrome. And, with a diagnosis, it led us to this blog…and to Dr. Adam Starr, hip trauma surgeon at UTSW/Parkland Dallas, and my husband got his life back… I still maintain that not all PS cases, post surgery, and rehab may parallel. In my husband’s case, once Dr. Starr got into his hip area, he found that my husband’s piriformis muscle had adhered to his pelvic bone and his sciatic nerve was being smashed behind the piriformis muscle and against his pelvic bone. Dr. Starr, who is at Dallas Texas county hospital, and a trauma hip surgeon, in his 25+ years, had NEVER seen this. His recovery was longer, as no one could estimate how long it would take for his sciatic nerve to get back to a NEW ‘normal’.

  27. Melissa
    January 17, 2018 at 2:33 pm

    Thank you for your detailed history. I am currently on a similar journey and in a lot of chronic pain. Very curious to know if you ever had any other “complications” develop after surgically releasing the piriformis muscle? If it comes down to the surgery for me, it worries me that messing with the attachment of the PF muscle could cause other long-term issues. Thank you for your response and thoughts!



    • Jim
      January 17, 2018 at 6:02 pm

      Hi Melissa, I see this idea repeated over and over here that suggests that Piriformis release is a “complex” operation. I live near NYC and the surgeon I saw does it regularly, several times per month. It’s done with many hip replacements as well. I had it done 8/16, afterward could not tell the difference – the piriformis is a tiny rotator muscle that really isn’t used much in normal daily life. I suppose if you were a worldclass ballet dancer… *maybe* you would detect the difference. Get a good surgeon that does this procedure regularly and you’ll see what I mean. You’re welcome to contact me by email if you are in the NYC area. Best of luck to you. As I’ve said many times before only a small number of people are helped by piriformis release. The best bet is strengthening and activating the glute muscles — and this take a lot of work, but for me it has been a source of progress.


      • JD
        January 17, 2018 at 8:04 pm

        Who was you surgeon, I’m right out of NYC myself and I couldn’t find anyone who would do the surgery.


      • Jim
        January 18, 2018 at 9:14 am

        You’re welcome to email me (libfrom22@yahoo.com). There are a few and the procedure is not as uncommon as many seem to think. I don’t think it’s a final solution for many people but it may help.


      • January 31, 2018 at 12:51 pm

        The release surgery carries a high rate of scar tissue issues. It also takes a year or more to try and recover from. The surgery should involve removing the muscle. it is an assist muscle.


    • January 18, 2018 at 7:32 am

      I have had both surgeries, Piriformis muscle release and then 10 months later Piriformis muscle removal. I have no movement issues from the muscle being removed. when its just released its high risk to reconnect to the nerve with scar tissue. My surgeon said the tendon and muscle flip like a rubber band back down to the siactic nerve. Then the scar tissue sets in making it worse. its a very difficult rehab, up to a year or more. With the removal I am back to work with only minumal surgery pain while I am rehabbing. Completely different than the release surgery.

      The surgeon who has perfected this surgery by modifiying the retractors so he can see all the way to the siatic notch is Dr. Tim Tollestrup in Henderson, NV. Good luck on your journey.


      • L
        January 21, 2018 at 3:11 pm

        I was reading your post again, and I am very interested in what you have to say, including your Dr. Tim Tollestrup in NV. I know there can be numerous reasons as to why a person would have PS. Do you know how are yours occurred ?
        I have had these sensations go clear down my leg to my big toe feeling like I am being electrocuted for two years now. Almost impossible to sit or lie down. My local doctors ( Central Texas) didn’t have a clue of what was going on. I have received six series of steroid injections which did not help at all. I have done the physical therapy for Piriformis muscle syndrome in 2016 and 2017 and also have had dry needling, all to which I keep getting worse. After much googling I found some doctors in Houston, trauma surgeon mentions Piriformis muscle on his website. In 2016 The doctors tried to perform and EMG here locally. It was totally excruciating to the point I could not tolerate it. After visiting the doctors in Houston they suggested I do this again which I agreed to. Again, the pain was so excruciating it felt like a spear. However, my doctors in Houston ordered an MRN which shows much more than an MRI. According to the reading I don’t believe I have any sciatic running through my Piriformis muscle.
        So my questions are:
        How did you come about PS ?
        Did you have an MRN ?
        Did you experience any of the problems I have mentioned ?
        I want to get as much information as possible, as this is my body and I want my doctor to do right by it. I cringe at the thought of only getting a tendon release and then having to go back months later, after more damage has occurred and have the muscle removed.
        Thank you for your time and I look forward to hearing from you.


      • January 31, 2018 at 12:46 pm

        L, I tried to write you a response and it wouldnt post. Email me at bschwarz@woh.rr.com


      • newwmn3
        September 27, 2018 at 2:13 pm

        mysijourney – I, too, would be very interested in communicating with you as I have been doing my research and, after almost 4 years of suffering, testing, numerous procedures, etc., have had piriformis surgery recommended to me. I saw elsewhere on this site that you’d had a surgery performed by Dr. Keppler in Cleveland who is the one that wants to do my surgery as well. However, I have heard some things about Dr. Tollestrup and have recently joined his FB page. Would you mind if I emailed you? Or, if you’d prefer to email me, I can be reached either at newwmn3@aol.com or cbarone777@gmail.com . I would be forever grateful!


      • John
        September 16, 2019 at 8:12 pm

        L from Texas (Houston)
        Did you find anyone for PS?
        Did you find someone who could read MRN studies?
        John in Houston

      • mysijourney
        September 17, 2019 at 5:36 am

        Dr. A. Chhabra at UTSW is the best at reading MRIs and MRN images. He was instrumental in the program for MRIs when he was at John Hopkins. Contact Stacy at Stacy.Myrick@UTSouthwestern.edu to send your images for him to read.

      • Tracy L Anderson
        September 17, 2019 at 4:23 pm

        Important FYI: He will not read your images without a consult and unless you are a current patient. UTSW has very strict protocols.

      • mysijourney
        September 18, 2019 at 11:37 am

        That’s not true, he read my MRIs I mailed him in Feb 2019. I have a friend I actually met on this blog who I talk with weekly, who just got several MRI’s read. She received her reports just a week or so ago.
        So yes, he will do this for patients who ask, you do have to pay. At first they were not going to bill my ins and they quoted me $160 per CD. But then they billed my ins and they paid most of it.

  28. JD
    December 13, 2017 at 6:38 pm

    4 month update (a week late) from my open surgery to release sciatic nerve from scar tissue.
    Unfortunantly I’m still in a lot of pain. The pain is not tremendously worse then prior to surgery but the incision still hurts and I’m not able to walk as far prior to surgery. I see my Dr. next week and I think they are going to try cortisone injection to knock down swelling. This is a long road and everyone who decides to get surgery must realize that in most cases this is not an instant fix. I like to remind readers I had and extreme entrapment for over 2 years.


    • Mitch
      December 13, 2017 at 11:44 pm

      Thanks JD for your updates. I always look forward to them. My next appointment is in late January. As much as I still want the updates, i’m going to do this in late 2018. Ugh.


      • JD
        December 14, 2017 at 5:04 pm

        Mitch, I wish you all the best. I have this nightmare bilaterally so I’ll be doing this again once the first side starts to improve.


    • Mitch
      January 14, 2018 at 11:48 am

      JD how goes the 5 month battle?


      • JD
        January 15, 2018 at 7:08 am

        Hey Mitch,
        I’m probably at where I started, maybe still in a bit more pain. I go back down in 3 weeks for 6 month MRI. I’m looking into neuromodulator trial also, I’m working with a great pain Dr. that thinks it may help. You may want to look into it as an alternative, from what I gather they really work well for nerve pain.


      • JD
        February 11, 2018 at 3:00 pm

        Hey Mitch how did you make out with Dr M?

      • Mitch
        February 11, 2018 at 5:05 pm

        Hey JD,

        There’s been some interesting turns of events for me but something has to be done, it’s getting worse. I did go down to see dr. M last week and I’ve decided to do the surgery in Canada. There is now a Dr. here in my home town that Dr. M knows who can do something very similar and they have worked together at times. It’s the same procedure but coming from a different angle (literally). I don’t want to get into too much right now for fear of people from Canada hounding me without doing some of their own research. I also don’t know the exact timing or details because I have only had an initial appointment and need to get in the “cue” for operating room time (welcome to Canada universal health care). But it will be done up here and this is where I will take my shot.

      • JD
        February 11, 2018 at 5:31 pm

        Please e-mail me. jwpdnyc@gmail.com

      • JD
        February 11, 2018 at 7:36 pm

        Mitch email me – jwpdnyc@gmail.com

    • January 18, 2018 at 7:38 am

      JD, you may be experiencing what I did. Recurrent Piriformis Syndrome. My pain came back at 5 weeks post op from release surgery. 10 months later I was no better, actually worse. But the pain did change. the pain was just in my butt and not down the leg. I went to Dr. Tim Tollestrup who has perfected the Piriformis Muscle removal surgery. He not only removed one muscle, but found a second one hiding from the first surgeon that did my surgery. Once removed, Pain was gone and has been. I am 5 weeks post op and doing very well. Minimal surgery pain and been in thereapy for 3 weeks.

      Dr. Tollestrup has a contact form on his website. I know he requested a surgery report from my release surgery. By looking at that he was not able to gurentee, but was pretty sure what happened. And he was right, He had to remove a bunch of scar tissue off my siatic nerve from my release surgery.

      By having the muscles removed I have no movement issues. he said these are assist muscles like your appendix, the body doesnt need them.

      Good luck on your journey. Never give up! Your pain free days will come!!


      • January 18, 2018 at 7:41 am

        Here is a report back in 2008 where they put something over the nerve for scar tissue. I contacted this Dr first, but he said he couldnt repeat the process. Thats when I found Dr. Tollestrup. https://www.ncbi.nlm.nih.gov/pubmed/18264837


      • JD
        January 18, 2018 at 7:44 am

        Thanks for your reply but my Piriformis was not released because it was not touching nerve. I had scar tissue that was compressing nerve removed, but still in pain, it never went away.


      • January 18, 2018 at 1:25 pm

        My surgeon said he had to do alot of “banging” off scar tissue on my siactic nerve when he removed my PM. He said I would have “aftershocks” from that. I have had 5 and none in the past two weeks. I am 5 weeks post op. I am surprised you still have so much pain. Did you have a peripheral nerve surgeon? I know my nerve surgeon told me orthopedics are hard on you and you need a surgeon that can be delicate with nerves. Thats why when an ortho did my release, I ended up with an incision leak and a hematoma. I was a mess.

        He also said its the tendon rubbing on the nerve that is so bad, its like rawhide. Not the muscle so much.

        I feel so bad that you are still in so much pain! I do hope you have pain free days soon!


  29. Crystal kidd
    December 13, 2017 at 5:11 pm

    I have had same symptoms and same injections done with no relief..are you still pain free and can you run end exercise again?


  30. B.
    December 2, 2017 at 11:17 pm

    Hello All,
    I posted a year ago but here’s a summary. I have taken the non-surgery non-drugs route, for what it’s worth…
    I had mild PS and was on restricted sitting (only in emergencies) for 10 years. That worked well until an accident which impacted my lower buttock and inflamed the area. That was the thing that destroyed me about 18 months ago. Since that time I have not sat…at all, ever, not even once…for the past 18 months. To get on and off the bed I use a thick piece of foam on the non-affected buttock as a landing pad to prevent any contact on affected side.
    No doctor, physical therapist, massage therapist, or anybody, has touched my pelvic area in this entire time. Every one of them will want to “prod” and I will lose 3 months trying to recover from that. Physical therapists and Chiropractors are utterly damaging, all of them. Avoid like the plague.
    I don’t fly at all, except on a private medvac. I travel lying on foam pad in back a van with seatbelt like attachments (like they do in an ambulance). It’s mandatory to avoid aggravating the area. Every time you sit and cause pain, you are just adding another month on recovery time (that’s my motto). For many months, I could only travel by ambulance.
    By following these rules I have slowly, ever so slowly, reduced the pain and slowly began to reduce the inflammation of my sciatic nerve.
    Was bedridden/unable to walk at all for 9 months. Lost almost all muscle mass in leg and foot, most of the feeling in my foot. Horrible. Then another 9 months of slow exercise to gain back my legs. Now I can walk maybe 50 feet with help.
    I hope to walk again like a normal person in another 6 months. Maybe drive my car, if I put the setback waayyyyy back and sit on a pad on the non affected side. I know however that I will never again sit in an airplane, never sit in a restaurant, never sit at an office desk. Cannot use a wheelchair. I am permanently handicapped and have accepted that. The alternative is unbearable pain and loss of all use of my left leg.
    I cannot take pain pills or anti-inflammatories like Mottrin, because all the steroids I took in the past damaged my kidneys, which means I have had to let the inflammation reduce by time and relaxation alone. Remember that painkillers dull the pain but do zero to reduce the inflammation so they are not helping except to help one endure the torture.
    Ultimately my only cure is to quiet the inflammation of the nerve, and to quiet the spasming of the various pelvic muscles which were crushing the inflamed nerve. The muscles spasm because of the inflammation, which causes more inflammation, which causes more spasm, it’s a downward spiral which can only be stopped by rest or anti inflammatories. Or surgery if one can identify the specify muscles causing the inflammation.
    In my case, the inflammation has been caused by proximal hamstring tendinopathy, which is chronic and no cure. The tendinopathy has caused scar tissue (maybe) and inflammation of he nearby cluneal or sciatic nerves.
    All this qualifies as deep buttock syndrome, not Piriformis syndrome. I’d go to Dr. M in Texas if I wanted surgery, but I can’t do that because of the kidney damage. Plus his surgery would not fix the tendinopathy so probably would be useless.
    Anyway good luck to all.



  31. November 15, 2017 at 7:10 am

    I have posted here before, had surgery with Dr. Kepler in Cleveland 8 months ago after suffering for 7 years. My deep dull ache pain came back at 5 weeks and has gotten worse since. I have been confirmed with Recurrent Piriformis syndrome. I have found out that if you just get a release done, there is some folks, not all, that get this. I am scheduled for surgery on December 12th to have this muscle removed. I found out about Dr. Tollestrup in Las Vegas on a facebook support group page (search Piriformis on facebook). I am following some people that have had surgery with this Dr. and believe he can help me. He said he has done revision surgery on others just like me. He finds that the scar tissue grows down to the nerve and in most, the tendon wraps itself around the siactic nerve.

    Just wanted to share this in case any of you may be experiencing this. I so hope to put this 8 year nightmare to rest once in for all!


  32. JD
    November 15, 2017 at 6:16 am

    My surgery was 3 hours. I stayed overnight in hospital. Pain was horrendous after anesthesia wore off. The next day I was able to walk out of hospital but following three weeks were pretty bad.


  33. Mitch
    November 14, 2017 at 5:39 pm

    Thanks JD,

    I was told about the requirement to snip a “branch” as well. It sounds to me as though you are healing to some extent after 15 weeks, if you’re only slightly worse off than before the surgery. I will await to hear your next update, it seems as though our surgeries could be similar and quite frankly it’s important for me to hear you’re on an upward trend before making a final decision. If the upward trend is at the 6 month point I can handle that easily


  34. JD
    November 14, 2017 at 5:14 pm

    The only reference I got was from my hip surgeon in NY who told me all the top hip surgeons in the country refer their patients to Dr. M for this condition. He pretty much is the world wide authority in this matter. I’m 15 weeks out and just about slightly where I was pre-surgery, if not a bit worse off. I will repeat though I had a very severe entrapment, I had a small branch nerve snipped and even vein in area removed. I was told this takes a very long time to heal, up to two years. If it’s any consolation I have this conditions bilaterally so I’m going to eventually go through same procedure again. Stay strong.


  35. Mitch
    November 12, 2017 at 10:42 am

    Question JD,
    Running out of time here unfortunately. We’re you able to get phone numbers/speak with references/former patients who had open surgery by Dr. M? I’m thinking of asking him next time I see him. Any improvement by the way?


    • Mitch
      November 14, 2017 at 3:34 pm

      If there are any other males under the age of 50 who have had “open” piriformis release and/or deep gluteal syndrome surgery, I’d welcome your healing experiences. Please, no comments from people who are second hand, did not have open surgery, or are not in the age bracket or sex category. I am well versed on the procedure and the physicians who do this so no recommendations needed on this front either.


      • Jim
        November 14, 2017 at 7:21 pm

        What would u like to know, I had open release and neurolysis in August 2016. Not hugely beneficial, but not a major operation and little downside with an experienced surgeon.


      • Mitch
        November 14, 2017 at 6:58 pm


        I’d like to know a few things: which hospital did you have the surgery done (no need to mention the surgeon’s name, I can figure it out from there), how long was the recovery time for full healing and why you would suggest it wasn’t a big operation given that the surgeons indicate a one to two year recovery (by all accounts that’s a major surgery). Last, i’d Like to know if any of your initial diagnostic testing work well? I.e. did you have lidocaine or Botox in the piriformis for diagnostic testing and therapeutic treatment and if that worked well, why do you feel the surgery didn’t provide equally beneficial results from releasing the piriformis. For me, although Botox is less than perfect, it has made the difference between me being a chronically depressed out of work individual with chronic pain, to a functional working person who can still conduct my business so long as I don’t sit for more than an hour at a time.


      • Jim
        November 14, 2017 at 8:13 pm

        Developed PS in 2010. 1) Mt. Sinai; 2) full healing(?) I walked to my car from the hospital; scar was fully healed in about 6 weeks; began exercising 4 wks post, but gingerly. No PS pain improvement until 6mos post-op, at which point I recovered to pre-op pain level after having been slightly worse. Very gradual improvement since, which I’d attribute to rigorous muscle strengthening program, yoga, etc. (as per guidance from by Dr. Loren Fishman). 3) this operation is done on an outpatient basis, takes about 90mins. Mileage, healing time and results vary. Did all the diagnostics (3 neurologists, 8 or 9 PTs, all the Rx drugs, etc.) – botox helped for a few weeks, but at $3000 per shot (and I have PS on both sides, 60/40) it’s not economic. Lidocaine… icy rush, but that was all. I’ve written a protocol that I use for PS, which has made it manageable, happy to send you a copy if you’re interested. Strongly recommend doing the hard work (muscle strengthening) before the operation if possible.


      • Mitch
        November 14, 2017 at 8:23 pm

        Thanks Jim,

        I think we have very different situations but I certainly appreciate the feedback. I only wish glute strengthening would work but they believe the nerves to my primary glute muscles is also irritated somehow making strengthening impossible no matter the technique or discipline. Hence the open surgery which i’ve Been told could last up to 5 hours.


      • Jim #2
        November 14, 2017 at 8:40 pm

        Mitch, in 2011, I could barely walk 30 feet from my house to my garage. I could not do any exercises. I started by walking a few hundred feet backwards up a very slight incline — that was all the glute exercise I could handle. I built up from there, but I attacked it from several directions. As for Piriformis release and neurolysis, unless your talking about something else, it’s a 2hr outpatient surgery. 5 hrs sounds like something else altogether. I saw the very best doctors and the top surgeon for PR surgery in NY, so that’s what I’m relaying to you. But PS is not necessarily similar from person to person, one reason comparing notes here may be like talking apples and oranges.


      • Stacey
        December 4, 2017 at 9:25 pm

        Could you give me some Drs names that have been recommended here? Thank u!


      • Mitch
        December 5, 2017 at 7:48 am

        I don’t like to give names of doctors on line but I find each of the doctors does something slightly different. The best doctor may depend on what the very specific diagnosis is. But there is a dr. In Milwaukee who has been mentioned on this board as well as dr. Affiliated with hospital at Baylor, ut southwestern and Johns Hopkins. There is now a dr. at mt. Sinai in toronto canada that has just been hired on. And then there are a few others scattered across the us. Such as in Milwaukee, Las Vegas, etc. If you google piriformis or deep gluteal, or pelvic pain/surgery you should find them. If you have the financial where with all i’d Suggest meeting each of them rather than reading on line.


  36. JD
    November 4, 2017 at 8:37 pm

    3 month update from my open surgery to decompress sciatic nerve from severe fibrovascular scar tissue:
    I have had an overall increase in pain from this procedure thus far. The incisional pain is still there although it has gotten better with time. The sciatic pain in the calf has intensified since the sugery. Sitting is still the worst. I was able to do a lot more walking prior to surgery.
    This post is not to give anyone false hope that surgery will not work. I still believe it will, but not as quick as I would like it to. I had this bad entrapment for over 2 years prior to surgery. I was reminded at my last appointment that there is a 2 year recovery. Never give up.


    • Mitch
      November 4, 2017 at 9:33 pm

      Thanks JD. I think anybody who is serious about this, is very thankful you’re hear to give us an update. Please give us another update in a few weeks. Your mental strength is admirable.


  37. Karen
    October 28, 2017 at 3:33 pm

    I am 4 days post op from piriformis release surgery,,,see how this turns out,,its been a long haul. Im praying this works,,


    • Mitch
      October 28, 2017 at 7:20 pm


      Thanks for your contribution to the board. I wish you the very best. Can you please keep us posted along your journey? A lot of people quite the board when they start feeling better/assume it didn’t work. Can we ask who the doctor was and whether it was open or arthroscopic. Further was the piriformis released or scar Tissue removed. Last, didn’t any diagnostic tools like botox or steroid work?


      • Tracy
        November 5, 2017 at 4:01 pm

        Mitch, Yes, it’s true. We research, find answers, have surgery and resume our lives. I will say that 2 years post op and my piriformis pain is gone. It was a process though, like waves. I had surgery in Dec 2015. It wasn’t easy. I was still feeling pretty miserable at my post op appointment 6 weeks later. But my case was more complicated then most. I had an SI issue, tailboneand sacrotuberous issue. Be patient as the nerve only repairs itself at 1mm a day from the source to the end. Your calf pain sounds more like SI Joint Dysfunction which would make sense as the piriformis muscle helps stabilize the joint. Maybe consider a SI Joint injection to get you over the hump? I ended up having stem cell injections in all 3 areas which helped. My surgery was in Texas with Dr. Starr.


    • Mitch
      November 5, 2017 at 7:44 am

      Karen, do you have a first 10 day update for us, I hope you’re feeling somewhat better


    • Mitch
      November 10, 2017 at 12:02 pm


      I am hoping to hear the surgery is working for you?


  38. Mitch
    October 21, 2017 at 8:37 pm


    Can you give us an update on how you’re doing and how the doctors appointment went?


  39. Tracy
    October 20, 2017 at 1:23 am

    So weird. I had open piriformis surgery for a bifurcated (split) muscle in Dec 2015 by Dr. Starr. I would advise you to get in to see Dr. Avneesh Chhabra at UTSW. He’s the top radiologist in the country reading MRN’s. He’s the first step to getting into Dr. Starr. You’ll have a MRN (3T Tesla MRI) and diagnostic Botox injections. After my first visit with Starr, I spent almost 6 months in Chhabra’s care until surgery. His info is on his website.


  40. Mitch
    October 19, 2017 at 6:42 am


    I will comment now that I am 4 weeks out of FAI surgery. The hypothesis that intro-articular issues cause piriformis syndrome, unfortunately have not remotely worked for me to date. Unless I see some massive improvement in the company months, I will have to move towards the more evasive surgery. I will say, if you’re athletic, it’s well worth pursuing this surgery first, because it is. Relatively easy recovery. It was worth a shot but count me in as one where it did not work.


  41. L
    October 19, 2017 at 5:37 am

    To All with the electrifying Piriformis muscle syndrome. ( this is long – but very important)
    This is what I have found with my studies. Doctors want to tell you something is wrong with your lumbar. You don’t want to doctor to open up your spine as he searches for what he hopes to find — piriformis muscle syndrome is often misdiagnosed as lumbar. The Piriformis muscle syndrome that is very very rare is one where you feel like you’re being electrocuted or struck by lightning. So, the following is a little information to ask your doctor to consider. I have tried numerous times to get into see Dr. Adam Starr in Dallas and have been rejected each time. However, I have found a doctor at Houston Methodist – – Dr. Neff shows skills almost identical to Dr. Adam Starr. — as mentioned , I am going to present this to him:
    Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment
    Institute for Spinal Disorders, Cedars Sinai Medical Center, Los Angeles; Division of Neurosurgery, Departments of Anesthesia, Neurology and Radiology, and School of Medicine, University of California at Los Angeles; and Neurography Institute and Institute for Nerve Medicine,
    Santa Monica, California
    Object. Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 con- secutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement.
    Methods. After performing MR neurography and interventional MR imaging, the final rediagnoses included the fol- lowing: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrap- ment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%).
    Open MR–guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injec- tion (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recur- rence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%.
    Conclusions. This Class A quality evaluation of MR neurography’s diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitiv- ity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p 0.01).
    Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.
    KEY WORDS • sciatica • piriformis syndrome • magnetic resonance neurography • open magnetic resonance imaging • outcome study.


    • John
      October 19, 2017 at 6:18 am

      Please don’t overload the system with articles. We understand you’re frustrated.


    • Tracy
      October 19, 2017 at 12:53 pm

      Why have you been turned down to see Dr. Starr?


      • L
        October 19, 2017 at 1:35 pm

        I had three different referrals sent to Dr. Adam Starr – I would never hear back so I would call the patient access number – – I would never get a nurse, they will not talk to you but I would get a call person – – they said they didn’t know – – after being very persistent one person did finally tell me that Dr. Starr only saw trauma patients – – my x-rays are near perfect , so I have no musculoskeletal bones that have been smashed and need to be put back into place. That is all I can tell you. I chose Dr. Neff at Houston Methodist because his skills are very much identical to Dr star, and he did see me with no problem.
        Do you mind telling me your issues ?
        Look forward to hearing from you.


  42. John
    October 10, 2017 at 1:19 pm

    Matt. I’ve been reading comments posted here for a number of years and decided to post something about my condition that might be similar to those in the minority, who might suffer from piriformis syndrome and lumbar nerve entrapment. Some of the comments and blogs here helped me diagnose my problems. Originally, I had a sudden onset of intense backpain and spasms after starting a bird dog pose. Months later, PT diagnosed my problem as SI and treated me with specific exercises that led to severe buttock pain. Unfortunately, the PT group decided that I had a connective tissue disorder and pointed me in the wrong direction. My back was fine but I couldn’t sit and eventually I had to retire from work. Years went by until I figured out I had PS. I had numerous provactive EMGs with varying results. Finally I got Botox (both sides) from a physician that understood the problem. And the constant pain diminshed where I could walk and sit longer. I later went to PT and discovered that my lumbar spine was contributing to buttock pain and lower limb disfunction and pain. After 3 months, we resolved PS to the extent that I could work. A year later, I rarely have PS pain, and it’s temporary when I get it. I still have lower limb problems but to a much lesser extent. We believe my PS is not independent of the lumbar spine, whereas most or typical PS is independent of spinal problems. The bottom line is I had to resolve both issues (PS and Lumbar nerve entrapment) combining two different approaches.


  43. Lisa
    October 5, 2017 at 2:36 pm

    I believe I suffer with piriformis syndrome from an injury I received at work . It’s is awful. Any help would be greatly appreciated


  44. Lana Jane
    October 1, 2017 at 12:35 pm

    I literally feel your pain and hope each and every one of you get relief. This has been a five year struggle for me, beginning with pelvic pain. During pelvic floor OT, my astute therapist mentioned piriformis syndrome. After MRI’s, tortuous nerve testing, CT’s and multiple epidural injections, it isn’t a normal lumbar issue. My glute hurts, my back muscles and butt muscles spasm. My toes go numb. I am recovering from an SI diagnostic injection that has nearly crippled me. I am trying to see Dr. Martin or Dr. Starr in Dallas. Just don’t know what to do if I can’t see them before my insurance runs out!!!! I’m needing pain meds daily and so hesitant to take them. They cause GI issues which I now have to take meds. Is it possible, based on all sorts of testing that showed nothing remarkable, that PS can be diagnosed simply because nothing else showed up and my pain totally fits the pattern? Can’t live like this! Thanks for sharing your pain and insights here.


    • L
      October 1, 2017 at 2:08 pm

      Laura Jane, ( Long but worth reading )
      I hear you loud and clear. Your description sounds like mine of which I have had for 18 months. I have had six series of injections of which did not work. I had three different referrals sent into Dr. Adams Starr at my request of which was denied each time. I was never told why I was denied – – neither do they call you back. I finally got ahold of one of the ladies at the access center number – – not a nurse – – she told me if you was not already and inside patient of Dr. Starr it would be difficult to get in – – I was told if I went through ER at Parkland I would probably not see Dr. Starr but at least I would be on the inside – – I did so last week when I was in such excruciating pain it was totally unbearable and my husband had to practically carry me in as I could not sit or lie down for this butt pain and electrocutions running down my leg all the way to my toe – it took 8 1/2 hours before I was dismissed. But they set me up with another doctor for follow up – – when I called to cancel my appointment I recognized the girls name “Gabby “– – I asked her if she knew Dr. Starr – – YES !
      However, after reading about Dr. Starr I believe he does only trauma surgeries, for example if someone has been in an accident and crushed, he goes in and straightens it out – – my x-rays and MRI showed nothing, absolutely nothing wrong for me. And I am in exuberant health apart from this pain in the butt.
      I don’t know if you would want to try this or not but I did a couple of days ago and got tremendous relief. I purchased young living essential oil’s using in a roller bottle with 67 drops of Panaway oil , 67 drops of Lemon oil, 67 drops of peppermint oil and 67 drops of (organic olive oil from your grocery).
      I roll this over the entire Buttock and sciatic area followed by Young Living Essential Oils Deep Relief roll-on oil ……. for the first time in months, I slept all night long, turning carefully, but this is the closest to no pain I have been in 18 months.
      I have done a lot of research and at the Houston Methodist center, their information speaks about doing an MRI for neurography, which will show exactly where the nerve is at that is causing problems. I mentioned it to Parkland ER and they didn’t have a clue of what I was talking about. This procedure is only done at MRN institutes – there are three in Texas – – Houston, Dallas and San Antonio.
      The downside of this is they do not except insurance of any kind – – if you are Medicare they will give you a break on the price which would be $3000.
      I have a scheduled appointment in two weeks to see one of the doctors. I do not choose to see a spine doctor because there is nothing wrong with my back, you can stand on my back press on it and probably jump up-and-down on it and my back does not hurt – – these guys just do not get it – it is my butt that hurts and causes me to get electrocuted – – they keep trying to tell me it’s my back and that’s why I want an MRI neurography scan.
      Another thing that really really helped was ultrasound deep heat applied to the piriformis muscle. Your chiropractor does not have the same thing PT has – – PT is much stronger. But my insurance only allows me to have PT once a year which is a six week session twice a week. When that is done I have to wait till the following year. I just want my problem fixed, without merely putting a Band-Aid on it.
      I hope I have been of some help for you. I pray for all also that has this horrible pain, one can’t do anything.
      Take care.


  45. JD
    September 30, 2017 at 4:30 pm

    I had my sciatic nerve decompressed almost 8 weeks ago (open procedure) and have had increased nerve pain. I’ve been told it takes a long time for nerve to settle down after surgery. Any insight would be great.


    • Mitch
      October 1, 2017 at 9:34 am

      I am watching for insight as I am only one step away from the procedure as well. As part of your post can you identify who did your procedure. I believe open is limited to starr and Martin but I could be incorrect. Matt will be able to give you some insight on “closed” decompression timelines, but my understanding is that open is much different. Because of the additions visibility I believe they get right into each layer of the muscles and watch ou the nerves glide and repair as needed. You may need to be more specific and only ask for “open feedback”


      • Mitch
        October 1, 2017 at 9:37 am

        ps I just had fai surgery, to this point I don’t think it helped much but only time will tell. I’ve read a lot of posts on the topic, for me the fai surgery was a piece of cake ( I am athletic), save running around on crutches for a couple of weeks. Don’t regret it at all, personally I think you have to go with the labrum fai surgery first before considering decompression surgery.


      • JD
        October 1, 2017 at 2:25 pm

        I also had FAI surgery which did not help posterior hip or sciatic pain at all. It did get rid of anterior hip pain. My surgeon is Dr. Martin. My nerve was extremely compressed by a large fibrovascular scar ( scar tissue with blood vessels). Luckily my piriformis was not impinging on sciatic so it was not released. I have about a 7 inch incision which is still tender. I’ve had an increase in nerve pain since procedure. I’m not getting any clear answer about when the pain should subside but from what I’ve been told it can take 6 months for nerve to settle down. I hope this helps, for me this has not been an instant fix but at least I have hope now because Dr told me I would have never freed up the sciatic without surgery. I have the same issue on other side too. Total nightmare but you can’t give up!


    • Mitch
      October 1, 2017 at 8:02 pm


      I would love to hear about your progress over the next six months. I am probably one step behind you on the exact same pathway, “open”, etc. (mine maybe slightly more complex). I’ve read a lot of stuff on this site and others and my personally take is if you are athletic and strong, a person can get through the surgery with healing time and exercises. I am curious to know if you follow all your exercise how much time it took for the nerve pain to subside and separate from that the incision. I’d also be curious to know your age and athletic demeanour. Would you be open to posting in the future (even as you heal and the pain is gone). It would be informative to the board and grateful since you took the plung first!


      • JD
        October 2, 2017 at 2:38 pm

        I was very athletic prior to this injury and I’m still in decent shape. I’m in my late thirties. I was a runner prior to this injury. This injury was brought about by overtraining. I’ll try to post every few weeks. This is not an easy recovery at all.


      • Mitch
        October 2, 2017 at 4:19 pm

        Thanks JD. I’m in my early forties, athletic and was a runner and baseball player. This started just when I hit 40. My situation my be more complicated because I have frequent urination as well from what feels like some sort of pudendal irritation. Botox injections into my piriformis and obturator have helped tremendously with all my symptoms, but once the Botox reaches it’s peak period in week 4 or 5 it’s down hill from there. Definitely a plague for all of us. Just had the fai fixed, going to take a break for a bit but will likely be back to Baylor when I feel it’s time to take it a more evasive surgery. Again, I’d be greatful if you could post even when you start to get better (there’s always an inclination to leave at that point). Even from preparing from a mental perspective, I’d like to hear about highs and lows, challenges, the type of pain your dealing with. Ultimately I hope to hear about your hard but successful journey that was worth it. I’ll watch for your posts. Thank you!


      • JD
        October 3, 2017 at 3:19 pm

        Be careful will Botox. It worked well for me when I had this in the past. About 10 and 7 years ago it totally got rid of all my pain issues. I tried Botox again 2 years ago and it made my pain much much worse, I could barely even walk until it wore off. Also from my understanding Botox may increase scar tissue, that is what I personally think happened to me. My scar tissue was below my piriformis.


      • Mitch
        October 4, 2017 at 6:13 am

        Yes, I understand the scar tissue issue. For me, botox has save my life and allowed me to function (to some extent). I know it won’t last for ever and with a lot activity the area really starts to be trouble some after the peak period of Botox ends. That being said, I’m going to ride this solution for the time being and will execute on the “open” surgery if the fai surgery does nothing and I have some time to take off work. I’d be curious to know what type of nerve pain you’ve had since the surgery. Is it debilitating? Uncomfortable? Down the leg? To the groin? Etc. Do the exercises dr Martin gave you help at all? Has the nerve pain been subsiding at all as time passes?


      • JD
        October 4, 2017 at 5:01 pm

        Nerve pain in the calf has gotten a bit worse since surgery. Overall pain has been way up since surgery. The stretches I was given have not helped, but they do not cause any pain. I still have a lot of incision pain too. Hopefully with time this gets better.


      • Mitch
        October 4, 2017 at 7:11 pm

        JD hang in there. And keep us posted please. I think you have to know the positive perspective, which is the incision pain will ultimately heal. As for the nerve pain, I’ve heard as much as six months. I would wait another month to see if you are starting to feel it subside. It may come in conjunction with the healing of the incision. Not that they’re connected but sometimes relief to a near by area also brings relief elsewhere. I know 8 weeks is a long time, but you’re still early in the game. Take a wait and see approach but know that incision will heal. I know a person who had their piriformis cut and back to normal took one year start to finish.


      • L
        October 4, 2017 at 7:36 pm

        In reference to your comments to JD, if your friend that had his Piriformis cut — was this a tendon cut ? — or was it partial removal of the Piriformis ? AND – what is it open surgery or laparoscopic ?
        I have had this Piriformis muscle syndrome for 18 months — getting ELECTROCUTED every time I sit down or lie down – – as long as I am on my feet I’m doing pretty good, but I cannot stay on my feet 24/7.
        I am considering surgery – – I look forward to hearing from you.


      • Mitch
        October 4, 2017 at 9:21 pm

        I don’t know. I didn’t get in to specifics with him because I derive most of my information from the experts. I’ve seen and spoken to a handful of doctors who do this surgery as well as those that do neuromodulation. Best to book an appointment and have them address your concerns directly.


      • JD
        October 5, 2017 at 1:27 pm

        Thanks Mitch. I was also told six months for nerve pain to ease, but it’s concerning to me that there is a dramatic increase in symptoms. Buy my entrapment was extremely severe, inter-operatively it was determined I had no had no movement of the sciatic at all. Post op the nerve moved well and was healthy looking so I think Im dealing with trauma of surgery itself. One of stretches I did pre-op that caused pain no longer does Post-Op and I do have a much greater range of motion. It’s just the pain that I’m dealing with. I’m lucky that when I lay down all my pain goes away. This made the labral repair look like walk in park, but even that took about a year to totally recover from.


      • Mitch
        October 5, 2017 at 2:33 pm

        JD, your explanation makes me think you’re going to be ok, I guess time will tell for certain. Think about how sensitive your nerve was just from fibrous bands touching. Imagine the doctor then taking a mental utensil to squeeze the nerve and pull it. I’m not sure that’s exactly what happens, but I believe the body heals. Let’s touch base in a week or do. All the best, I think you’re going to make it.


      • Mitch
        October 7, 2017 at 7:20 am


        I was thinking About a story this morning that I hope will bring you a hope. I’ve always been a little bit embarrassed to tell the story because it was damage I did to myself. In September 2016 I was late to get my Botox injection in my muscle starting to tighten and I was upset about that so I stretched it is hard as I could Being type a personality and athletic. Worst mistake I could’ve ever made I must’ve ripped a little bit of fashion but at the same time I irritated the nerve significantly my pudendal nerve. From September 2016 till approximately December 30, 2016 I was in significant pain with a continuous urge to urinate. It didn’t really start to subside until about February 2017 with any significance. So I think my point here is that if you irritate nerves at least in my experience that Irritation can last five or six months with the decline starting after about three or four months. And to top it off this was a hard stretch not even somebody taking a metal utensils to squeeze the nerve and pull on it to keep the hope alive have a good weekend


      • Tracy
        October 5, 2017 at 3:17 pm

        Hi JD, I had open piriformis realease with Dr. Starr in Dec 2015. It took quite awhile for my nerve pain to simmer down. The nerve heals at 1 mm a day so be patient. Message or tag Resa on this page. She had surgery the same day and ended up with some scar tissue issues. Be patient. It’s a slow process.


      • JD
        October 7, 2017 at 2:44 pm

        Thanks for your response. Was your nerve pain worse after surgery? Before surgery I was very mobile, I could do just about everything other then sit more then 20 mins. Post surgery walking any great distance is a challenge and I can’t sit very long at all. How many months until you felt improvement? Also, as I mentioned before, my piriformis was spared because it was not touching the nerve at all. My conditions is better described as deep gluteal syndrome since my main issue is scar tissue.


      • Mitch
        October 11, 2017 at 7:09 pm


        How goes the battle? As i’m sitting here recovering from FAI surgery, knowing what’s next, I can’t say as i’m looking forward to it. I hope you’re seeing some minor improvements day by day 🙏🏻🙏🏻


      • JD
        October 13, 2017 at 3:24 am

        Unfortunately I have not had any improvement thus far. Gonna need more time, it is a major surgery. I’m still have no regrets I did it though. It took at least 6 months for FAI surgery to start feeling better and a year until I had no pain at all. I see Dr. in a week so I’ll keep you posted.


      • Mitch
        October 13, 2017 at 6:12 am

        Thanks for keeping me posted jd. Certainly you’re maintaining the right attitude. I’m surprise you mention fai surgery took that long to recover. I’m 3 weeks into fai and with the exception of a week leg, i’m pretty much fine. I hope this goes better for you. This is a big next step because i’m Canadian and I will have to pay cash for the surgery. If your open to letting me follow your journey please add me as a friend on Facebook mgilbert.mba2005@ivey.ca


      • Mitch
        October 18, 2017 at 7:26 am


        All the best with dr. Martin this week, I hope you get additional guidance.


      • JD
        October 21, 2017 at 8:48 pm

        I saw Dr. M this week and he examined me. I questioned him why I am still having pain. He examined me throughly and did an ultrasound of sciatic to see how it moved. It was moving well although he thought he could see a minor entrapment when he bent my leg but it only caused minor pain so he was not concerned. He reminded me it takes 2 years to recover from this surgery I had a severe entrapment , I’m only 10 weeks out so pain is expected.

        I was prescribed a nerve pain medication by a pain Dr. called gabapentin and it has helped a lot with nerve pain in legs. Dr. M told me it works well post surgical so I will continue to stay on it, I was on this before surgery and it did nothing.
        I have the same entrapment in my other hip so I will be going under the knife in 7 weeks to fix it. Hopefully this will give me time to strengthen the operated side which I was instructed to do. Got to keep moving forward, never give up!

      • Mitch
        October 21, 2017 at 9:05 pm


        I hope you recover, I really do. As i’m sitting here my 3 month Botox has run out (next injection Tuesday thank goodness) and it is so tight. I was never a complainer and it got worse over the course of 2 years. I should have never have done leg squats to the degree I did. Funny you should mention gabapentine. I’ve been weening off it lately because I found it to be completely useless for a tight piriformis. I’m glad to hear it’s working for you and you don’t have to go on something heavier like clonazapan.

        Still, I very heavy mental journey. I’d be lying if I said I wasn’t worried. When I spoke to dr. M, he had suggested I could be back to work in 3 months time, with the full recovery taking a year +. I hope that will be the case.

        The inclination for me is to continue on, I have tried every alternative to man and this ailment has cost me tremendously in my personal life. Something I won’t be able to get back. Anyways enough of a journal, i’ll watch the Yankees lose now. If you’re still open to adding me to Facebook so I can follow your journey please do so. Sorry for the spelling errors.


      • JD
        October 22, 2017 at 6:08 pm

        I’m not on Facebook but I’ll try to give updates.
        I totally understand the effects of this syndrome on your personal life, I’ve lost a lot from this condition myself, hang in there but understand that surgery is not an instant fix for the majority of people. And more importantly never give up.


      • Mitch
        October 22, 2017 at 6:30 pm
    • L
      October 2, 2017 at 11:46 am

      I have had pain in the butt for 18 months – – cannot sit down or lie down without being electrocuted !!! It runs clear down my leg to my big toe, often my foot will be totally numb. I would love to hear when your pain goes away. And who did the surgery, where ?
      You are in my prayers. Take care.


  46. Karen
    September 8, 2017 at 1:31 pm

    Hi….I am awaiting authorization for piriormis release,,,I want to do it as i have been in pain r 4 years,,had a hip labrum tear repaired,,,but the most extreme pain is in my right buttocks,,How are you healing up? I’m worried about my future,,being active with this muscle gone,,any feedback would be great!!


    • L
      September 8, 2017 at 2:26 pm

      To anyone – I would also like to know how you function without your Piriformis muscle – I have been everywhere and done everything from MRIs, x-rays, PT, dry needling – – you name it and I have done it and still in pain after six series of steroid injections. I am considering talking to a doctor about getting the Piriformis muscle removed – – I know there is literature and videos on getting the tendons clipped – – I don’t want to talk to just any of the local doctors – – they have not done this, I want to talk to a doctor that has done this many times – – but that will not work if your sciatic nerve runs through the piriformis muscle – – most people it does – – but there is no way to know for sure without getting an MRN which shows exactly where the nerve goes – – not covered by insurance, at least not Medicare. So, I eagerly look forward to hearing from anybody.


    • Jim
      September 8, 2017 at 3:37 pm

      I had piriformis release surgery a year ago. In my case the sciatic nerve seems to be compressed close to the base of the spine, so piriformis release can help a little, but didn’t result in a substantial improvement. Unless the compression of the nerve is further in the direction toward the greater trochanter, the result isn’t that significant. As for not having the muscle functioning anymore — there is virtually no difference from prior to the surgery. This is a tiny muscle which is one of many hip rotators, I’d guess few people notice the difference after release surgery.


  47. Chrissy Mason
    August 31, 2017 at 3:48 pm

    I have posted before regarding my husband and a work-related injury. There is so much detail regarding all that he has been through and the pain he is in, that I can’t even list it all. But, it’s all what most of you have experienced, anyway. He is at a standstill right now seeking further treatment because of work comp and IME report/recommendation and current doctors not knowing what to do next. IME recommended a particular CT scan to see how and where the nerve is being compressed or compromised. Ortho said a spine doctor needs to order this and read it. Ortho doesn’t know a spine dr to refer him to. And, the other doctor, is a pain management doctor whom my husband doesn’t want to see anymore. My question is: what type of doctor performs the PS surgery (not the piriformis release, but the surgery in which they cut around the piriformis muscle to relieve the pressure on the nerve)? We aren’t sure if we should be looking for a spine doctor or another, more experienced orthopedic surgeon. ???
    This nightmare is not going away and now only getting worse for my husband and our family.
    Thank you for your input.


    • L
      September 1, 2017 at 8:20 am

      I hear you loud and clear – – I have the same problem for 1-1/2 years now.
      Where do you live ?
      I have seen the video of the surgery done, but I believe it was in the UK.


  48. Julie joyce
    August 21, 2017 at 1:33 pm

    Please could you tell me the consultant who did the procedure
    Thank you


  49. August 1, 2017 at 4:51 am

    I have been experiencing these exact symptoms for almost 2 years. It started onset of receiving an intramuscular quad injection on my right side. My life has been pure hell!!! It is progressively getting worse. The pain has afffected all aspects of my life. I cannot work, drive most days, and recently started using a walker for the first few hours after the pain wakes me up. I only sleep 2-3 nights a week for a few hours. I start testing tommorow at the Mayo Clinic. I have been an active and healthy mom of 4 and this is killing my entire family. Please email or contact me as I would like to find a surgeon willing and experienced in this surgery.


  50. Rob Griffiths
    July 5, 2017 at 2:26 pm

    Hi, this blog offers me hope.

    After going to see a hip specialist for what I suspected to be piriformis syndrome I’ve undergone an arthroscopy for a labrum tear which descended into a microfracture and FAI.
    Unfortunately I still have the symptoms that you describe exactly.
    I need to find somebody in the UK who may be able to help me.


    • July 7, 2017 at 6:50 am

      Hi there is a post somewhere on this from a lovely lady in the UK called Elisha, she used a consultant in Staffordshire by the name of Mr Justin Lim, you can google him. See if you can find the post. The best thing you can do is literally scroll through all the forum posts there are some from the UK. I believed I had Piriformis, as my pain was all buttock, but the docs, consultants wouldn’t entertain it here in the UK as I do have osteoarthritis. They all said no I required a THR, so here I am having had my THR on Monday 3rd July 2017. Doing well 5 days on. Hopefully this will solve the problem. Anyway if you do find the post from Elisha, you will see that she had a piriformis release by this guy in the UK.


  51. nicoledoran93
    June 7, 2017 at 1:03 pm

    I have bilateral piriformis syndrome. MRI shows
    Enlargement of right and left piriformis
    No compression of sciatic nerve
    I have not been able to sit on my right buttock
    For one year longer than 20 minutes
    I have sciatica to my feet.
    Lumbar MRI neg
    I’m ready to lose it
    Had steroid injections. Relief for a week
    Tomorrow I am getting Botox injections
    Never had any type of surgery before


  52. Robert
    May 24, 2017 at 1:50 pm

    Hi there ! Amazing blog! I think I have Piriformis Syndrome and am not sure where to start. I am thinking about trying ART first, then surgery.
    How are you doing now that it has been 4 plus years since your procedure?


  53. Tracy
    April 17, 2017 at 12:58 pm

    UTSW in Dallas. I had great success in his care.


  54. Brian
    April 16, 2017 at 8:21 pm

    Dr Starr is in Dallas at UTSW


  55. L
    March 4, 2017 at 3:15 am

    That should have read, to anyone with electrocutions and butt pain.

  56. L
    March 4, 2017 at 3:12 am

    Hey- with all the pain you experienced after your accident in your butt pain did you experience any thing feeling like you were being electrocuted ?
    After an injury I have been electrocuted every single day for over a year now. I am in Temple Texas and just trying to follow up on anyone else that is having the same symptoms as I am – – electrocutions and back pain. ?

  57. Dee
    March 3, 2017 at 4:02 pm

    Hi Matt….I’m new to this piriformis syndrome issue….slipped in ice and down on knees not buttock or hip….2 months later still ongoing and severe deep right buttock pain no sciatica yet. Was wondering if you feel the Graston Method helped any as I am interested.


  58. March 3, 2017 at 11:09 am

    Hi all,
    I am almost 1 month post op piriformis release and doing great! My physical therapy is challenging. I have a good range of motion but my muscles are weak. The incision hurts still too, but the overall pain is gone completely!

    I had my surgery at Scott & White hospital in college station, tx by Dr. Seabolt who practices at Central Texas Sports Medicine. He also performed my FAI and torn labrum surgery in July 2015.

    I believe a car wreck I was in in 2007 started everything (car did a nosedive and flipped upside down I flew forward from the back seat and landed on the sunroof on my left side), Dr said I probably tore my labrum then and the next 8 years the FAI contributed to it tearing more. 2 mris taken 2 years apart both showed my piriformis muscle was enlarged.

    Anyway I’m glad I had the surgery it had been a lifesaver!

    • April 17, 2017 at 9:14 pm

      I had piriformis muscle release surgery 7 weeks ago with Dr. Louis Keppler at St Vincent hospital in Cleveland. He was recommended by a rehab Dr at Cleveland clinic. He has done this surgery many times. I had complete pre surgery pain for 5 weeks. I had a pin hole in the incision from day 9 post op to day 24 post op and it finally closed. During that time I had an ultrasound and they found a hematoma. At week 5 I started to feel some achey pain, close to the pain I had before surgery. Dr is positive the nerve and muscles need to calm down. And that will take a few more months. My concern is scar tissue. Dr. Is just now wanting me to do small stretches, no major pt or exercises. I am back to work, office job. I have a stand up sit down workstation, but still like as yoyo, up and down all day. I’m concerned because I’m 7 weeks post op and no pt. I don’t want The scar tissue to put pressure on my nerve. What exercises are you doing? What you of pain are you dealing with post op?


  59. Judy
    February 27, 2017 at 2:01 pm

    Can someone tell me where they had successful endoscopic surgery for this awful buttock pain. Matt?

    • February 27, 2017 at 2:46 pm

      Dr. John Heinrich in Milwaukee, WI. You can Google him. I highly recommend him.

  60. Tracy
    February 24, 2017 at 7:57 pm

    The difference between Matt’s surgeon and Dr. Starr is that he does orthroscopic and Dr. Starr does open. Dr. Starr relies heavily on diagnostic testing to make sure you actually have an impingement with your muscle and nerve. Furthermore, a lot of insurance companies will no longer pay for the release at the hip only as they end up having to have a second surgery. I consider myself a Starr success case and grateful to have done my research in finding him. My surgery was Dec2015

  61. Dee
    February 20, 2017 at 12:11 pm

    Not sure where to hop in on this thread….maybe you could guide me?

  62. L
    February 6, 2017 at 8:30 pm
  63. L
    February 6, 2017 at 7:27 pm

    I would love opportunity to visit with you briefly on the phone, if that is OK with you. I live in Temple Texas. If so, when would be a good time. ?

    • February 6, 2017 at 7:51 pm

      L – we would love to share “our” journey with you, as it was Dan who watched a CA neurosurgeon on a youtube video and Dan self-diagnosed; and it was I who found this blog. If it hadn’t been for this blog…I can’t begin to imagine. Would you send me your e-mail address and we can share our numbers outside of this blog?

    • February 6, 2017 at 7:52 pm

      BTW – Adam Starr is from Temple, TX…his Dad was our first doctor we saw at Scott & White/Temple in 1977…small world!!

  64. L
    February 6, 2017 at 6:23 pm

    Good information – is the smaller number the BETTER Neurography ???

    • prestonjjrtr
      February 6, 2017 at 6:49 pm

      The Tesla 3.0 is much more detailed than the lower 1.5. I’ve had MRIs done on both machines and the 3.0 is the best.

  65. L
    February 6, 2017 at 6:20 pm

    Thanks, it is certainly something to think about.

  66. L
    February 6, 2017 at 6:06 pm

    I have been doing daily exercises given to me by PT – – after researching I found out exercises are necessary to keep the muscles from atrophy in your butt area. So, your husband was in therapy for how many months, because his muscles had extra atrophy ?
    How long was it before your husband could walk normal again ?

  67. L
    February 6, 2017 at 5:58 pm

    Sounds very interesting – – I will certainly keep this in mind.
    Thanks again

  68. Mitchell
    February 6, 2017 at 5:16 pm

    Just an FYI I believe the neurography institute uses a 1.5 Tesla. Might want to check into that. Not saying it will make a difference but the MRN’s at UT southwestern, Johns Hopkins and HSS uses 3.0 Tesla.

  69. Mitchell
    February 6, 2017 at 5:13 pm

    Botox can last from 3 to 6 months. Given that there is a peak point after about 4 weeks and then slowly wear’s off after that, personal experience suggests a maintenance program every 3 to 4 months if it’s working. As for the long term prospects, nobody really knows. They say after 20+ years the body may become immune to the botox. I know of one person who’s been getting botox in the piriformis for 10 years (must of been one of the first!) and no decline yet. I don’t think botox cures anyone’s problems but for many people it certainly is a good band aid. I wouldn’t give up looking for another solution even if it does work, no one should ever give up until it’s completely gone. But it is a life saver for many people. Further, there a many people in the pain clinic getting botox for a variety of reasons because of their lyme disease. The ones I spoke to were please enough vs. the alternative.

  70. L
    February 6, 2017 at 4:11 pm

    Thank you for so much detailed information. Just the thought of having my piriformis removed really scares me. That is the muscle that allows your leg to move forward. Plus, that would leave a huge dent in my tush. I am trying to schedule a referral appointment with him ASAP .
    Thanks again,

    • February 6, 2017 at 4:43 pm

      Neither of your concerns seem very likely to happen to me L. I’m fully functional and have a nice round tush even without my PS muscle attached.

    • February 6, 2017 at 4:52 pm

      L – I’m not sure that my husband even notices not having the piriformis muscle. Or he’s learned to compensate. The incision, about 12″, is down side of the hip/leg, not on your buttocks. And, I can tell you he’d take a damaged tush any day to being able to function without pain. His nerve pain, being that the sciatic nerve was being smashed, was 24/7. In fact, we told the OR people when we got to the hospital that we were happy to get this surgery done!! I’m telling you, he is outside today working his behind off with this gi-normous oak tree. He’s bundling up all of the limbs as we speak and hauling them to our street for pick up. This is the first season he’s been able to do this…again, he is 150% compliant on rehabbing, and he will tell you, like so many others, that it’s rehab, rehab, and rehab. First, he could only walk. However, he NEVER used crutches and after about two days, was walking without his walker. You cannot go wrong with Dr. Starr and his staff. The only thing that kind of threw us a curve in all of the process is that Dr. Chhabra said he didn’t think it was piriformis. My husband wasn’t a candidate for botox as Dr. Chhabra said his piriformis muscle had atrophied. Probably it was due to it being smashed and stuck to his pelvic is why it appeared small. However, Dr. Chhabra did inject him with something else and he did get relief for about one day, which is a diagnostic tool for Dr. Starr is knowing it’s piriformis. Good luck and keep in touch!!

      • John
        February 8, 2017 at 5:55 pm

        Hi Sharon
        “He’s bundling up all of the limbs as we speak and hauling them to our street for pick up.”
        When did your husband have surgery? According to your comments, it sounds like your husband is doing great after the surgery. Does he have any limitations on sitting for 2 hours at a time? Is he able to walk without problem? Any gait issues? Can he go up and down stairs without creating problems during or after? Can he jog or ride a bike? Were his original symptoms bi-lateral? Does he recall how long he had PS, and did he have symptoms after a specific event or was a slow progression?

      • February 8, 2017 at 10:43 pm

        Hi John – My husband’s story and my comments on this blog go back approximately to July-Aug 2015 timeframe. You may find them under Brian’s comments. He had surgery the end of September 2015 and he said he was immediately 80% better. He would have taken 80% over the hell he had been going through for the previous seven months. I’ll recap his story. As I’ve mentioned before, it is “our” opinion that not every case is the same. Such with my husband. He herniated discs in April 2013 sitting down in the airplane seat on his flight going to Atlanta. He flew home two days later, and they had to wheel him from the airplane to the parking lot at DFW airport. He couldn’t walk. His discs had herniated inward and on top of the nerves, resulting in paralysis. He ambulated by using crutches and used his arms to walk and pull his leg. Nine days after the injury, he had invasive surgery at Zale Lipshy/Dallas and was in the hospital 7 days. It was really serious and his rehab began with him learning to walk again as he had no balance. He is 150% compliance in rehab, and is one to research and watch youtube video’s to figure out how he could do more to improve. The last set of muscles to wake up were the butt muscles on the side where he eventually had piriformis syndrome. I’m telling you this story, as he feels it all could be associated. So, April 2013 he had herniated disc surgery; followed by November 2014 total knee replacement. Feb 2015 he travels to Edmonton Canada, 5 degree temp, he walks out of a restaurant and is hit with below zero wind chills and he had a horrible nerve pain, that took him to his knees, he said it felt just like his disc herniation. This is when “it” started. He went back to our internal med doctor, who ordered an MRI. The MRI showed spinal changes on the opposite side, nothing on the side he was having the issues. The pain started at his lower back and went down his leg, all the way to his foot. Nerve pain. No medicine helped…so he stopped taking it because of the way it made him feel. We then went back to the neurosurgeon at UTSW/Dallas, who referred him to another neurosurgeron for an injection. The injection helped maybe a day and it was back to square one. He could not sneeze, cough, sit on the commode, sit, without constant, 24/7 nerve pain. He couldn’t sleep, he couldn’t roll over, he looked like he was being hit with lightening when he walked and I had to witness all of this. This condition plays havoc on relationships, as there are none. You are doing whatever you can to exist and get through. going to doctor, after doctor, test, after test, therapy, after therapy, and finally my husband found a youtube video by Dr. Aaron Filler, Neurosurgeon in CA. He was excited that this doctor explained exactly what he had been experiencing. Dr. Filler is also the one who has the patent on the MR Neurography. My husband spoke with his PM&R doctor and told her he felt he had piriformis syndrome. BTW, the PT was a spinal PT specializing in the McKenzie technique…she also engaged her colleagues in using dry needling, cupping and pelvic PT. The PM&R doctor and PT’s listened to my husband. He was avid at figuring this out…he would have PT, feel pretty decent, and by the time he got into the car to come home, back to square one. Back to relationships…it was hell for him, and it was hell for me having to watch him go through this and not have any answers or be able to help. We could not go anywhere as he had to sit on the edge of the chair and it could not be cushioned. We couldn’t travel, go to the movie…it was debilitating and life changing. And, when he found Dr. Filler…I then found the blog, which led us to Brian who had surgery here in Dallas. It was like a Godsend that we found someone here in our backyard who could help. I know there were comments made about Dr. Starr and a; however when you have a debilitating condition, without sustaining resulting from other medical professionals, and finally find someone who listens and understands what you are going through, it’s cause to raise the roof. Dr. Starr has been recognized as one of the top traumatologists in the USA several times. He is a hip surgeon at one of the largest county/trauma hospitals in the area, so in his 20+ years of doing surgery, he’s seen lots of hips. He uses the open technique so that he can see and feel everything that is going on, as until they get you open, they don’t know what they are up against. In my husband’s case, Dr. Starr said his piriformis muscle was adhered to his pelvis and his sciatic nerve was being smashed behind it. In Dr. Starr’s 20+ years of doing hips at Parkland, he had NEVER seen this before. No wonder my husband’s nerve pain was 24/7 and he could NEVER get relief. My husband started walking outside with his walker less than a week, as Dr. Starr said walk, walk, walk. He doesn’t remember exactly; however, believes he gave up the walker just after a week in the house, and used it less than two weeks on his walks outside. After six weeks or so, he got back in with the PT at Zale Lipshy (UTSW) and he still continued seeing the PT monthly until last November. He and his PT were a team, he would figure out what muscle was the issue and she’d give him extensive exercises. I mean you wouldn’t believe all of the exercises she’s given him in hopes of getting back past that 80%…he feels now he’s 95%…doing all the work he’s done the past three days in trimming these huge oak trees, climbing ladders, using the overhead extension saw, dragging HUGE branches, cutting them and making bundles for pick up…well, it’s none less than amazing. He hated having to have people do work like this, that he enjoys doing…it made him feel handicapped! It’s hard to go back and think about how horrible this was in 2015…it seems so long ago, and resurrecting all the details is not as easy to remember!! He can walk up and down stairs NOW without any issues; he cannot job because of his knee replacement; he uses an eliptical for 50 minutes with no problems. He does planks for six minutes, twice. He does 30-35 minutes of core work every day. He has a workout routine and alternates days with different exercises. All of this saying that he HAD to work up to this… You will hear rehab, rehab, rehab…he is a believer. Last March his internal med doctor told him he would have less issues with his spine if he lost some weight, so he did 1500 calories a day and in 7 months lost 60 pounds. He understands from back issues, that he cannot be in one position longer than a two hour stretch. After the surgery, there were so many things he could do; however, he was finally able to sleep. Have you watched Dr. Filler’s youtube video? https://www.neurography.com/dr-aaron-g-filler-md-phd-frcs-jd/ Good luck and keep in touch. If you need to speak w/my husband, send me your e-mail. He is a walking wealth of knowledge and this blog and subsequent surgery gave him his life back. It was hell on earth!!

      • John
        February 9, 2017 at 9:31 am

        Briefly, what type of back surgery did your husband have, disectomy, fusion, or something else?

      • February 9, 2017 at 11:09 am

        John – they removed the disc that had “squirted” out and into his nerves. I’m reading notes back to when this all began in 2015 and sharing with you notes from March 2015 as you had asked if it were bilateral. Again, so many of the details have been “forgotten” since he is now post op and doing so well:
        Dr. White or Dory:
        I had extensive travel last week that involved a lot of sitting. I walked out of a restaurant & when the extreme cold air hit me, I immediately experienced muscle spasms and sharp pains in my left lower back/hip area. I have no pain in lying down, unless I do leg lifts, which causes shooting pain in low back/hip. Any position sitting or standing that puts pressure on the low back/hip, causes numbness and shooting/radiating pains down the back side of the leg. Sitting in soft cushioned chairs causes pain generating from low back/hip down to my leg. Lifting arms above my head, bending/stretching as in doing backbend stretch motion causes sharp pains down left side. This numbness feels too similar to the herniated disc of 2013 – but has not reached the extreme in off-the-chart pain. The pain sometimes lessens but never goes away. Do I need an apt w/you or my primary care MD? FYI total L knee replacement 11-19-14 w/successful rehab.

        Dory – thanks for getting back with me. I’m going to call today for an appointment as I continue the following:
        Spasms, cramps, numbness, discomfort in my lower back, butt, legs can begin by the following motions:
        standing up out of bed to quickly
        bathroom – showering bending over , brushing teeth – shaving
        coughing, sneezing, BM generates pain;
        sitting in soft chairs; raising out of a chair;
        raising my arms above my shoulders – putting on shirt
        squatting or bending downward picking up computer case
        moving my neck backwards;
        standing and shifting/moving in a lateral position
        taking a longer than normal walking stride
        MRI lumbar and pelvis at S&W/Temple, with changes
        scheduled for injection March 25th; however, I’m concerned as now pains are on both sides, so I want to be evaluated back at UTSW neurosurgical for options and treatment.

        Dan saw Dr. White yesterday to discuss what’s “next”. They are conservative in their approach; however, with Dan’s symptoms now being bilateral, Dr. White discussed decompression surgery may not be the answer, that he may need to fuse and that is a much bigger surgery and recoup time. Dr. White said he wanted to discuss Dan’s case at the spine conference this Thursday to decide the best plan.

        These are the notes that we e-mailed Dr. Starr on 08-01-15, so you have details of his journey:

        My wife found your name posted on a Piriformis Syndrome blog by Brian H. I hope you can help me, as well…

        I’m currently receiving Physical Therapy @ UTSW, Zale Lipshy PM&R for piriformis syndrome (PS). They have used needling and cupping techniques and Monday, I’m being seen by another PT for pelvic rehab.

        My pain is consistently severe and chronic, ranging from levels 5 to off-the-chart (coughing, sneezing, sitting on the commode, the least lateral movement, and tilting/bending forward).

        I have a high pain tolerance. I don’t want to depend on pain meds. They don’t give me relief, so I am not taking anything. I am 63 years old and a Quality Manager.

        In the mornings when I wake up, the first hour is excruciating pain, so severe that I get extremely nauseated to the point of feeling like I’m going to throw up. I struggle every morning to walk and get dressed and get through this by doing chair stretches. When I get to work, I “walk” the plant for approximately an hour, so this helps me move and get the muscle warmed up. I must avoid standing in one place as it generates numbness and sharp pain in both buttocks, predominately in L, radiating down L side.

        I am tired of suffering with this constant pain. Relief tomorrow wouldn’t be too enough.

        I presume you are able to access my UTSW records; however, I have included some history/treatments below:

        L 3/4 herniated disc surgery, Dr. Jonathan White, Neurosurgeon, UTSW

        L total knee replacement, (Dr. Kirby Hitt, Scott & White/Temple)
        In rehab, lying on back doing leg lifts, began experiencing popping/grinding in lower back area, above buttocks. It has never gone away and consistently pops when I’m sitting in a chair putting on my socks, slacks, and shoes.

        Feb 20 & 23, 2015
        Two prolonged (20+ hr) travel days, lots of sitting in airport/plane/car.
        Feb 25, in Edmonton Canada with 5 degree temp and below freezing wind chill factor, I walked out of a restaurant. I didn’t slip or trip, just walking. When that extremely cold wind “hit me”, I immediately experienced grabbing muscle spasms and extremely sharp pains, in my L buttocks/hip area, that took me to my knees (PL 10+). The extreme spasm felt exactly like the pain I experienced when I herniated my disc on 4-15-13.

        Sunday, I presented at Scott & White/Temple ER, with pain predominantly on L buttock/hip, radiating and burning all the way down L side to my calf. Diagnosed with inflamed nerve endings and prescribed flexeril and tramadol; follow-up with Primary Care Physician (Dr. Barbara Weiss, Internal Med, Scott & White/Temple).

        MRI Lumbar Spine W WO Contrast (Scott & White/Temple)
        1. Stable postoperative change of laminectomy at L3-L4 with resolution of disc extrusion previously noted at this level. Enhancing fibrosis is noted around the thecal sac without compromise of the central canal.
        2. Interval enlargement of right central to right foraminal zone disc protrusion at L4-L5 with resulting moderate central canal stenosis and moderate to severe right neural foraminal narrowing.
        3. Additional degenerative changes predominantly involving L2-L3 and L5-S1, stable from prior exam.”

        X-Ray Hip Two views of the left hip (Scott & White/Temple)
        FINDINGS: No acute fracture or dislocation noted. No hip joint space narrowing or other radiographic findings of arthropathy identified. Right SI joint and pubic symphysis appear normal.
        IMPRESSION: No acute radiographic finding.”

        Dr. Weiss basically told me the MRI showed changes on R side, which wouldn’t affect my L side and referred me to Dr. Mounir Fawzi Khalil (PM&R, Scott & White/Temple)

        Dr. Mounir Fawzi Khalil also said he saw nothing on the spine MRI that would be causing my symptoms on the L. Dr. Khalil ordered an MRI of the pelvis to rule out the SI

        MRI of pelvis W WO Contrast (Scott & White/Temple)
        1. Postoperative change of laminectomy at L3-L4 and disc protrusion at L4-L5 as described on the recent prior MR lumbar spine exam. No evidence of additional MR findings in the pelvis to explain left sciatic symptoms.
        2. Additional MR findings as above.”

        Appt w/ Dr. Jonathan White, continuing to experience severe nerve pain predominately on L side, radiating from buttocks/hip down to my ankle; and R side, radiating down to back of thigh. Dr. White referred me to Dr. Al Tamimi, Neurosurgeon, for possible injection

        Straightening of the normal lumbar lordosis. Degenerative facet arthropathy from L3 through S1. Multilevel anterior and posterior osteophyte formation, most pronounced at L3-4 through L5-S1. There is mild anterior subluxation of L4 vertebral bodies resulting in minimal retrolisthesis at L3-4 and anterolisthesis at L4-5. Accentuated L4-5 anterolisthesis on flexion and reduced L3-4 retrolisthesis on extension suggest underlying ligamentous instability. Moderate to severe facet arthrosis throughout the lumbar spine.

        Dr. Al Tamimi did “burst” injection to lower back (Zale Lipshy). Relief following day (04-02-15); and pain gradually started coming back and by 04-04-15, pain same as before injection.

        Appt w/ Dr. Jonathan White, he advised he would review my case with his colleagues. Referred to Dr. Wayne Gluf, Neurosurgeon, UTSW, who specializes in botched back surgeries and complex cases.

        Appt w/ Dr. Wayne Gluf, he also agreed symptoms didn’t parallel MRI findings. He said he could do surgery, but it probably wouldn’t help and I’d still have the same symptoms. He suggested referral to UTSW PM&R physician @ Zale Lipshy, Dr. Kavita Trivedi for injection.

        Target injection by Dr. Trivedi (UTSW)
        Results: next day was like I had nothing wrong; symptoms gradually returned and by day five, I was back to where I started;

        Began using Flector patch (1 patch x a day; then reduced to ½ patch a day) with some relief on muscle in buttocks, other symptoms remain. Causes dull headache and some stomach issues; discontinued

        Appt w/ Dr. Trivedi. Told her I thought I had Piriformis Syndrome based on youtube by Dr. Aaron Filler. Referred to PT with one of two PT’s at Zale Lipshy who specialize in the spine.

        Began PT at Zale Lipshy for Piriformis Syndrome. With only a couple of exceptions, PT has been twice per week. Plus, I am doing daily PT at home.

    February 6, 2017 at 12:21 pm

    My name is Amanda Ferraz, I live in Brazil. I have been suffering from unbearable pains in the left hip for 3 years because of pyriform syndrome. Here the last procedure I did was application of butox. (After 8 months the situation worsened to the point of compromising the right piriformis. I believe my case is surgery but here in Brazil there are no specialists. Could you pass me data from the clinic or hospital where this procedure was done ( ENDOSCOPIC LIBERATION OF PIRIFORMES). Sorry for the possible spelling mistakes.

  72. L
    January 29, 2017 at 8:21 pm

    Did you ever feel like you was being electrocuted with very hard and painful spasms – – especially while sitting or lying down – – ? – also Pain going down your leg and effecting your foot — like it had a hot iron on it – – or the other side of foot like it had been whacked with a crow bar ?

  73. Jeff
    January 23, 2017 at 7:37 pm

    Looking for someone who developed PS after total hip replacement. Had right THR in March 2015…have never been the same since. Pain in right buttock radiating down right leg to toes. Main complaint is walking, extreme pain. Ortho doc denies any hip issues, multiple post op hip x-rays were negative for complications related to hip replacement. Multiple physical therapy appointments not helpful. Cortisone shot only temp relief. We live in Vermont, anyone know any good docs here.

  74. Jo
    January 21, 2017 at 7:07 pm

    Is there anywhere in the Milwaukee, WI area to get the MRN (MR Neurography) 3.0 Tesla scan for the sacral pelvis with sciatic nerve imaging ?

    • January 21, 2017 at 7:09 pm

      Sorry Jo but I don’t know of a place.

      • Jo
        January 21, 2017 at 7:12 pm

        Thanks, any idea where may be the closest site that may ?

    • Mitchell gilbert
      January 21, 2017 at 10:49 pm

      Unfortunately there is no place in Milwaukee that does this. There are a lot of hospitals now that are developing 3 tesla sequences to “chart the course of the pudendal nerve” which is essentially neurography so you could ask around for that. Otherwise i suspect you know of Hollis Potter at HSS in New York, avneesh chhabra in Dallas and Jan fritz in Baltimore all do neurography on 3T.

      Here’s my two cents on what to do and I have quite a long history. I think Matt can vouch for me. I am blantanly going to say the 3t neurography is overrated for diagnosis. Look at chhaabra’s most recent work on doing neurography on a cadaver. Not so conclusive in many regions along the course of the pudendal nerve – study did not focus on sciatic unfortunately. I had an MR neurography with chhaabra and it didn’t show any issues. I was in excrutiating pain and couldn’t sit. I was out of work. I went for Botox in the piriformis with 70 percent relief and was back at work. Now I get Botox in the piriformis and obturator with 85 pain relief.

      Having an MRN is certainly ok but why not try Botox or a cortisone injection first if you don’t have easy access?

      MRN has a lot of difficult picking up muscle tightness and is some cases scar tissue.

      Quite frankly I think the doctors who do this are very excited about what the future holds for neurography but just like pelvic floor therapist I think they need to put the coolaid cup down just a little bit. Still an excellent technology but far from being a better diagnostic tool than injections

      • prestonjjrtr
        February 6, 2017 at 3:15 pm

        Special thanks for all of the info Mitchell it is appreciated. Since I also have Lyme, I’m unable to take any steroid shots, but never considered botox shots. How long did the botox shots work for you or how often do you have to get them and is there a limit to them ?

    • L
      February 6, 2017 at 2:54 pm

      Call (877) 724-6674 The main number for the MRN Institute. This number handles all the scheduling and she said the closest one to Milwaukee Wisconsin was in Merrilville, Indiana.
      Hope this will be some help for you.

      • prestonjjrtr
        February 6, 2017 at 3:16 pm

        Thanks for the info L, wish the Merrilville, Indiana was closer.

  75. Brian
    January 18, 2017 at 10:12 am

    Sara- There is a Facebook group for PS and in that there are others in the UK who have had surgery. Please connect there for info, its a good group. Hope you find help!

  76. sarajp
    January 17, 2017 at 5:23 am

    Hi Matt I’m in the UK like you, but in the West Sussex area, but will travel, please can you tell me where I can get the Provocative EMG done? I’v googled and can find the british society for clinical nueropathy, but can’t find any info of where in the UK or which consultant might perform this for me. I’m getting desperate long history of spine issues had spinal fusion, now being told need hip replacement due to osteo arthritis, I’m convinced my buttock pain is all piriformis syndrome and no one will listen to me, Spine surgeon keeps giving me injections, hip surgeon wants to put in Hip Replacement. I just want some tests on piriformis to confirm one way or the other, but hitting my head on brick wall. Where did you get your Provocative EMG done in UK please? Not sure if you are still following this blog and I don’t have your email, does anyone else have Matts email please in case he is not following? Thanks all, ps my email sarajpaul@aol.com if anyone else in UK knows or can help.

    • January 17, 2017 at 5:56 pm

      I’m still maintain my blog. I had my Provocative EMG done by Dr. Scott Hardin, at St. Luke’s hospital in Milwaukee, Wisconsin in the US (where I live).

      • sarajp
        January 18, 2017 at 6:42 am

        Ahh I see sorry Matt I got the wrong end of the stick, I’v read more of your blog, I originally thought you were UK based, but now realised your are US based. I’l keep pushing on over here, Loads of EMG tests available but no one seems to have heard of Provocative EMG, I will show them your tests and see if that helps, if I can get referred to someone. Here in the UK we can’t get to see these Dr’s unless we get referred by our General Practicioner or consultants even if we go private. Thanks for the blog by the way, please keep it running. Regards Sara

  77. Noushaba
    January 12, 2017 at 1:32 pm

    Hi Matt, I am suffering from undiagnosed hip pain for the last 9 year. We are in Illinois and are planning to see Dr Heinrich. Do you know where we can get the provocative EMG done?

  78. Patti
    December 29, 2016 at 4:09 pm

    Kim there’s a Dr Borg-stein at Harvard. I’ve not seen heard but only heard of her. Aside from that there’s a doctor in Manhattan who treats a lot of PS.

  79. Judy
    December 29, 2016 at 2:29 pm

    So sorry for all you’ve been through. It’s been 5 years for me and I can’t drive or sit long. Have to sit on left cheek right side. I have been diagnosed as having PS by Dr. Fishman in NYC but Drs in Boston don’t agree or aren’t sure. If you find a Dr. in Boston please let me know. I am just going to pain management (no more shots, haven’t worked) and learning to live with it which is not acceptable but no choice. Good luck and let me know if you find someone.

  80. Kim
    December 29, 2016 at 2:14 pm

    will be 39yo in a couple of weeks and have lived with chronic PS since at least MIDDLE SCHOOL (I was a competitive gymnast and suspect this is what caused it)! It has impacted many areas of my life – I can count the number of movies I’ve seen in a theater on one hand, I can’t drive for long distances without excruciating pain, and flying is torture. I also have periods of time when the pain is non-stop making it difficult even to sleep or concentrate on much beside the pain.

    I haven’t gone to a doctor about the pain since high school when, after some PT, I was sent on my way and told it was in my head. I had an acute attack (with sciatic nerve involvement) a couple of years ago days before I ran the Boston Marathon and got some short-term treatment then – enough so I could walk again, but again was sent on my way without much of a plan.

    I’m wondering if there’s anyone in the Boston area who has found a doctor who has significant experience treating PS. Thanks in advance!

  81. Tracy
    November 25, 2016 at 3:46 am

    I had open Piriformis release surgery 14 Dec 2015. I can say that for the most part it was successful. I don’t for a minute regret my decision. I secretly giggle when I hear medical professionals dispute PS and the pain we suffer. After researching, including this blog, I diagnosed myself and found a doctor who was willing to properly diagnose me. Never give up! I cringe thinking of my life a year ago.

    • L
      February 6, 2017 at 3:00 pm

      How are you doing after your Piriformis release surgery ?
      Prior to your surgery with all your agonizing pain did it also make you feel like he was being electrocuted. Where did you get your surgery done ?
      My pain has been going on for a year now – – cannot sit down More than 10 minutes or lie down For more than 2 to 3 hours and that is only if I am lying on my left side in a certain position – – if I move I get electrocuted – – and I mean big time electrocuted looking and acting like I had been struck with a bolt of lightning – – was this also your symptoms .
      I look forward to hearing from you and the name of your doctor and where he is at.

    • February 24, 2017 at 9:08 pm

      Tracy – my husband self-diagnosed, as well. He found a youtube video of Dr. Aaron Filler Neurosurgeon in CA, and after listening to this video, my husband said Dr. Filler could have been interviewing him…and then I found this blog, and Brian H’s comments about Dr. Starr, who basically was in our backyard, and the rest is history!! No doubt, Dr. Starr gave my husband his life back, as he had nothing but 24/7, shocking nerve pain. Dr. Starr listens…and understands, where other healthcare professionals he had been seeing were just testing…

  82. Stevo
    November 19, 2016 at 3:47 pm

    Hi guys. I’m rather new to this and hope someone can advise me. I am scheduled for a Nerve Conduction Study because I suspect I have a nerve trapped by piriformis and perhaps also gluteus medius.

    (1) I discovered certain physical actions & rest can ease the pain in a very welcome way. Would a Nerve Conduction Study reveal less information if I did those pain-relieving actions before having the test?

    (2) Is it worth having an electromyogram (EMG) at the same time to test my piriformis as well as other buttock muscles? I am thinking of piriformis, gluteus medius and TFL muscles.

    • Jim
      November 24, 2016 at 12:02 pm

      1) probably not. 2) The EMG is similar to NCS in that it is measuring nerve function, rather than muscle function. I have bilateral PS, in my case neither of these tests were helpful in diagnosis, although they may identify other issues. The key test for PS would be the ‘provocative EMG’ which compares signal in normal prone position to signal in F.A.I.R. position, if there is a delay/deviation of greater than X (read Matt’s blog on this) in the signal between the two positions, it’s indicative of interference with the sciatic nerve at the level of the piriformis. (the study was developed by Dr. Loren Fishman).

  83. Jennifer Sniffen
    November 17, 2016 at 8:34 am

    Sounds like me! I was diagnosed with piriformis syndrome when I was 25, and now have si dysfunction/sacroiliitis. I had the platelet rich plasma injections and he injected a lil of the plasma into my sciatic notch (where the pain mainly is)…gotta say, the most painfully brutal 3 weeks of my life! Insurance didn’t cover it & was $500 per round. I definitely think it helped…but what really helped was the si nerve ablation s1-s5 nerves are dead : ) now mine is all muscle spasm pain. The only thing that brings me some relief is moist heating pad every night, foam roller from mid back to my butt (you can look up piriformis foam roller release), nerve floss & piriformis stretches. The best piriformis stretch, for me, is putting my leg on a table & leaning forward

  84. November 16, 2016 at 11:23 pm

    I’ve commented on a few things before here. I recently had cortisone shots #4 and 5 earlier this month, that makes 4 total this year starting in August and 1 last year. #4 and 5 came after a terrible experience getting #3 shot at a pain clinic so I went to my surgeon who performed my FAI surgery and he directed me to one of the doctors in his office. I have SI joint dysfunction and the doctor who gave me #4 and #5 noticed my piriformis muscle was tearing, hence the 2 shots.

    She mentioned a therapy, and I can’t remember what it’s called, but it uses your own plasma and injects it into the damaged tissue to help it repair faster. Has anyone heard or tried this? And does anyone have SI joint problems coupled with piriformis syndrome?

    I feel like these last 2 shots are helping a little, I also have a standing desk which helps relieve pain, but I don’t feel I’m completely pain free.

    I’m wondering if this is something I will continue getting, shot after shot after shot. I don’t know how I fs.eel about another surgery but I’m kind of over this pain.

    • November 17, 2016 at 4:37 pm

      I had si joint dysfunction that had contributed to minor piriformis issues but ultimately the tendinous insertions by glute medius were worse on one side of pelvis.Yes PRP (Platelet Rich Plasma) is excellent to help heal tendon issues as cortisone ultimately is not good in the long run. The question is what are you doing to help your si dysfunction? (Such as si belts, taping checking leg length discrepancy, prolotherapy to help tighten ligaments, physical and chiropractic care etc) If that were under control then piriformis can have a better chance to heal and be less problematic. Very sincerely Kim-AHE Health author of my personal blog: http://www.si-instability.com

    • Stevo
      November 22, 2016 at 1:10 pm

      Doesn’t those cortisone shots you had partially degrade muscle in the same way it is know to do to tendon tissue?

      • November 22, 2016 at 5:57 pm

        Not sure but I do know you’re not supposed to have more than 3 and I’ve had 5. I’ve got a follow up soon to discuss further treatment. The shots seem to help a little but if I sit too long I can feel pain flaring up again

  85. Jane
    November 14, 2016 at 11:34 pm

    What about Spinal Pain Pumps/Spine Stimulators?

    Given the apparently very low success rate of surgery, has anyone tried these other options?

    • October 4, 2017 at 12:28 pm

      I think if you truly have piriformis muscle issues, you need to build up your core and glutes. if that doesnt help, seek surgery. My surgeon said it would have never got better. Over time, scar tissue develops, and there is nothing at that time except to cut it off your siactic.


  86. Joshua
    November 14, 2016 at 11:45 am

    Hi Matt,

    Can I message you privately to as you a couple of questions?



  87. judy
    November 10, 2016 at 4:23 pm

    I haven’t Joshua but I only found one Dr. here who after much effort was able to read my MRN from Dr. Filler. He did not agree with a diagnosis of piriformis syndrome and did not see what Dr Filler sees. No other diagnosis from him either. None of the Drs I talked to here reacted to the positive provacative EMG from Dr. Fishman either. I would travel but have had numerous injections, piriformis, SI joint, etc. to no effect at all. It has been suggested by my primary care that it may be post hepatic neuralgia though it is murky at best and doesn’t all add up. It has been 4 1/2 years and just seeking help, let alone the symptoms is exhausting. I wish you luck in your quest and hope all of you reading this find help. Joshua, if you DO find anyone in the NE area please let me know as this is the only diagnosis I have. Again, good luck to you.

  88. Brian
    November 7, 2016 at 8:33 pm

    Sure! You are welcome to email me any questions and keep contact any time. Bkhobby@yahoo.com

  89. John
    November 7, 2016 at 8:31 pm

    Thanks Jim
    I’m starting to track, so far I’ve got about 4; Jim, Matt, Brian, and maybe your suggestion.
    Got it keep it honest. And I need a way to get follow up. Thanks.

  90. John
    November 7, 2016 at 8:31 pm

    Thanks Jim
    I’m starting to track, so far I’ve got about 4; Jim, Matt, Brian, and maybe your suggestion.
    Got it keep it honest. And I need a way to get follow up.

  91. John
    November 7, 2016 at 7:31 pm

    Thanks for the update. Is there a way to keep track of you for another year or so? I would certainly appreciate it.

  92. Brian
    November 7, 2016 at 7:26 pm

    I can speak up as one who had a successful surgery and outcome. My story is all over this board and I was the one who introduced Dr Adam Starr here. I had PS for 8 years and tried everything possible to get it fixed. This week marks my 2 year date from open surgery with Adam and I have absolutely no pain. Have been pain free since surgery and no relapses at all on pain. I would HIGHLY recommend you do open surgery if you do this as there is way too much anatomy that can be causing problems. Once the Dr is in there he can fix several possible issues. I notice that a lot who don’t do open don’t get healed. It makes sense to me since all they do it snip the tendon and done. That’s just not enough in my opinion. Hopefully you can see all my comments going back to Nov 7th 2014. If you do truly have PS the only thing that will fix this is surgery so do all your homework and try all you want but I have never met anyone who fixed it w/o surgery. Hope that helps and good luck! It’s a miserable problem!

    • L
      February 6, 2017 at 3:06 pm

      Prior to your open surgery for PS, did you have symptoms of being electrocuted severely when sitting down or lying down? – –
      When Adam Starr did your open surgery, did he also remove the piriformis muscle? – – How was your walking gate after surgery? – – How long till you felt like you could travel and walk normal ?
      I have been in agonizing pain and feeling electrocuted every day for year now.
      What caused your problem to begin?
      I look forward to hearing from you, we will have a great day.

      • February 6, 2017 at 3:59 pm

        thanks to Brian we went to Dr. Adam Starr…no regrets. He does the open technique so that he can see what’s going on, as we all know PS is a syndrome and not quick to diagnosis. Dr. Starr found that my husband piriformis muscle had adhered to his pelvic bone and his sciatic nerve was being smashed, no wonder he continuous felt he was being electrocuted. Dr. Starr removed the piriformis muscle. My husband has had extensive rehab in getting his muscles back to gliding; however, he is astute in rehab’ing and figuring out what nerve is affected and the PT at Zale Lipshy listens to him…in other words she and my husband are a team addressing his issues. He continues to work out at home, and today, he’s worked for 5-6 hours trimming our huge live oak, I don’t know what kind of saw, but it’s an extended tree saw, to cut big limbs and branches. Saying all of this is that had he NOT had the surgery, he would be debilitated, as he definitely was debilitated before the surgery. It’s been a year and almost five months and he’s back to almost normal. I say almost normal, as he had herniated disc surgery on the opposite side in 2013 and total knee replacement in 2014, so he’s dealing with other issues as well. However, Dr. Starr and his team gave him his independence back…and you cannot put a price on that!! Dr. Starr and his team LISTEN intently to your issues and they totally understand and get what you are going through…unlike the neurosurgeon who my husband had been seeing!!
        The blog is how we found Matt’s story…leading us to Brian’s story…and that lead us to Dr. Starr…who gave my husband back his life. My husband has said many times that he understands why people going through such suffering “take a bullet”.

  93. John
    November 7, 2016 at 7:14 pm

    Curious, how many people have you counted on the forum that have a complete recovery 2-3 years after surgery? I must be missing something in the comments here, most of what I’ve seen are people mainly looking for advice and a minority of comments from people that have had recent surgery, and even less from people that are 2-3 years out. Maybe you can point out some of these people for me. I think I’ve also seen some with unpleasant complications. I’d like to keep track. Thanks.

    • Jim
      November 7, 2016 at 8:19 pm

      You could look back about a year for the case history provided by username “Lea” who had a full recovery and is presently 2-3 yrs postop and remains fully recovered. I’m not ‘tracking’ this, but have read and conversed privately with a number of posters who’ve had good results.

      • Ralph_124
        November 19, 2016 at 3:54 pm

        I have a skeptical physio who almost snorted when he said that the success rate of surgical release was very low. I don’t know what to make of that. Maybe that’s a typical physio’s point of view!

    • February 6, 2017 at 11:55 pm

      It is my thought that not every piriformis “case” is the same; and those having open technique vs non-invasive could be factors as well as to their recovery and success. I say this as before surgery, my husband had all sorts of PT, from dry needling, to cupping to pelvic therapy and the PT’s all felt he had an entrapment. This is what the surgeon felt as well, and until he did the surgery, which is open technique so that he can see and feel what’s going on, he did not know the piriformis muscle had adhered to my husband’s pelvic bone with the sciatic nerve behind it and behind smashed. This is a nationally recognized hip trauma doctor, practicing in the county hospital in Dallas TX, so he’s seen lots and lots of hips, and he had NEVER seen a piriformis muscle attached to the pelvic bone.

      • Jim
        February 8, 2017 at 9:57 am

        Sharon – exactly, there is often an initial idea that PS is simply a kite string trapped on a lower branch of a tree which needs to be released (sometimes that’s the case) — but often the kite is at the top of the tree and the string travels all the way to the ground through many branches, brush and whatever else — and you don’t have a clear idea of how or where it is hung up.

    • Mitchell
      February 8, 2017 at 4:42 pm


      I do not believe this is the answer Jim was looking for when he made his comments regarding knowing how many people on the forum have had a complete recovery 2-3 years after surgery. I’m also concerned about the over promotion of Adam Starr. I have done a lot of investigation as well and from a reputational perspective the feedback on Adam Starr has been very positive. However, like Sharon said, every case of piriformis seems to be different, hence you can go wrong with any doctor no matter the reputation. If someone is touting a doctor I think they need to put that caveat in every time. Matt is very good at mentioning that his doctor was very good for him but he won’t go further than that.

      Now Jim, in direct response to your question, I had the same aggrevation that everything seemed second hand or opinionated on this website with the exception of Matt who had a direct experience. I am considering surgery and was frustrated like you so I am really working hard to do my own research.

      I went to see Matt’s doctor personally (this is how real research is done). He was very cordial and I asked him a number of direct questions similar to yours on this web site.

      You can’t totally quote me on this because I can’t recollect the exact stats but I believe he was doing at least one surgery a week for piriformis syndrome. He said the patients he works on tend to have butt pain and no other major symptoms, if they do, he is less open to doing the surgery. (Even those with just butt pain go through a battery of tests). He said he felt that in those patients with pain exclusive to the butt, the results of his surgery where somewhere in the neighborhood of at least 70 percent improvement in 90 percent of the patients (again this is anectodal and I suspect he would never be quoted on paper saying this, and rightfully so). He said when patients come in with butt pain and pain that travels all the way down the leg, the results seemed to diminished substantially (and still somewhat of a mystery why). You’ll have to do your own research but it sounded like on that second class of patients (ie butt and leg pain) he could reduce the butt pain but the pain down the leg continued to persist to some extent. Not that there wasn’t an improvement but patients with leg pain seemed to have a lower overall level of improvement.

      I hope this helps and directly responds to at least a portion of your question.

      • Jim #2
        February 8, 2017 at 5:50 pm

        John, good post, thanks — the original question about how many people had good results 2-3 years out actually came from “John” — the discussion part of this forum is a bit difficult to follow. I had release surgery about 6mos ago in NYC, jury is out on whether it will help — I have leg & feet symptoms as well, all of which points to some involvement of sciatic nerve close to base of spine. Nonetheless, I used to have a lot of lower back spasms and that stopped post surgery.

      • John
        February 8, 2017 at 6:15 pm

        Jim #2
        Hey, Thanks for the update! Can you provide a bit more information? What are your PS symptoms like now; sitting hours, etc? It sounds like you don’t have any acute surgical complications affecting other parts of the body, is that true? Were your original PS symptoms coincident with lower back pain since you mentioned that you had back spasms? Did you have the lower limb symptoms before surgery, and if so, did they start before or after PS symptoms, and how long before or after? Were your symptoms bi-lateral?
        Yes, I agree that these discussions are difficult to follow so I’m having trouble following updates on those that had surgery. Many thanks for the update.

      • Jim #2
        February 8, 2017 at 8:11 pm

        John, my earlier reply was actually meant for Mitch. In regard to your questions: symptoms now are similar, sitting or standing for more than 2hrs gets challenging, pain is butt and feet – sensitivity to heat, cold, pressure. No surgical complications. Original symptoms all began about the same time — my neurologist felt s1-s3 might be involved but no spinal issues in MRIs etc. bilateral-yes, 60:40, left is worse. I am managing with minimal painkillers; exercising & stretching 3x/wk; use benfotiamine supplement — now testing krill and l-tyrosine. Some days are 2s & 3s pain wise, some are 4s & 5s. It’s always a challenge, always seeking new ways to gain an edge.

  94. Jim
    November 6, 2016 at 7:37 am

    Not always that straight forward. A few people have an immediate benefit, some have a delayed benefit as the piriformis atrophies. My surgeon has had cases where there was no immediate benefit and then a year later the pain went away. I suspect that there are only a minority who see a significant improvement within a couple months. A consistent and thorough PT program and exercise routine post-op is important.

    • Jane Turner
      November 7, 2016 at 4:03 pm

      So far I have seen few successes of any kind. After 6 months people develop scar tissue again.

      • Jim
        November 7, 2016 at 5:38 pm

        If you read through the forum there are cases of full or nearly full recovery (Matt’s of course the most obvious). I’m about 2 mos post-op and saw an immediate stop to lower back spasms — I used to wake up a couple times a week with severe back spasm, I’ve seen slow improvement in sciatica symptoms, but I am also doing a lot of PT and exercise, which I feel is really a big part of beating this. One reason for mixed results is the non-uniformity of the syndrome, it just isn’t straight-forward like repairing a joint or peripheral tendonitis. I have had asymmetric hips and hyperpronated since I was a kid (throw that in the mix).

  95. Mitch
    November 5, 2016 at 10:49 am

    I am contemplating visiting Hal Martin can those with experiences with Hal Martin please provide comments. In particular detailed comments. Comments such as “he was great” or “he killed me” have no merit. What was the procedure, what did he predict the outcome would be, was he correct, how long was recovery, overall thoughts?

    • Jane Turner
      November 5, 2016 at 11:51 am

      Hi Mitch,

      First, did you read Hal’s papers on Deep Gluteal Syndrome? Google them. The 2015 paper is very detailed.

      Where is your pain…middle of butt or lower butt? This is important.


      • Mitch
        November 5, 2016 at 6:01 pm

        I have read everything. And I mean everything. I have met dr. Rossos and dr. Dellon in person to discuss their capabilities. I have spoken to dr. Starr’s office and I have had an MRN from avneesh chhabra. I believe in gathering as much research as possible before making any decisions. I have also explored labral tears and neuromodulation. My question above remains the same for those that can answer.

  96. Mitch
    November 2, 2016 at 5:15 pm

    I’m wondering if there’s anyone else from Canada who has had/considered surgery for Deep Gluteal Syndrome and/or Piriformis Syndrome. I would like to chat with them about their decision making process. I will watch online for responses over the next little while.


  97. Jennifer
    October 30, 2016 at 1:20 pm

    Your history is almost identical to mine….was diagnosed with piriformis syndrome at 26 (I’m 38 now)

    Two years ago…
    1. “its referred pain from your back”, 2 years of lumbar injections then clean discogram ..can’t be my back
    Past year…
    2. “It’s referred pain from your si joint” – si belt, injections, platelet rich plasma injections & s1-s5 nerve ablation …no more nerves left, can’t be my si joint!

    Now they’re thinking autoimmune, Ankylosing spondylitis, &
    omly thing that’s ever helped was piriformis stretches (standing, leg on desk only), sciatic nerve flossing, heat, graston technique massage & foam roller (has to be all of them together or it doesn’t work) any other suggestions?

  98. Shawn
    October 28, 2016 at 1:50 am

    Does anyone know a doctor in Colorado that will perform a provocative EMG?

  99. Patti
    October 26, 2016 at 6:33 pm

    Mitch: I’ve had an MRI of my hip in which they said there are no gross labral tears (within the scope of the MRI). I’ve not been able to obtain an MRA of my hip capsule though, can’t get a doctor to order one. I’m continuing on with non surgical treatments, but it’s not easy. At. All.

  100. Ashly
    October 19, 2016 at 10:56 pm

    I had piriformis release surgery in January. Mine was so bad the surgery ended up being open instead of arthroscopic. I got better for awhile, but did too much and went downhill. The struggle is real and this is taking forever to heal. This blog is amazing because it creates a community and we get to hear other people’s struggles and personal stories. There are several articles in medical journals that talk about all the risks, benefits, and outcomes of piriformis release surgery. Google piriformis release, Hal Martin, and patient outcomes. If you cannot find them, let me know. My insurance company would not initially pay for my surgery. I used these articles as evidence; they paid for my surgery. For me, surgery wasn’t an instant fix, but I am definitely better than before surgery. Hopefully, things will continue to improve. I guess the longer your nerve is compressed, the longer it takes to normalize. Good luck. This certainly isn’t any fun.

    • Mitch
      November 2, 2016 at 5:20 pm

      Would be open to letting us know who did your surgery. Also was does “went downhill” mean as it relates to doing “too much”. As for as I’m concerned the surgery should either work or not and you have to keep up with physio to remove scar tissue from the surgery, but there should be no reversal of outcome unless the surgery did not work?

  101. John
    October 19, 2016 at 7:02 pm

    You’re absolutely right! There’s no PS staging or accurate diagnostic testing or sufficient patient number to create a double blind protocol for a clinical trials to analyse PS cure rates. On the other hand, there aren’t established clinical trials regarding complications associated with PS surgery. Without a reliable and established PS surgery complication rate, there isn’t a suitable guideline for selecting surgery over an alternative. Given the small numbers of people electing surgery, data bias is possible – good vs bad surgeons. Ultimately, it’s a small number stat problem that isn’t easily solved. In this case, Matt’s website is attracting more people and those that are seeking surgery are looking for names, and it seems, many of those go to the few recommended surgeons here. So this site may a reasonable site to contact PS patients regarding surgerical complications to create a small, and honest, database to assess the complication rate among certain surgeons as well as some general rates. People want a solution but don’t understand the potential problems, complications, associated with surgery ; and therefore, can’t make an informed decision. If I believed that surgery resulted in no late complication rates, then it would be a no brainier, get surgery. But there isn’t enough honest data to conclude who or what will improve your situation. You have to start somewhere, and do no harm is the most conservative. Starting with complications seems reasonable since you don’t want to create more problems.

  102. October 17, 2016 at 6:57 pm

    What a good idea. Releasing a muscle is no small matter.

  103. John
    October 17, 2016 at 6:25 pm

    Would it be possible to contact those that submitted comments that they had or were planning to get surgery to get a rough idea of outcome over a year or two? I think it would be very helpful for everyone considering surgery as well those that had surgery.

    • Jim
      October 19, 2016 at 1:21 pm

      John, it’s a good idea, although, given the unique nature of each case, you may or may not find a lot of comparability from case to case. I suspect there are a few very clear-cut forms of PS such as Matt’s, which resolve directly as a result of release surgery, but I also speculate that there are many, less clear-cut instances which may involve the piriformis and possibly other issues. There is also the duration of PS prior to surgery which can play a role — chronic irritation of the sciatic nerve may over time become increasing difficult to fully resolve even with surgery, as there are other factors such as the tonality of the surrounding muscles. I would go a bit further and also say that post-surgical PT is fairly critical to recovery — the surgery itself is relatively simple, but may not in and of itself, be a ‘silver bullet.’

  104. Mike abruzzo
    October 17, 2016 at 12:04 pm

    I should have mentioned I have had this pain for 4years and did everything under the sun before the surgery. My L4 L5 and S1 were all good as well. I still have knots deep in my hamstrings and my IT bands as well. Will work those out as the months go on. I live in Phoenix so it was a tough decision to go to Milwaukee but I’m glad I did. I believed eve Matts blog set me on the right path and I am grateful to him for that. Feel free to email me directly w any questions. mikeabruzzo@gmail.com

  105. Mike abruzzo
    October 17, 2016 at 11:52 am

    I’m sorry to hear that your pain was not released after your surgery. Matt and I both used DR Heinrich in Milwaukee. The doc required a lvl3 MRI, ECG, and a piriformis injection before he would perform my surgery. I had surgery aug 18. Recovery was literally in days. A bit sore from surgery but no pain killers needed. I go back nov17 for the other side. Hope that helps

  106. October 17, 2016 at 9:08 am

    Thank you, honestly, for sharing such a detailed timeline. And it really drove home your hopes and disappointments over such a long time. My own Ortho surgeon and pain mgmt Drs have moved just as conservatively over 2 yrs to treat my sciatica. Finally on 9-20-16 I had an L5-s1 microdiscectomy and laminotomy. He removed three huge disc fragments which had ejected past and were not compressing the S1 nerve root (clue #1) and I woke up in recovery howling; the sciatic pain had never been worse Clue #2). They kept me hospitalized for 3 days for pain mgmt.
    I was supposed to go back to work in 2 weeks. It has been a month.
    So I’ve lain flat researching and what do I hear of for the 1st time in my 45 yrs? Piriformis syndrome. And every motion test I can manage to do without compromising my disc recovery is positive (clue 3). I’m on lyrica, Celebrex, Vicodin and dilaudid, walking with a cane. All they give me is steroid epidurals! The Ortho keeps suggesting “going back in ” to “look for a missed fragment of disc or bone irritating the nerve”.
    So this past week I mentioned PS to my ortho’s PA for the first time and she said , “Well it would be a 1 in a million but yes, you could have both ( a ruptured disc AND PS)”.
    But I am absolutely convinced of it. I was trail running 6 mi/day and had introduced a lot of incline running when the pain took me down.
    I see the Dr for a post op this week and I am going to suggest MR-Neurigraphy ( a $4k out of pocket test to visualize root and peripheral nerve compressions and sciatic nerve confirmation above, below or throughvth piriformis). I want to know if you had MR-Neurography AND what type of specialist performed your release surgery. That’s a huge step and you must have been terrified.
    If you see this, I beg you to write back! Thank you for sharing. I’m in so much pain and I’m really scared I may know more than my caregivers at this point. – Michele M., Tucson

    • October 19, 2016 at 1:49 pm

      Michele Martinez I’ve sincerely read your post several times and I keep thinking about the why behind the how in your situation. Have you ever considered biomechanical issues regarding your sacroiliac joints and pelvic neutrality. The piriformis gets over worked when there is a problem with the joint(not in neutral or rotational patterns) as it is a stabilizing muscle to the sacrum. Also if the feet are pointed out it shortens the piriformis. Over tight piriformis can cause the horrible sciatica and the nerve pain not be from the discs themselves. Also si joint dysfunction contributes to disc fissures bulges. Also any anatomical leg length discrepancy contributes to rotational patterns and many people don’t know this till later in life after things start going wrong. I’ve talked to many athletes because of my own personal blog and have lived the journey myself and out the other side now. I do encourage the MR neurography to see the position/irritation of the sciatica, along with a provocative emg test of piriformis comparing the difference in H-wave between neutral and FAIR position. Now a complete release of the muscle for some patients can have a destabilizing effect to the si joint. Just wanted you to know that your post did not go unnoticed. Very sincerely, Kim-AHE Health http://www.si-instability.com

  107. Ashly
    October 12, 2016 at 4:28 pm


    That is amazing. I’m so happy for you. I’m so glad Dr. West was able to help. My piriformis and nerve are quite stubborn and taking their time healing. I was doing amazing in March, but over did it and went backwards. I’m just barely back to walking. I guess after my nerve was compressed for so long, it needed more time and I pushed too hard. It’s 100% better than before surgery. I can sit for hours now. My insurance decided last week to cover my surgery.

    Glad you’re improving!

  108. Tamily Butterton
    September 13, 2016 at 9:45 am

    Hi your diary of events is very similar to my story, I have suffered for over ten years now with piriformis syndrome. Took a long time to get a diagnosis as many Dr’s didn’t believe me and Nov 2010 I had a large open incision to release my piriformis muscle, sadly I’ve deteriorated and I have a feeling I have scar tissue forming catching the piriformis muscle. Sadly the other buttock and leg is bad too. The surgery isn’t as advanced on the NHS and finding help is proving very hard.
    I am from Birmingham UK and interested in knowing who helped you with your piriformis syndrome and in particular the surgery? I’d be grateful if you could help me as it’s constant agony and I’m in so weak in my legs. It’s literally ruining my life.
    I’d appreciate your help. Thank you

    • Georgetta Morque
      September 27, 2016 at 7:05 am

      Has anyone been told about crossed syndrome? A physical therapist, my 10th person over 8 years, thinks I have this problem – forward pelvis, tight hip flexors which are impacting the glutes and piriformis. Maybe it could make sense but so far I can get the hip flexors to release.

    • Jag Dhami
      October 19, 2016 at 12:06 pm

      Hi Tamily,

      I live in Oldbury, I’ve had piriformis syndrome for over 8 years. I’m currently in contact with a Dr Dieter Mortier in Belgium who has a lot of experience in piriformis release surgery. I’m trying to get a bit more info about him and the success of his Surgery. Type his name on Google with piriformis and you will be able to see the links for his website.

      I was just wondering if you don’t mind, can you tell me how you got the open incision surgery on the NHS? They are not even looking down this route for me & I just wanted to how it compares to Dr Mortier.


      • Ak
        November 20, 2016 at 2:39 am

        Hi jag,how did u get on with this doctor in Belgium?

  109. Mike Abruzzo
    September 6, 2016 at 3:01 pm

    I am NOT a fan of Dr. Filler based on my research on the net from others. I had surgery two weeks ago done by Dr. Henriech. He did an amazing job. I go back in Nov for the other side

  110. Kay Borkowski
    September 2, 2016 at 10:50 am

    If you are in Florida, check out this web site and ASK who they would recommend as a piriformis doctor in Florida. The group gives second (or first) opinions on MRNs. Dr. Michael Zlatkin of National Radiology in Deerfield Beach/Weston, Florida. The National Radiology web site is http://nationalrad.com/radiology/radiologists/?radiologist_id=1 .

  111. Tom
    August 31, 2016 at 8:43 pm

    Hi all,

    I just wanted to check opinions. I have decided either to see Dr. Flller in LA or to seek a botox shot. I had a steroid shot but is was pretty poorly done so don’t know.

    Which is best for “emergency” attempt to get back using a leg?

    My situation:
    Unlike most on this board (maybe) I can’t walk at all…my leg was immobilized for 12 weeks and now I have no let muscles at all AND severe PS in that leg. Every one of my gluteal muscles in in perma spasm. Don’t even know if that leg will ever work again. Stuck in bed, can’t get to appointments with Docs (because you have to walk into their offices).



  112. Ashly
    July 16, 2016 at 5:30 pm

    Sharon, I would love your contact info. My nerve is acting somewhat similar to your husband’s. I had surgery in January, it was open due to the amount of scar tissue.

    • August 19, 2016 at 3:27 pm

      sorry, just reading this…please send me your e-mail

  113. Shelley
    July 16, 2016 at 12:18 am

    Suffering for 5 years. Reading your history is like reading mine including all injections, P/T which left it worse. Pain doctor said piriformis problem and gave injection which gave me temporary relief, but injections are not helping as much. I want my life back. I had to give up tennis and can’t even walk my 3 mile walk. I’m 59 and can’t remember what it’s like to walk without a limp. So depressed but then found this site. I’m in Houston TX, medical Mecca with a jillion orthopedists…Any physician recommendations in Houston? I’ll travel if necessary.

    • July 16, 2016 at 11:39 am

      Shelley, have you ever considered lack of neutrality of your pelvis and/or sacroiliac joint dysfunction whether a joint dysfunction(inflammation within the joint) or more realistic extra articular laxity or positional torsional going on that causes the Piriformis to be over working. I would suggest looking into postural restoration institute trained therapists and you would have to make a trip to Austin for some good ones as there is only one listing I think in Houston. Here is PRI main website that has tab upper right to find providers: http://www.posturalrestoration.com
      Now this would only help you regarding bio-mechanics but if there is true scar tissue on the nerve then a neurolysis surgery down the road. I found out in my own journey that my undiagnosed anatomical shorter leg created some of my torsion to my pelvis and then pressure on Piriformis. And I’m 56, all good now. Here to help in any way sincerely, Kim-AHE Health, my personal blog: http://www.si-instability.com

    • July 16, 2016 at 11:42 am

      Shelley – my husband had open piriformis release from a hip trauma doctor here in Dallas, TX. “our” story is through Matt’s blog, which sometimes you have to go deeper and deeper in the comments to find. Dr. Adam Starr (UT Southwestern @ Parkland) and Dr. Chhabra is the Radiologist who specializes in the injections. Highly recommend and so worth the trip. You won’t be disappointed. Google and read about Dr. Starr…he was named as one of the top traumatologists in the US!! Even though my husband is 80% better and is now able to function, he still has issues with some of the other nerves and muscles, continues to work out every morning, and continues to go periodically to PT at Zale Lipshy/Dallas, for more deep needling and cupping, in trying to wake up muscles. You see, he had disc herniation surgery in 2013, and had lots of trouble in trying to wake up muscles that had been inactive due to the trauma. He had total knee the end of 2014, which aligned him back to a new normal, and Feb 2015 is when the piriformis “hit”. We feel all the issues are connected and now he’s trying to get back to a new normal. Before the PS surgery, he basically had 24/7 nerve pain, and coughing/sneezing/sitting on the commode, were unbearable. Dr. Starr in his 20 plus years of putting hips back together at the Dallas County hospital, which is a “bunch”, said he had NEVER seen a piriformis muscle adhered to the pelvic bone with the sciatic nerve behind it being smashed. So, it makes sense that the sciatic nerve being smashed for we know 7 months, may take longer to get back to a new normal and not “instant” as some others may have experienced. My husband’s was not “split”, like some. Good luck and google Dr. Starr; go to UTSW website and read about him…he is the nicest guy you would ever want in your arena!! We feel the same about Dr. Chhabra!! The problem we learned is that people go years seeing doctor, after doctor, after doctor, who don’t understand or care to know about PS! Dr. Starr and Dr. Chhabra know and understand, and are there to help you get better!! It would be totally worth your 4 hour drive to Dallas to see these guys!! If you want more information outside of this blog, please send me your e-mail. Good luck!

    • July 16, 2016 at 11:55 am

      One more comment…people will ask, is the surgery worth it? Every case is different…I can tell you watching my husband BEFORE surgery, and now 10 months afterwards, it WAS worth it! Even though he wasn’t “cured”, he at least has a better, functional, life back, that he deals with ever morning by going through an hour plus routine of stretches and exercises. He continues to research the internet/youtube, etc., in trying to figure out what muscles are involved and need “working”. His PT “LISTENS” to him, and understands he is not the “normal” patient, and that he is over the top compliant in doing every thing and more in getting back to a more functional life. He has not golfed in four years and his goal this year is to at least putt. This condition is life altering and life changing, not only for the patient, but the spouse. It’s not been pretty under our roof. It’s difficult to be pleasant when you are struggling just to move. It’s difficult to have the load on your shoulders (i.e. mine), and be nice and understanding. We’ll be married 39 years next month and this past year and a half has put the most strain on our marriage than anything else. Did I say it was life altering and life changing? Yes, I’m repeating…it is a struggle for the spouse, as well. So, when people are asking, was it worth it? It is my opinion that no two cases are identical. You have no idea what other underlying health conditions others may have…some say they had instant relief, others, like my husband, 80%…80% is so much better than where he was, so YES, it was worth it!! All of my husband’s “back issues” were on the opposite side…thank the Lord they weren’t on the same side, as he would have had unnecessary back surgery! Good luck and send me your e-mail if you would like to have more dialogue…

  114. Deanne
    July 13, 2016 at 3:27 pm

    Does anybody know about a doctor in South Florida that specializes in piriformis syndrome? I have been told that I have this about 8 years ago. Like everybody else, I have had Botox, PT, many injections, pain management – used Lyrica, Gabapentin. – you name it and I’ve tried it. I am never without pain. Sitting and lying down are the worst. I will appreciate any advice or info.

    • KB Sloan
      September 2, 2016 at 10:15 am

      Hi, did you find a doctor in florida that does piriformis release? I have suffered constantly for years and have tried every form of therapy and shots.

  115. Mike Abruzzo
    July 11, 2016 at 6:34 pm

    Hi Matt,
    I was hoping you could email me so I could ask some questions going forward with Dr. Heinrich. I just got in touch with Debra to strart the surgery set up process. I would really apprectiate it. My email is mikeabruzzo@gmail.com Hope to hear from you soon. If anyone else on here wants info that I may be able to help feel free to email me. Just put Piriformis in the subject line.
    Thanks Matt

    Mike Abruzzo

  116. Patti
    June 28, 2016 at 4:14 pm

    Be very sure you’ve got the correct diagnosis before surgery.

  117. George Shanley
    June 28, 2016 at 3:19 pm

    I’ve had PS for a year now. Tried every treatment available in the UK including injections.
    Can’t find any surgeon who is will to perform surgical release. Willing to travel anywhere.

  118. Ashly
    June 21, 2016 at 1:01 pm

    I’m still waiting on the insurance. I know he’s done three surgeries since mine. I’ll ask if those companies covered it next time I go. We have a local Utah insurance company for teachers and apparently they’re just difficult. The doctor is almost positive it will get covered. It’s just slow. I haven’t gotten a bill yet though 😊 You’ll see his PA Jenny first. She’s amazing!

    • Paula
      June 21, 2016 at 2:33 pm

      Ashly, how are you, now that some time has passed? Do you feel the surgery was worth it? How long did it take you to feel back to normal or do you? Mine hasn’t been going on as long as others or yours, but I can’t stand much more of this. My butt area has been numb since Dec 6 (but no, it is not cauda equina or whatever) and have had MRI’s, 5 injections in 6 months (with little relief…none have been in the piriformis yet and when this initially started, it was more in my right side and now its more in my left…weird), 14 PT visits (that didnt help). I am now sleeping in a recliner at night, because a bed, is just agony. Walking, standing, sitting and especially laying flat down is all awful. Driving is really bad too, so I’m limited where I can go. I have a daughter, who I have missed out on things with, due to my stupid limitations and pain. I’ve had 2 back surgeries in the past and this doesn’t feel like that…I mean, the leg pain does, but the origin, is clearly felt in the area of the piriformis. I press on it and its jolting…I can feel it all the way to my ankle, which feels like its on fire…very tender to the touch. If I drive too long, my right foot goes numb, with the back of my thigh burning. In any case, I can’t go years like this..This is no life. I am glad Ashly that you found someone in Utah; trying to find a Dr with a clue is exhausting. I see my back dr on Thursday and will ask him for a referral to Dr Hugh West. Do you think it is worth it to ask for a shot in the piriformis, while I wait? I went to see a hip Dr yesterday and he took xrays of my hip, but apparently didn’t find anything wrong and said he felt my issue was with my back…same as my back dr…but if that really were the case, why is my butt numb and why are the back injections not working, when they used to work just fine. So, I hope Dr West will see me, even though I don’t have hip involvement, it appears. What are your thoughts?

      • June 21, 2016 at 10:21 pm

        Paula have you ever considered sacroiliac joint dysfunction as the piriformis muscle is a strong stabilizing muscle for the joint. About 40 % of people with si joint issues have concurrent piriformis syndrome. If you were to get a piriformis release and the underlying cause is a hypermobile si joint, the joint will further get destabilized. Just sharing food for thought. Sincerely, Kim -AHE Health author of my own personal blog http://www.si-instability.com

      • June 22, 2016 at 12:08 am

        Kim, I had not considered that, nor heard of it. I will research more into it. Thank you for bringing it to my attention. I will also make sure that I get 1st and 2nd opinions before I opt for any kind of surgery. I just want this pain to go away. Injections usually fix my leg pains, so it has been frustrating to not get that kind of relief. And the medications that do help with nerve pain, don’t agree with me and the others are not yet legal in my state. I also had had an EMG done that came back basically normal, but now I am realizing they should of done a FAIR EMG (I hope I have that correct), to get a more accurate picture. I see my back Dr on Thursday, do you have other suggestions or thoughts that I should talk with him about?
        Thanks, Paula

      • Ashly
        June 22, 2016 at 5:05 am

        I’m so sorry. That is awful. I would definitely recommend a shot in the piriformis and possibly your SI. You’re in Utah? My email is brown.ashly@yahoo.com. We could have lunch 😊 Everyone said it was my back too. Right now I’m doing some interesting breathing that helps with stress and pain. Meditation is also great. I was doing excellent, then I went back to work and back to every day life, too much too fast I guess. My SI joint got so sore, then my foot started to tingle. They made me go back to crutches. Still on crutches. I go tomorrow, we’ll see. They also took away all PT except the pool and nerve glides. Are you doing nerve glides? It’s back to being better, but I have to be careful. I’m learning to be patient. I also had two SI joint injections that really decreased the tingling. I guess sometimes piriformis and SI problems go together. I’m not sure you need a referral for Dr. West. You’ll see Jenny first. She’s great, my favorite. I think she decides if you need to see Dr. West, even if you have a referral. Good luck! Please let me know if you have other questions. I cannot sleep and this hasn’t been proofread😉

      • Paula Randall
        October 12, 2016 at 3:43 pm

        Just to follow up, I was able to get in to see Dr. Hugh West at TOSH in Salt Lake City, Utah thanks to Ashly’s suggestion and he really does know his piriformis. It was nice to finally talk with a Dr. who knew and understood what I had deducted. After getting an MRI of my hip area and being referred to a Pelvic Floor PT, because I am having multiple issues with my legs/butt…he is convinced my left side pain is from my piriformis. I just had an injection a few weeks ago into it and had almost immediate relief! Prior to that injection I was sleeping on a recliner for the past 6 months, but after the injection, I have been able to lay on my back again and therefore, in my bed again! I hope this injection lasts, as I have ZERO pain in my left afterwards (and fwiw, the first injection in my piriformis from another Dr…didn’t do squat). I know that what is causing my pain on my left is the compensating that I am doing to stay off my right butt cheek/leg and I can’t NOT do that, until my right is fixed…but its not my piriformis causing my right side pain, unfortunately….its much more complicated than that. Thank you for this blog…without it, I would not have found Dr Hugh West and would still be in agonizing pain!

  119. Alan
    June 17, 2016 at 6:59 pm

    Matt, I don’t know if you’re still monitoring this site. I just had the surgery on May 11, 2016.
    I’m still in quite significant pain. I noticed you said that your recovery took 6 months. Could you give me a little more detail about what you went through in recovery.

  120. Maria
    June 7, 2016 at 7:02 am

    Greetings…I had an accident 3 years ago and I’ve been living with excruciating pain. I have been under doctors care through workers comp and I am sure they have missed something. I diagnosis myself its the only explanation for the pain…I am looking for a doctor that can diagnose and treats Periformis Syndrome in the Miami Fl area… Thank You

  121. Rob Sutherland
    May 6, 2016 at 2:52 pm

    This mirrors exactly what I have been living for the past 8 years. Can you please advise who your surgeon was – I am Canadian but will travel anywhere and pay whatever it takes.


    • N. Vosylius
      May 19, 2016 at 2:35 pm

      I am in the same boat – please let me know if there is a response for the Canadian surgeon.

  122. judy L
    April 16, 2016 at 6:30 pm

    Kim, I had MRN at Hohn’s Hopkins that showed some little things but didn’t show PS. Later I had provocative EMG by Dr. Fishman in NYC that confirmed PS. I had the PT protocol but didn’t help so at his suggestion had Dr. Filler’s MRN done in Boston. That suggested PS, It was worded “consistent” with PS. That info led some surgeons in Boston to revisit with me but 3 could not read it and the one that could did not see or agree with Filler’s report. I would consider traveling to one of these PS Drs but maybe only to hear they can’t help me. I have not responded to any shots and have had multiple, piriformis and SI joint. Also had Botox. So wondering if this is even what I have. 4 1/2 years. Good luck to you on this quest. It is not an easy one.

    • April 17, 2016 at 12:18 am

      thank you Judy for all the good info, I just need it for other patients that contact me personally on my own website blog wanting to know about MRN’s. . I hear your heart cry and only other suggestion I can make for you is Postural Restoration Institute(PRI) trained p/ts have had success with some of my website fellow patients that I have referred to for piriformis syndrome. PRI exercises have a very interesting way to re-orientate the body/pelvis to neutral and I have worked with my PRI therapist for 5 full years straight. I’ve yet to see other conventional p/ts explain or do the same thing. My sports doctor says there is in most cases some component of SI joint dysfunction going on but I assume you have been manually checked for this also. Here is link to the homepage and a provider search tab is in upper rt corner: https://www.posturalrestoration.com/ Sincerely, Kim-AHE Health http://www.si-instability.com

      • judy L
        April 17, 2016 at 6:54 am

        Thank you Kim

      • Kay Borkowski
        June 18, 2016 at 7:24 pm

        I believe that Dr. Michael Zlatkin of National Radiology in Deerfield Beach/Weston, Florida, gives second opinions on MRNs . The National Radiology web site is http://nationalrad.com/radiology/radiologists/?radiologist_id=1.

        Hope this helps,

    • Xander
      April 17, 2016 at 10:10 am

      Thank you for sharing this info Judy. I am also in Boston and I am looking for answers 14 months in now. 5 MRI’s, Ct Myelogram, X-rays and several other tests, a discectomy and almost 90 appointments and I still have bilateral leg and buttock pain. I’m thinking of having this MRN done soon. The question for me is do I go with the Nuerography institute and pay double what they charge to have the test done on both sides or do I go to a hospital like John Hopkins to have it done. When you had you test at John Hopkins did they scan from your lower spine (L4) done to your leg?

      • judy L
        April 17, 2016 at 9:18 pm

        Xander, I had spine L-5 and also pelvis done at John’s Hopkins. This is the description of the technique ………….
        TECHNIQUE: High resolution fi/Rl was performed of the lumbosacral plexus and sciatic nerv”e employing MR neurography techniques on a 3-Tesla system using multiplanar 3-D anatomical and fluid sensitive sequences. Contrast material was not administered. Multiplanar, multisequence images of the lumbar spine were obtained.

        For me the results were basically the same as all the other MRIs I had at different hospitals. None of them showed anything.

        The MRN which I had with Dr. Filler, the Neurography Institute was the only one that suggested PS in agreement with Dr. Fishman’s provocative EMG.

        Dr. Filler’s MRN opened up some doors for me to see some surgeons but none of them could read it and the Dr. that could didn’t agree with it. They had all heard of Dr. Filler but didn’t have anything to say about his MRNs. I guess I expected more positive feedback, although no one said anything negative just had doubts or just didn’t know. The problem with even a probable diagnosis for me is that I have had multiple piriformis shots by different hospitals along with botox and nothing worked, even temporarily.

        Have you had any shots? Did they give you even temporary relief?

        I don’t know if this has helped much but this was my experience. Yours could be better.

        Please let me know if you do decide to get the MRN and you find a Dr. in the Northeast who can read it.

        Good luck and keep us posted. :))

      • Xander
        April 21, 2016 at 12:58 pm

        Thank you Judy, I had an injection in my right buttock a few months ago and it knocked the pain down from a 9/10 to about a 4/10. It only lasted a few hours though and the problems with me is the pain is always shifting. Sometimes it’s in both sides other times only one side.

        I’m looking into seeing Dr. Chhabra.

      • judy L
        April 21, 2016 at 8:52 pm

        Xander, the fact that your shot brought you down even for a while supports a piriformis diagnosis. I have heard really good things about Dr. Chhabra and Dr. Star and I haven’t been able to find anyone with their experience in NE. I think he has helped a lot of people on this site. Good luck to you and keep us posted. I hope you find the help you need.

  123. Tracy
    April 16, 2016 at 1:52 pm

    Avneesh Chhabra (Radiologist) at UTSW in Dallas.

    • Xander
      April 16, 2016 at 6:12 pm

      Thank you Tracy!!

  124. Xander
    April 16, 2016 at 11:16 am

    Hi everyone, one quick question. Does anybody know any hospitals in the US (preferably the Northeast – New England area) that does Neurography? I’m familiar with the Nuerography Institute but was wondering if their might be anybody else who does these scans and reads them in the US?
    Thank you in advance!

    • April 16, 2016 at 12:39 pm

      An addition to Xander’s request, is there a specific place I thought I’ve read previously on this chat in Texas that did the Neurography that was independent of the Fuller Institue and read their own scans. And/or anyone done business with John Hopkins for piriformis syndrome. Just trying to find some resources. Thank you Kim AHE Health

  125. April 7, 2016 at 3:42 pm

    Xander, it was great talking to you in person and I sincerely hope I answered your questions and inspired you to keep the good fight of faith to find a resolve and help in your situation.Sincerely, Kim-AHE Health http://www.si-instability.com

    • Xander
      April 16, 2016 at 11:14 am

      Thank you Kim, likewise!

  126. judy L
    April 4, 2016 at 8:02 am

    Dr. Borgstein is great. She really tried with me. We discussed prolotherapy but thought because I had no relief at all from shots she gave me that good chance it wouldn’t be effective. If I had had some relief for even a shot time she would have tried it. I would suggest she is a person worth seeing if you have had SOME success with shots.

  127. Tracy
    April 3, 2016 at 8:27 pm

    I had open PS surgery but the cut was from below my hip to the bottom of my bum. The glutes were separated but not cut. If you message me your email I can post a photo or even send you the surgical report. He should have a clear understanding of how it was done with the report.

    • Jim
      April 3, 2016 at 8:44 pm

      Hi Tracy, when did you have surgery, how long was recovery process (weeks?) and how are you doing now?

    • Kay Borkowski
      August 19, 2016 at 1:15 pm

      Hi Tracy,

      I would like to either talk with you or e-mail you about your open surgery with Dr. Starr. I understand you travelled to Dallas for your surgery and stayed some place there until you were able to fly back to your home. Please e-mail me at kaybork@yahoo.com.

      Kay Borkowski

  128. judy
    April 3, 2016 at 4:39 pm

    Thanks Patti. I already spent some time with Joanne Borgstein. She gave me shots with no success. I was referred to her by a Dr. from MGH. Joanne ultimately referred me to a surgeon at Brigham and Women’s who gave me another MRI and Myleogram. He didn’t find anything that would cause this. After Filler’s report I revisited all my Drs. sending them Filler’s report. This surgeon that Dr. Borgstein had referred me to agreed to see me again. He reviewed Dr. Filler’s report and looked at the actual disc with other radiologists and they did not see what Dr. Filler saw. No one does. He DID agree to operate on me but it would be more exploratory. He had only done a performis release a few times some 20 yrs ago. It would be open and if it were piriformis that would not be so difficult but it’s slicing thru the gluteus maximus that’s the worse part he said. Long recovery and only 30/70 odds. Odds of only 30% success. I am not that big a risk taker and if I could find a Dr. that agrees with Dr. Filler’s report, has done a number of these surgeries I would do it.

    Thanks so much Patti for your lead and good luck again to you.


  129. Patti
    April 3, 2016 at 4:32 pm

    Hi there, her name is Dr Joanne Borg-stein. I don’t have personal experience but know someone who travelled from Australia to see her. Apparently she can request and read mris or images of si ligaments and she does regenerative injections like prolotherapy. Non surgical solutions. Google her to see if she looks like what you are looking for.

    I also had an mrn done by dr filler and my local doctors also disagreed with it. Tough to find qualified doctors.

  130. judy L
    April 3, 2016 at 3:13 pm

    Patti. I just saw your post regarding possible Dr. at Harvard. I would also be so grateful if you could find his/her name as I am in Vermont.

    I am still dealing with this and just end up full circle being referred to yet another surgeon who can’t read Dr. Filler’s report or do not agree with it.

    I am glad to hear you are doing better and hope you find a full resolution soon.

    Thanks much,

  131. Patti
    April 3, 2016 at 2:31 pm

    You might want to try Dr Joanne Borg-stein.

  132. Patti
    April 3, 2016 at 2:28 pm

    I have the same symptoms as you. You might want to try a ct guided piriformis Botox injection. Also maybe see a pelvic floor physiotherapist and be assessed for sacroiliac joint dysfunction(Sijd). I’ve been diagnosed with Sijd and secondary piriformis syndrome. I’ve been getting g regenerative injections – prolotherapy and recently platlet rich plasma (prp) injections. They have helped me as has the Botox injection, but nothing has completely cured me. Diagnosis between the lumbar spine, si joints and piriformis is difficult. There are only a handful of doctors in the US that I’m aware of who can tackle it. They diagnose through diagnostic injections – numbing a small area and seeing what effect that has on you. They are known as interventional Orthopedic specialists. One is Dr Shiple in Philadelphia and the other is Dr Brown near Seattle. There is a doctor at Harvard, I will try to find her name for you.

    • Xander
      April 4, 2016 at 1:00 pm

      Thank you!

  133. Xander
    April 3, 2016 at 11:32 am

    Hi Matt –
    Thank you for this blog. My story is very long as well (way to long to type here) and still no one has found what is wrong with me. I am in the Massachusetts area and hoping that you or someone here might be able to help me find a doctor that can help with this and tell me if I do in fact have Pirifromis Syndrome. I have bilateral leg and buttock pain, sometimes it is only in one leg(and/or buttock) and othertimes it is in the other or both legs(and both buttocks) at the same time. – First is that normal for Piriformis to be in both sides and/or one side at a time and shift throughout the day(s)?

    I had a discectomy on L4/L5 for a herniated disc last May and I am still in pain. Prior to this I had a Transforaminal Steroid Epidural Injection at L4/L5 a few months prior. Before I had this injection I had zero leg and/or buttock pain. After the injection the pain in my legs occurred. I have had 5 MRI’s on my lumbar spine, an EMG, several more injections, a CT Myelogram, been to 3 physical therapists, just about every major spine surgeon/doctor in the Boston area including others; and no one can pin point where my pain is coming from. The CT Myelogram shows a little compression on my left side but doesn’t explain the pain on my right side. I had a Piriformis injection without steroid on my right buttock and it numbed the pain down from like an 8 or 9 out of 10 to maybe like a 4, but it barely lasted. Is their anyone that maybe you or anyone here knows in the MA or Northeast area that can determine if it is my Piriformis by performing an MRI, etc?

    I have been in extreme pain and essentially disabled for 14 months, around 90 doctor appointments. I am 34 y.o. male and previously to this in extremely good athletic shape.

    Please help.

    Thank you all very much and God bless.

    • Georgetta Morque
      April 3, 2016 at 12:02 pm

      So sorry to hear about all of your suffering. I too have had a long history of piriformis, glut, and high hamstring pain and have had many different treatments. It’s been more recent, however that doctors/PTs are pointing to the SI joint as a possible source. I had an SI joint injection which maybe helped a little, plus addition PT ( I have all kinds of PT ) but with the premise that the sacrum/pelvis is misaligned and I have muscles that have not been used and others have been overused, which is causing the pain. While most of my pain has been on the right side, my left side has been bad as well perhaps from compensation. So I don’t really have piriformis syndrome. I’m not free of this and maybe never will be, but I think I might be heading in the right direction. Have you seen someone who is a specialist in body mechanics? I’ve found better luck with experienced therapists ( with advanced degrees) who I think know more about how the body works that the doctors. Don’t know if this is at all helpful but maybe something to think about if you haven’t already. Hope you can find relief and live life as you should be.

      • Xander
        April 3, 2016 at 12:24 pm

        Thank you for the reply. I have seen 2 PT’s that are available I guess generally, and then I paid a lot of money out of pocket to work with a trainer/PT who works with professional and Olympic athletes in the area. Did everything to a T and nothing gave unfortunately.

    • April 3, 2016 at 11:04 pm

      Xander, one of the best professionals is Vicki Sims, PT at Gainesville, Physical Therapy in Gainesville, GA an hour north of Atlanta. to evaluate for Sacroiliac Joint Dysfunction and she works with an excellent Pain Doctor in Atlanta that does a thorough provocative emg testing of the piriformis. His name is Dr. Ernest Howard. Also the other suggestion is I’ve referred some athletes in LA to specifically trained Postural Restoration Institute Trained physical therapists that bar none made an impact on these athletes with similar pain issues. Search here is a link to their website that has a provider search tab in upper right hand corner. http://www.posturalrestoration.com/ If you can’t find someone in your region there is a top clinic in Georgia (Cantrell Clinic) I send another patient too. Anyhow, just wanted you to know you are not alone in this journey to sort out the pelvis. Sincerely, Kim-AHE Health author of my own personal blog http://www.si-instability.com

      • Xander
        April 4, 2016 at 1:03 pm

        Thank you Kim. If you don’t mind me asking, did you have Sacroiliac Joint Dysfunction? Are their certain symptoms that I should be aware of etc, that perhaps align with mine? How would they diagnose it?
        I was looking at the Nuerography Institute in perhaps having a scan done to see if that helps pinpoint where the culprit of pain is stemming from. There is an outpatient office in Boston I believe. Thank you again and look forward to your response.

      • April 4, 2016 at 4:51 pm

        Georgetta Morque, I read your reply. Please contact my website contact page at this direct link: http://si-instability.com/contact-kim/
        I am here to listen and help as a loving gift to the internet world. Would love to go over the details with you so send me a direct email if you would please with your phone # and I will call you to chat and we can take it from there. Rest assured I am a patient just like you and I’m not selling or soliciting anything. I just wrote my own blog/website like Matt did here in order to help others. I have a passion to see the suffering ended if at all possible from SIJD. Thanks for inquiry!

    • April 4, 2016 at 3:09 pm

      Xander, Yes I had extra articular SIJD meaning ligaments were not holding my alignment of the pelvis and I had left anterior rotation and right ilium upslip posterior rotation. I never found out I had a true shorter leg till later in life pre-disposing me to the pelvic rotation issues. I had a chronically tight and stretched left piriformis and and tight right one. Now 3 years after my si screw fixation surgery the muscles have much more balance to them. I was getting piriformis sciatica(which creates non dermatonal specific nerve pain diffused throughout the buttocks and back and front of thighs and when really severe going the rest of the way done the leg) on my left side but did not have a piriformis release. I wanted to see how I would do first with stabilization of my SI joints. For me I made the right choice and now 99% of the time I do very well with simple maintenance massage and fascia rolling. SIJD is truly a hands on diagnosis by a trained chiropractor/ or physical therapist as in many cases nothing will show up in the joint until there is wear and tear damage and inflammation. With SI dysfunction pain usually gets worse in the day and better after rest because it is the weight bearing joint. People with SI problems usually can’t sit too long or stand too long in one position. The piriformis muscle is a stabilizing muscle to the si joints and if the joint is unstable is is normal for that muscle to be on alert to take over and stabilize. Now of course there are other reasons as discussed on this site blog but I am answering in regards to SI dysfunction. Also it is very common and normal with an SI joint situation to also have concurrent L4-S1 lumbar issues, herniations, buldges fissures. I blew out my L5-S1 when the SIJD happened. Even though the L5-S1 was fixed, I still suffered 10 more years of the undiagnosed SIJD(or should I say diagnosed by chiropractor but not by mainstream medical). I just encourage you to look into this issue while simultaneously have your Neurography testing done too. Besides going to the lady in Georgia, I believe the PRI trained pt’s have the best help for analyzing the pelvis. I’ve had many fit athletes call me on my website contact and I encouraged them to be evaluated for the SI and/or going to a PRI trained P/T and everyone loved the PRI trained p/t’s. Sometimes its as simple as imbalance of muscles with natural asymmetry that we all fight against. That is where PRI therapists excel because of their training in understanding the predisposed asymmetry we all can have let alone and injury on top of it. Feel free to contact me directly on the contact page of my website for further discussion if you so choose. Always here to listen and help in any way possible.

      • Georgetta Morque
        April 4, 2016 at 3:32 pm

        This is very interesting information since I’ve been told I have SI joint disfunction which could be the cause of my pain in the piriformis, gluts and hamstrings and chronically tight muscles. After injections everywhere else possible ( hip, periformis, glut, hamstring PRP, etc) I’ve just had an injection to the SI joint. I’m back to doing strengthening exercises but I’ve done so many exercises for years and my pelvis still cannot maintain alignment and I also have a rotation and a leg length difference. Maybe I should look into the surgery you mentioned although it sounds so frightening. Where did you have it done? What is your website? I’ve love to find out more about the PRI therapists you mention. I feel like I’m going in circles but maybe on the road to the right place with the SI joint. Thanks.

      • Xander
        April 5, 2016 at 10:49 am

        Thank you again Kim. I may reach out to you soon if that is okay? I recently had an XRay of my hip and the doctor said that my joints looked okay – it was an extremely quick visit though and felt brushed off as usual at most appointments.. Odd thing is, my left pelvis/hip sometimes feels as if you can imagine the bone is protruding out of the skin…not so much pain like the pain I feel in back of my hamstrings, buttocks and outside behind my outer knee; but rather just a discomfort. Spine surgeons say it has to do with the spinal discs but I don’t know. This was the first thing I felt after my TSEI 14 months ago which started this whole thing.

    • Joshua
      November 10, 2016 at 9:39 am


      I am a 34 year old male, living in MA, who is experiencing similar problems. How can I message you privately, so we can combine out efforts to find a solution?

  134. Debbie
    April 1, 2016 at 12:44 pm

    Hi Matt
    My son has been suffering from PS for at least 2 yrs. It has been debilitating to him as well as his family. I am wondering if you know of any Dr’s in Massachusetts that performs the release surgery.

    Thank you

    • April 1, 2016 at 12:47 pm

      Im truly sorry to hear about your son’s condition Debbie. Im also sorry I dont know a reputable physician in your area. Please search the blog to see what others say.

  135. John Temple
    March 20, 2016 at 4:55 pm

    Has anyone had this procedure completed in Texas? If so where, and by whom?

  136. Patti
    March 18, 2016 at 3:47 pm

    I’m having trouble getting help in Ontario, Canada. The surgeons here don’t want to do piriformis release surgery. When push comes to shove they say, oh well, you probably have multiple things going on, it’s not just your piriformis. That’s essentially healthy tissue etc. I’ve had every non surgical treatment possible too. Right now I’m doing platlet rich plasma injections to my sij and Botox to my piriformis.

    • Mitch
      October 26, 2016 at 6:16 pm

      Hi Patti it is a struggle hear in canada. I am contemplating going to the US to investigate. I’ve done about as much research as you can and getting prp into the SI and Botox into the piriformis is as far as you can go. One suggestion (and really it’s just a suggestion) have you had an MRI of your hip. I get that your trying to tackle the instability on the SI joint side of the pelvis but for full scope investigation would it make sense to have an MRI of the hip too?

  137. March 8, 2016 at 7:23 pm

    I live in Canada.they don’t believe in pirifoemissyndrome.l went 2 of orthopedic surgeon . Both of think this muscle does not give the problem.

  138. Char
    March 2, 2016 at 9:11 am

    Thanks Ashley, I’ll look into it, how is your recovery going?? Did it take u long to get back to speed? Are u doing post surgery PT??


  139. Patti
    March 1, 2016 at 7:08 pm

    Hello everyone, I’ve been suffering for 5 years. All of the signs are pointing to ps and I’ve had all of the possible non surgical treatments. Would it be possible for everyone who has had ps surgical release to post the name of their surgeon? I’m in Ottawa, Ontario, Canada and there is no surgeon here. Desperate.

  140. Ashly
    March 1, 2016 at 3:39 pm

    I recently had piriformis release surgery. I feel so much better. It has been a slow recovery. My doctor studied with Hal Martin, in Texas, but I had it done in Utah. It was the first time the surgery was done in Utah by this doctor. I felt good about the decision and thought my insurance would cover the procedure in-network. They denied the claim. I had surgery anyway, because I couldn’t handle the pain any longer. I’m in the process of appealing the insurance decision. I’m wondering how many of the piriformis surgeries on here were covered by insurance and your journey with your insurance company. Any evidence and specific information that you have is greatly appreciated. I feel like I should be able to say, “These insurance companies Texas are covering these procedures.” Thinking this might help. My doctor is also helping me with the appeal process.

    • March 1, 2016 at 4:01 pm

      I will help you Ashly. Ill reply later tonight. I had to fight with UHC to get the surgery covered here in WI. I think I have the actual document my surgeon wrote and submitted to UHC. Btw, UHC initially rejected it simply because this surgery didnt have a defined code associated with it. Therefore UHC’s system defaulted it to a general code (e.g. 9999) which was defined as “UNKNOWN”.

      • Ashly
        March 1, 2016 at 4:10 pm

        Thank you! I have used this blog for three years. It’s given me so much hope. Thank you!

    • Char
      March 1, 2016 at 6:25 pm

      What is the name of your doctor in Utah?
      I am in Boise and thinking I may need surgery, but there is no one here that does the surgery. Utah would be the closest place. Thanks.

      • Ashly
        March 1, 2016 at 7:55 pm

        I’m from Idaho! I love Idaho! My doctor’s name is Hugh West. He’s at TOSH in SLC. Make an appointment now, it took a few months to get in. Good Luck❤️

    • Patti
      March 2, 2016 at 9:33 am

      Ashley, how much did the surgery cost for self pay?

      • Ashly
        March 7, 2016 at 11:43 pm

        Sorry it took so long. My surgery ended up having to be open because of blood vessel proximity to my sciatic nerve. It was 24,000. I’m hoping the insurance appeal process is successful. My pain is gone. It’s just a slow recovery process.

      • Patti
        March 8, 2016 at 4:18 pm

        Ashley – how were you diagnosed? The surgeons in Canada say no surgery as they look at an MRI and say – that’s essentially healthy tissue.

      • Ashly
        March 16, 2016 at 11:57 pm

        I spent three years trying to figure out what it was. I had read about it and was convinced early on that it was my piriformis. I had given up, thinking that I had fibromyalgia or something, but my PA insisted I see one more doctor. He took x-rays of my hips. I had an FAI and a torn labrum. So, then I went to a hip specialist. The FAI and torn labrum weren’t bad enough to cause the sciatica I was having, or bad enough for surgery, but they assured my I was in the right place for my problem. The doctor tried all the PT I had been doing again. It didn’t work. I had an injection to numb the area around my piriformis and the pain was gone until the numbness wore off. I even tried a pain psychologist before surgery. I had an MRI of my piriformis, there was a definite difference on my left side. The doctor would not do surgery until I was absolutely at my wits end. It was the first time he had done the surgery, he went to Texas and studied. I couldn’t sit for longer than 10 minutes, couldn’t sleep, was always in pain, so I decided to have surgery. During the three years previous, I had an MRI of my back, MRI of my hip, CT of my hip, SI joint injections, tailbone injections, piriformis injections, dry needling, accupuncture (which sent intense nerve pain down my leg), and tons of PT and yoga. I’m really glad that I had the surgery. It helped. However, I had to have it open because of the amount of scar tissue and blood vessels near my nerve. It’s taking forever to get back to normal because of this. Eight weeks and I’m still on one crutch. I’m so sorry you are going through this. It is the worst. Listen to your body. The doctors will eventually listen to you. Good luck!

      • June 20, 2016 at 2:46 pm

        Thank you Ashly for sharing your success and a Dr in Utah that was willing to do the surgery. I am calling him now. BTW, were you able to get the insurance to cover it?

  141. judy L
    January 11, 2016 at 3:49 pm

    I had dry needling. I didn’t find it that painful. It IS painful for a few seconds but it doesn’t last that long. It’s quick, you recover then on to the next one. My sessions were an hour at a time and I went for 10 sessions. My provider was highly credentialed and respected and there were some people in her waiting room who had traveled hours to see her and were getting help. It didn’t help me. This was done in MA and I don’t think would have been covered by insurance. At any rate she didn’t take it. If you are just afraid of pain I would give it a try and see how it goes. I don’t think it was bad at all but everyone has a different threshold for pain. I know it works for lots of people but don’t know about PS. Good luck. I hope you find relief. I don’t wish this on anyone.

    • Georgetta
      January 12, 2016 at 1:39 pm

      Thanks Judy. I think I will try it. I don’t think it’s covered by insurance and in NY it isn’t even an approved practice. It is in Connecticut, though so I will try there.

      • judy L
        January 12, 2016 at 1:49 pm

        Good luck! I hope it works for you. Let us know.

  142. Noushaba
    January 7, 2016 at 10:53 pm

    I am suffering with outer thigh pain and hip pain for last five year.all my test r clear.dr said it is not the priformis pain.i did Mir of the hip.mri of pelvix.mrn every test is clear but if I just sit for 30 mins my pain get worse if I sleep on my right side my outer thigh is hurting if I sleep on my left side the left outer thigh is hurting no one have a answer of my pain if any one help me please help me.

  143. Jeannie
    December 30, 2015 at 3:58 pm

    Like Matt, I suffered for over two years with piriformis pain. I had open piriformis release one week ago and was immediately better. Scott McCloskey in NC is giving me my life back. I had countless injections, PT, RFA, acupuncture… All with minimal relief. I could walk the day I had surgery without the searing right side pain, and have no numbness or tingling. I’ve had very little leg pain and hope it will go away with time. I can sleep sll night with just Advil, and have not slept all night with serious pain meds in over two years. I would do this surgery again in a minute!

    • Lea
      December 30, 2015 at 4:50 pm

      Congratulations! I am 10 months out from open surgery. The past 4 years were like a bad dream. I am 100% now.

      • Ashly
        March 7, 2016 at 11:46 pm

        How long was your recovery after the open procedure? My pain is gone, but it’s been six weeks and I’m still on one crutch. I’m ready to be walking. When were you walking without crutches?

      • John
        February 8, 2017 at 6:17 pm

        Hi Lea
        Hopefully your still visiting the website. Can you give us an account of how you’re doing now?

    • Patti
      December 30, 2015 at 4:51 pm

      Jeannie: can you please describe your symptoms in more detail prior to surgery? I’ve been struggling to determine if the root of my problem is my piriformis or my sij. I have lots of leg pain which is nerve type pain and it’s not in any particular pattern and whether it’s down the back, down the inside thighs etc seems to vary day by day. So confusing to say the least, and frustrating. I’d give anything to get off of pain pills and get my life back.

    • Ashly
      March 7, 2016 at 11:47 pm

      How long until you were able to walk without crutches?

      • March 8, 2016 at 7:17 am

        No more than two weeks.

  144. Georgetta
    December 25, 2015 at 2:28 pm

    Has anyone tried dry needling to release the muscle? I’ve heard it’s very painful and it’s not approved in many states. I’ve had trigger point injections, a hip injection and Botox, acupuncture and tons of PT and nothing was very long lasting. Now I’m having myofascial release treatments that don’t seem to be helping very much. I don’t think a therapist’s hands alone can break through the tightness. I’ve had this for about 8 years now and have tried many things. So I’m desperate now.

    • Pam
      January 11, 2016 at 3:25 pm

      I had dry needling done for my chronic piriformis tendonosis in both glutes. It was not a cure-all, but it enabled me to be able to walk without pain. I have done PT, PRP, dry needling, and now am trying shockwave treatments.

      Dry needling does hurt, but given the pain I was in, it was worth it. My motto though is if it doesn’t hurt, it’s not working.

      • Georgetta
        January 12, 2016 at 1:37 pm

        Thank you Pam. I guess it’s worth a try.

      • January 12, 2016 at 1:40 pm

        To All, I forgot to mention on my Treatments page that I also tried Shockwave Treatments at a Sports Injury Clinic. It hurt like heck having it done and wasnt helpful at all for me.

  145. Georgetta
    December 25, 2015 at 7:17 am

    Jim, might you be able to share where you are going for your shockwave treatment and glute exercises? I’m in Westchester County, just outside of NYC. I’ve been suffering for close to 8 years and have tried so many things to no avail. I’m now having myofascial release treatments which aren’t helping either. I’m ready for surgery if that’s what it takes. I can’t live like this any longer. Thanks. Georgetta

    • Robert Keller
      January 23, 2016 at 7:13 pm

      Georgetta, reach out to dr. Mitchell Yass. I just did a week of one hour a day excercises with him this week and it’s alleviated most of my symptoms. I don’t believe you need to do surgery. You just need to strengthen the muscles around the Piriformis muscle. Drmitch@mitchellyass.com
      Trust me!

    • Jim
      June 22, 2016 at 2:53 pm

      Robert, I did about 3 months of PT with Dr. Yass’ Long Island office a couple years ago, and spoke with Yass directly on a couple occasions. Yass ‘gets it’ and understands PS — essentially he sees it as a muscle strength imbalance which leads to stress of the piriformis. I still do one of the exercises I was taught by them (gluteus medius side lift) although having seen several other PTs, I have learned additional aspects which go a step further — such as training the glutes to “re-activate” which has been critical to my own improvement.

  146. John
    December 24, 2015 at 11:29 pm

    Mitchell and Jim
    I believe both of you stated you were participants in the Botox Trial (Fishman). I have a couple of questions.
    1. When were you told if you received Botox (months after injection)?
    2. What schedule do have for follow up (how many follow ups and time interval , e.g., every 6 months for 2 years etc)
    3. Are you continuing with follow up?
    4. Why are looking for other treatments instead of working with the doctor that initiated the clinical trial?

    • December 25, 2015 at 10:53 am

      John, yes, I participated in the trial with Dr. Wilkins, Dr. Fishman’s associated. He was very thorough and thoughtful throughout. I did my left side only.

      I received my Botox injection immediately following the PT regimen and it did provide relief. This is now eight months ago.

      Because of my schedule I was unable to return for an appt for several months and when I did return I was told the study was completed. If I wanted another Botox injection the cost would be $3000. There was no other type of injection suggested to provide relief on my right side.

      Dr. Wilkins suggested I do the PT on my right side and then follow up, but again my travel schedule and life in general has not allowed for that yet. But I do plan on starting the PT protocol after the New Year.

      Compared to others on this head I think I am in better shape than most: I’m able to work out and run some. I also find yoga to provide some relief.

      That said, there are indeed days where my right side is uncomfortable. On a bad day my gluten gets very sore (I wouldn’t say painful), and my right foot is quite altered.

      Thanks for all of the thoughtful questions and suggestions. Onward.

    • Jim
      December 25, 2015 at 12:41 pm

      John, I enrolled in the study and received injections on both sides, followed by 12 weeks of PT — protocol provided by Dr. Wilkins. There were one or two mid study follow ups for repeated provocative EMGs to measure changes and also a final p-EMG at the end of the study. My PT followed the protocols exactly (2 sessions per week for 12 weeks — 12 sessions per side as allowed under the study) and took detailed notes. At the end of the 12 weeks, it was revealed that I received placebos on both sides (go figure), but the study entitled me to receive Botox on both sides, which I went ahead with.

      Following the legit Botox injections there was some improvement over the following 2-3 months, but marginal. I opted to give it one more try and paid for a further round of Botox on left (worse) side and got more significant improvement, but it faded after about 6 weeks. The cost, as Mitchell mentioned is $3k per side (Botox for this purpose is considered off-label) so it isn’t an economic solution on a sustained basis.

      After, the first round of Botox, I also had an MRN scan which revealed nothing unusual. My PS dr. concluded there wasn’t much more they could do, although they provided me with names of a couple surgeons in NYC that do Piriformis release. I met with one surgeon who was willing to do the release but said he couldn’t guarantee it would help — this would be out of network, so quite expensive. I put it off until a 6 hrs drive in October resulted in pretty severe pain and I decided to pull the trigger.

      However a couple days thereafter (before moving forward with surgery) I bumped into a friend who is a PT and suggested radial shockwave therapy (RST) in combination with a specific set of glute isolation/activation exercises. I’ve done the RST & exercises for almost 2 mos and seen as much improvement as with Botox, and continuing on this path. I don’t want to give anyone the idea that this is a straight forward or complete solution, I’m feeling better, still having rough patches, survived the same 6hr drive last weekend with less pain. Able to manage right now without heavy duty painkillers, only an occasional aleve a few times a week. I also take 500mg 2x/day of benfotiamine + b-complex (benfotiamine has been used for decades in Europe for sciatica).

      I should add that I am in very good physical shape, early 50s, and go to the gym 3x/week to do a cardio, strengthening & stretching routine including the aforementioned glute exercises. I think hypotonic glutes may be a common factor for those of us developing ‘spontaneous PS’ without a prior causal trauma.

      • Emily
        January 30, 2016 at 10:23 am


        Would you mind telling me who your physical therapist was (if you recommend him/her). I am seeing Dr. Wilkins now for physical therapy and am having trouble finding a PT who will follow his instructions.



      • Jim
        January 30, 2016 at 11:38 am

        Really? That’s a little surprising, if you give them a copy of the protocol, that’s what they are supposed to do. Anyhow, there are plenty of good PTs, so I’d suggest finding someone local. I went to Reddy-Care in Great Neck, NY.

  147. December 23, 2015 at 10:27 am


    Cn you be more specific about your feet symptoms?
    1. Location: Top, bottom, medial, lateral, toes, ankle
    Tends to be entire foot up to ankle. No pain. Does feel like a bit of burning. All symptoms relieved with Heat and no symptoms upon waking in AM.
    2. Sensation: Burning, pins,cramping, tendonitis, frequency, duration
    3. Can you walk or stand without foot pain?
    4. Does neural flossing, hamstring stretch, or leg extension aggravate your symptoms?
    5. Does piriformis stretching create paresthesia?

    NOTE: I have had all neurological testing for the scary stuff such as MS, etc. All test negative.

    Many Thx.


  148. December 22, 2015 at 10:16 pm

    I am a 55 year old male. 6′ 165. Excellent shape. Three year Periformis sufferer. Did study with Dr that included blind injection test (saline vs Botix) plus therapy and after 12 sessions I had relief. Also had Botox. Now one year post, study over, and severe PS on right side. Frankly, comes and goes and is absolutely exacerbated by sitting. Strong relief from stretching plus heating pad. Wake up symptom free and them symptoms grow during day. Pain in buttocks with no radiating pain down leg but altered sensation in feet (like a too tight sock).

    All MRI’s inconclusive expect for hereditary bulging of same disc as Mom and sister. No pain.

    Stretch. Roller pad. Etc, all consistently to varying relief.

    Would prefer no surgery and looking for Dr in NY NJ area for treatment. Any suggestions greatly appreciated.


    • Jim
      December 22, 2015 at 10:42 pm

      Mitchell, your symptoms are similar to mine, after 5 yrs of doing everything possible, I am slowly seeing improvement thru radial shockwave treatment combined with a very specific method of doing glute isolation exercises. I’m very determined to avoid surgery although I have met with a surgeon in NYC who does pir. release.

      • judy L
        December 23, 2015 at 6:39 am

        Jim, I am wondering if you might share the name of the surgeon who does pirifonmis release in NYC? Thank you.

      • Jim
        December 23, 2015 at 8:07 am

        First, Judy, happy to share Drs name by email — shoot me a note at libfrom24@yahoo.com.

        To John’s comment below, I also have very specific types of foot pain which are attributed to S1, S2 but nothing ever showed up on any of the many MRIs and MRN. I tested positive for bilateral PS with provocative EMG. I also did the Botox study. My current PT is McKenzie certified and is actually the one who introduced me to radial shockwave therapy and trained me to do Glute isolation exercises. After three years of doing extensive stretching and yoga, I concluded that stretching could only help so much and I now believe that strengthening and relearning how to activate these muscles is critical to further improvement.

      • john
        December 23, 2015 at 9:41 am

        Cn you be more specific about your feet symptoms?
        1. Location: Top, bottom, medial, lateral, toes, ankle
        2. Sensation: Burning, pins,cramping, tendonitis, frequency, duration
        3. Can you walk or stand without foot pain?
        4. Does neural flossing, hamstring stretch, or leg extension aggravate your symptoms?
        5. Does piriformis stretching create paresthesia?

      • Jim
        December 23, 2015 at 10:13 am

        John, sure — the bottoms of my feet and toes are very sensitive to heat, cold and pressure, in the early years of PS, I couldn’t have a bed sheet covering my feet due to the sensitivity, until recently I couldn’t wear socks due to the discomfort. I’m basically painfree when I wake up in the morning and there is a gradual increase that begins an hour thereafter and reaches a peak by about 3pm I’ve seen 5 PTs (and of course several Neurologists, etc. who were unable to help), and done therapy with each for periods of a couple months to a year. Pain is associated with STATIC positions — sitting, standing in place. Stretching helps to relieve symptoms (no paresthesia), so I have a thorough stretching routine, including Parivrtta Trikonasana (which I learned from Dr. Fishman). It has been a long journey and I keep learning things that have allowed me to continue to recover — the RST and glute isolation/activation seem to be helping me reach a new level of recovery.

      • john
        December 23, 2015 at 10:44 am

        Thanks Jim. And what about buttocks: location, sensation, frequency, and activity that aggravates it?

      • Jim
        December 23, 2015 at 1:55 pm

        John, in response to your second question about buttock pain — the pain starts just to the outer side of SI joint on both sides and continues out to greater trochanter — pain is greater on left side, about 60/40 left/right. The pain is a burning “sunburn” kind of a pain which begins to become noticeable about 30-60mins after I sit and continues to increase thereafter. Driving a car can be a killer, although I now have recaro seats which makes it more bearable. The sides of my thighs become quite sore and by the end of the day, I sometimes feel like someone’s been whacking me with bamboo. As I said, its a slowly increasing burning sensation that begins in the morning and gets worse through the day, everyday.

    • December 23, 2015 at 12:41 am

      I assume that you went to Fishman if you were enrolled in a Botox trial. The trial should include long term followup so why not continue with the doctor that conducted the trial?

      Sensation in the feet, depending on the location, may be a clue if there’s nerve involvement from the lumbar spine region or neural tension. You might consider finding a PT that specializes in spine therapy to help diagnose and resolve some issues. However, finding a good PT that understands nerve involvement isn’t trivial but someone with McKenzie certification/20 years experience might be a good start. A good PT can slowly identify if symptoms are contributed from nerve involvement within the lumbar spine area, neural tension, or something else. A bad PT will probably hurt you.

      You stated that heat and stretching help; is this something you do after pain starts or is this something you do multiple times a day regardless of pain level? Also, is the pain more like a burning pain in the buttocks or more like a deep bruise?

      Stretching: does that provide immediate relief or does it sometimes create or increase pain?

      Do you have tight calves or hamstrings; tight in the sense that you can’t get the muscle/tendon to release during the stretch. Or do you have camping anywhere along the legs: hamstrings, calves, shins, ankles, or feet?


  149. Tracy
    December 22, 2015 at 2:23 am

    Hi Everyone, Please see my post regarding my “Open” Piriformis Surgery last week under the Treatment tab above. It took some time and 2 Peer to Peer calls between my doctor and UHC but the surgery was eventually approved. I couldn’t be happier and can’t wait to get my life back. I’m rooting for everyone who suffers. I’ll keep you updated on my progress.

  150. Tracy
    December 22, 2015 at 2:11 am

    Hi Everyone ~ After 2.5 years of suffering I finally had “Open” Piriformis Surgery last week in Dallas. My piriformis was bifurcated (divided) and my sciatic nerve went right through them. Most of my piriformis was cut out and the sciatic nerve was released. I was quite surprised to wake up from surgery and have no pre-surgery pain. I have a very large incision from the front of my hip to the top of my glut. It is bruised and sore to say the least. I used crutches the first couple of days and am now walking with only 1 crutch. Walking is slow, sitting is very thought out and getting up from a seated or laying position takes much effort. The majority of the pain is incision pain, muscle pain and bruising. I’ve been on pain meds and muscle relaxer since the surgery and I’m guessing I will be for awhile. One negative has been the muscle cramping in my thighs, butt and calf but I’ve been told it will subside in time. I can’t say it has been easy (I need help putting my pants and socks on) but I’m taking it slow as I know the worst is over. I won’t lie…the first few days were rough. From trying to roll over to trying to pee…none of it was fun, but it’s worth it to get my life back. The best advice I can give is to not give up. The Doctor I used in Dallas has been getting a lot of attention due to this message board and it’s my understanding their process has changed. If you have the ability to have treatment in Dallas, get your paperwork together (all test results, films, list in chronological order all every procedure with date, doctor and location and medications. Then ask your doctor to refer you to Dr. Starr. He will refer you to Dr. Chhabra (Radiologist) who will order an MRN and Botox injections to diagnose PS. In my case, I had to fly to Dallas 5 times for treatment before surgery which spanned 7 months. It wasn’t cheap and it certainly wasn’t easy; but in the long run I’m getting my life back. My post op is in 2 weeks and I will most definitely update my progress. I’ll admit, I had a few dark days but just know there is hope so don’t give up!

    Back story: In SEP2013 I fell off a 4 foot counter while painting. From SEP2013 – APR2015 I had 4 back MRI’s, 1 pelvic MRI, 2 pelvic CT’s, back surgery, SI Injections, Epidural injections in my back, Ablation of nerves to my SI Joint, X-Rays, to name a few before I started going to Texas. Since APR2015 I’ve had 2MRN’s, SI Injections, Steroid injection in my hip, Steroid injection in my transitional vertebra and Botox to my Piriformis, all in Texas at UTSouthwestern.

  151. Brian
    November 27, 2015 at 11:33 am


    I am on United here in Tx(Dallas) and all of my Neurography AND my injections(botox) were all covered by insurance. My story is all over this board but I was the one that introduced Dr Starr/Dr Chabbra to this blog as that is who I used for MRN, Botox, and open surgery. If you go through a hospital system such as where they are then it seems to be more covered than not. If you try these Neurography centers by Filler it is NOT covered at all since they are a stand alone facility and it is for some reason seen as experimental through those. I tried for 8 years dealing with this and everything possible as a solution. Unfortunately nothing ever worked and I had to do surgery. I am 1 year from it and 100% pain free and have my life back. I don’t think the surgery is near as much a “gamble” as most people say. However, getting a proper PS diagnosis is the key and more difficult. I have never come across anyone who has truly had PS and gotten rid of it other than surgery. I hope to one day hear of one because I know all to well how hard it is to live with this and how scary surgery is as well. I wish you all luck getting pain free!!

    • November 27, 2015 at 12:08 pm

      We are also in Dallas, TX, have Federal Blue Cross Blue Shield,and have had NO issues with insurance covering any of my husband’s procedures, injections, PT (including needling, cupping and pelvic PT), MRI’s, two MRN’s (Dr. Chhabra) and surgery (Dr. Adam Starr). I believe last count, my husband has seen a total of 11 doctors since Feb 2015. My husband had surgery 9-28-15 by Dr. Adam Starr. Dr. Starr is a highly recognized (top 29 traumatologist in the US) orthopedic surgeon, specializing in hip trauma. It is my understanding that they really don’t know what they are up against until they get in there, and this is why Dr. Starr does the open technique, so that he can see and feel what’s going on. In my husband’s case, his piriformis muscle was adhered to his pelvic bone and his sciatic nerve was being smashed behind it. In Dr. Starr’s 20+ years of doing trauma surgery at Parkland (Dallas County hospital), he said he had NEVER seen a piriformis muscle attached to a pelvic bone. My husband is 80% better and he would do the surgery all over again to get 80% relief. What he is dealing with now is the sciatic nerve, that was being smashed for seven months. He has undergone another MRN, has had two injections, one to the si joint and one that covered the sciatic nerve (Dr. Chhabra), is having deep tissue therapy through Airrosti Rehab; is having deep tissue massage through our LMT, exercising (stretching, walking, etc.), in trying to work through this last equation of this monster. His mornings are tough until he gets through his workout and then his day is tolerable. We feel we are in the VERY best hands with doctors here at UTSW/Dallas in treatment and care and would highly recommend them to anyone dealing with this affliction. The surgery was a huge success for my husband and now we are dealing with the sciatic nerve that was damaged by the piriformis muscle. To our knowledge, the MRN did not show the piriformis muscle being adhered to the pelvic bone. We educated ourselves with googling and reading about Dr. Adam Starr and Dr. Chhabra.

    • Tracy
      December 3, 2015 at 12:02 am

      Brian, you have UnitedHealthCare?

      • Brian
        December 3, 2015 at 11:31 am

        Hi Tracy.. Yes, I do have United….

      • Tracy
        December 3, 2015 at 12:48 pm

        Brian, I assume you had surgery? I was checked in for surgery on Monday when I was told UHC denied my surgery. 😢

      • Athena Fremstad
        December 3, 2015 at 2:26 pm

        Tracy, do you have Dr. Starr’s email. If so can you please email it to me. I’m at afremstad@aol.com. Also, I’m so sorry about the insurance. I have United as well so I’d love to hear why they denied the surgery

      • Tracy
        December 6, 2015 at 4:57 am

        Brian would you be willing to contact me at tracyinthehood@gmail.com

      • wendy
        December 7, 2015 at 1:10 pm

        tracy, were you able to get the surgery with dr. starr? was your surgery eventually covered? i do not live in the state of texas (i live in pennsylvania) and also was trying to see dr. starr and also have UHC. they just called me to tell me that my UHC insurance from PA will not be accepted in TX. also, they will not take self-pay patients. i am so hopeful that you got it worked out.

  152. November 25, 2015 at 12:27 pm

    Oh! Yeah – this whole idea of things being “rare” is so being debunked by the internet communities forming around so-called rare conditions and side effects. I’ll grant there are truly rare conditions. But who defines what statistics determine rarity? And who collects those stats? Pharma paid individuals and groups. Also – there are many critiques of sampling methods used in FDA drug testing which imply that much of the stats quoted in determining rarity of symptoms are completely inaccurate.

    All by means of saying, I may very well be correct in my self-diagnosis. Though I’m never adverse to having experts opine over me!

  153. November 18, 2015 at 10:29 am

    I can’t do that for you Tracy. I think you need to edit your user settings.

  154. jihn
    November 14, 2015 at 11:12 am

    Did Starr review your spine before looking at your pelvis or did he start at the pelvis? Can you elaborate on how he diagnosed your problem?

  155. Charlie
    October 13, 2015 at 1:44 pm

    Has anyone has the endoscopic procedure for PS by Dr. Benjamin Domb in Chicago? Also how long does it generally take to return to work after the endoscopic procedure?

    • Maureen Bonnamy
      May 3, 2016 at 11:13 pm

      domb forget … he took 6 min. looking at me; ps wasn’t even addressed; all he wanted to do was a hip replacement to be scheduled in 6 weeks! Then send me to a back dr. to rule out lumbar issues. unbelievable!
      I’m now looking into other surgeons in chicago who at least will address this condition. most of them look at me like I have 3 heads. i did have ps shot at a pain clinic which did give me some relief immediately and didn’t last that long. but I did have relief. MRN places forget; ins. won’t cover it; looking into some surgeon that can do a fair test or something. MRI’s are fine, some OA of hip; that’s why domb wanted the hip replacement. he didn’t or wouldn’t even address ps; even though his website says he treats it. he also claims to do prp and stem cell; all boggus!

  156. Jennyd
    October 5, 2015 at 12:17 am

    Thank you for your info! I will definitely bring it up to my doctor. My situation is similar!!

  157. Patti
    September 11, 2015 at 3:47 pm

    That is great news! Best wishes for a successful surgery. Hopefully the incision will only be 6 inches. I’ve heard that the sciatic nerve heals at a rate of 1 mm per day so have patience after the surgery. I’m in Canada, surgery for piriformis or sijd is not readily available so I’m envious of you guys.

  158. Jim
    September 4, 2015 at 12:28 pm

    Cured my Bi i lateral piriformis syndrome after 18 months of suffering.

    Hello my name is Jim I suffered with Bi lateral piriformis for over 18 months. Here is my story and cure.

    Type A personality always on the move workout eat well 178 lb @ 6′.. Work for UPS as over the road driver 11 hours driving 10 hours off in bunk.

    Diagnosed with Bi lateral piriformis from extensive sitting due to work. Suffered for over 18 month out of work for over 12 months.

    Live on the east coast went to the following for treatment.

    University of Penn. rehab no help.

    Jefferson hospital rehab. No relief.

    Cornell NYC rehab injection into muscles. Little relief.

    Johns Hopkins for rehab no relief.

    Rothman institute rehab no relief.

    Tried every stretch, exercise and cure you could ever thing of.

    Severe pain did not sit for over 12 month. The pain go so bad it was hurting to lay in bed.

    Spent over $80,000 on being out of work and treatment after 18 month did not know if I could return to work. My wife and I sold our dream home we worked so hard for with our three kids. House was so nice it sold in one day for full asking. We remodel the w hole home. I’m telling you this part because I uderstand the pain and stuffing that is associated with this affliction
    And how I recovered.

    When the house was put up for sale the whole house was remodeled except the basement floor. In the listing of the house I said the basement floor would be covered in hardwood. About 1400 sq ft.

    In severe pain I started to lay the hard wood floor over the next week about 8 hours a day.

    If you are not familiar in how hard wood floor is laid you need to consistently be in the swatting and bent over position the whole time. Pivoting from left to right and moving forward to grab more wood. After the first day of squatting for over 8 hour I started to feel some relief.

    After a week of laying the floor I was 80% better. The extensive long stretching over 8 hours a day of the piriformis helped the muscle to finally release. Today I’m totally cured.

    Find someone who is laying hardwood flooring for over a week and jump in.

    Trust me it works..


    • Summit1
      September 8, 2015 at 8:53 am

      Jim, that is an amazing story. I sort of get the idea of the squat/walk that you described. I don’t have opportunity to lay flooring, but thinking I could try squat-walking the perimeter of my yard which is fairly large. I think you should do a short video to demonstrate for those of us that want to try it. THANK YOU for posting your story!!!

      • September 8, 2015 at 9:42 am

        Dear Jim, you jumped to conclusion that I didn’t want to publicize your post on my blog. I usually do a weekly mass approval because I do take the time to read every single post.


      • November 23, 2015 at 12:27 pm

        Summit – Did you try this for an extended period, too? If so, did it help you?

    • Summit1
      November 23, 2015 at 2:28 pm

      PSpC, I tried it for two weeks, seemed to help at first, but then caused greater aggravation.

      However, I have since stumbled onto something which seems to be working. After 5 years of trying everything (similar story to Matt’s and JIm’s), I think I may have just avoided surgery by the skin of my teeth. My PS was not caused by a traumatic incident, but came on over the course of about 6mos in 2010 — I was very physically active. I’m now 5 weeks into a combination of radial shockwave therapy and 3 very specific glute isolation exercises done in a particular manner, and the results so far are encouraging. I have tried MANY exercises, stretching techniques, yoga, botox, cortisone, chiro, etc., etc. which have NOT worked, so I really didn’t expect much with this, but the PT was very specific about how to activate the glutes in order to get them firing again. This is critical. My symptoms are dying down and I seem to be slowly recovering.

      • November 24, 2015 at 3:21 pm

        Thanks, Summit, for the info.
        About a year ago I started to gradually have hip joint/ab- and adductor muscles/knees/Quads area pain. I lost flexibilty in my hips and couldn’t cross my leg over my knee to put my socks on. I’m 59, female. Don’t do strenuous regular exercise nor work at a desk but DID spend a two month period sitting nearly 24/7 in winter 2013-14 which may have helped precipitate this…or maybe not, who knows. In November 2014 I started a job on my feet 5 days a week and that’s when I started getting progressively worse pains. I could find zero logical pattern for the pain except the mild exercise of working on my feet, as the pain gradually subsided on my days off. So I figured it’s inflammation, somehow from normal moving. But I also started getting horrible joint pain shooting from my hips – both of them, at random times including while in bed trying to sleep. I found out that the JOINT pain was caused by Levothyroxine (hypothyroid med) because I read other blogs like this one, by people who had the exact same issues from LevoT. I stopped taking levot. in September 2015 – my doctors had no idea that this was a known side-effect from levoth. Almost immediatly, all joint pain stopped, but I am left with very painful muscle pains which seem like symptoms of piriformis syndrome, so now I’m in the process of further self-diagnosis, dang it!

        I notice that my left hip is more affected than the right, though both have pain and reduced mobility, which causes me to have poor balance. In reading all these posts, I’m trying to avoid spending years in pain trying ineffectual methods. I’ve been, perhaps mistakenly, applying heat when I get home in pain. I’m going to try ice, see how it goes. Also will start researching how low income citizens can access the piriformis experts. Already went to an orthopedist who didn’t mention it at all.

        Matt, thank you for this website. You’ve apparently already helped several people.

    • Summit1
      November 25, 2015 at 11:11 am

      Plaid, So, here’s the thing, you can spend a lot of time ‘trying things’ that don’t ultimately work, if you don’t have a clear diagnosis of the underlying problem. Unfortunately PS is a) not easy to diagnose, b) often the incorrect diagnosis (could be some other structural, joint, muscle/tendon issue), and c) usually is diagnosis by exception — ruling out other problems. This means a lot of time and expense. Before going much further, I’d recommend you read Dr. Loren Fishman’s book on “Piriformis Syndrome: Diagnosis, Treatment & Yoga: Pain In The Butt” which may be the least expensive way you can get a better understanding of what your next step should be. PS is a complex, highly individualized and rare occurrence.

      • November 25, 2015 at 11:15 am

        Well said Jim. A provocative EMG was the most definitive diagnostic for my case.

      • john
        November 25, 2015 at 11:44 am

        I agree with Summit1’s statement, “Before going much further, I’d recommend you read Dr. Loren Fishman’s book ….” And probably the better idea is to make an appointment with him to get a proper diagnosis. PS may not be that rare according to Fishman and Filler; however, PMRs are taught that it is.

      • November 25, 2015 at 11:49 am

        I agree John. I don’t think it’s rare. What is rare is a proper diagnosis without jumping through many loops, hitting many dead ends, spending thousands in useless tests, imaging, and treatments including unnecessary spinal surgeries.

      • John McGary
        November 25, 2015 at 11:55 am

        Matt Why can’t I respond to your opinion you posted as the last word? John

      • john
        November 25, 2015 at 12:20 pm

        I agree that you need a correct diagnosis and that it’s difficult to find someone that is knowledgable as well as skilled in this area; and hence, the advice to see someone that specializes in PS. There are few people that specialize in PS diagnosis; someone like Fishman is extremely rare. Fishman is one of the few PMR docs that has conducted clinical studies on PS and is the person who developed the FAIR provocative test. At the other extreme, you may find that you’re in the hands of a hip surgeon who will diagnose PS and perform surgery without resolving the problem. I have not found, to date, conclusive evidence, either from clinical trials or reasonably good clinical studies that indicate success rates for PS surgery, within the context of an accurate diagnosis.

      • November 26, 2015 at 9:58 pm

        Piriformis Syndrome (Summit1) is definitely not rare amongst Sacroiliac Joint (SI)Dysfunction sufferers as the muscle is usually in spasm trying to stabilize a malaligned SI Joint and/or loose joint. Also as Matt shared a provocative EMG should be done early on in the diagnostic process to identify compression under the piriformis of the sciatica. I believe pressure needs to get off of the sciatica; however working to get to the underlying cause is very important and a thorough work up regarding the condition of the SI joints (especially by manual therapists such as Chiropractors/physical therapists with good pelvic training) is paramount. If the SI joints already have instability and a piriformis release is performed without stabilizing the SI joints then the patient will be in a worse predicament. I follow Matt’s blog closely to keep informed on PS issues while I likewise have my own blog regarding SI-Instability and talk to patients around this country that have simultaneous horrible piriformis issues with nerve pain. All food for thought!

      • John
        November 26, 2015 at 11:03 pm

        SID as the origin of PS like syptoms is difficult to diagnose correctly. PS may be associated with SI symptoms, where piriformis shortening can rotate the pelvis. Chiropractors use visual cues to assess pelvic/hip rotation and perform various realignment manipulations to help relieve PS like symptoms; however, the PS symptoms may remain for a variety of reasons, none of which have anything to do with pure SID. Physical Therapists, too, can visually assess what appears to be SID and teach self-manipulation techniques to patients to resolve pelvic misalignments. If it works, great. If it doesn’t then SID may not be source and you’ll need to look for other sources. PS can be the result of other underlying problems which can confuse most health care providers. With respect to SID & PS, finding a skilled and knowledgable PT, Chiro, or PMR doc is not easy; furthermore, they may not exist within your area. Unfortunately, most health care providers will treat you according to their assumptions, which may not be to your benefit, so you need to read up and take extensive notes to help diagnose your problem while searching for someone to help.

    • Summit1
      November 27, 2015 at 10:14 am

      AHE, perhaps the term ‘rare’ requires more precision, I was referring to PS which arises with no trauma and no other obvious contributing factor. Along the lines of Matt’s history, where he was active, no other issues and then the PS started up without an apparent traumatic event. PS brought on by SID may be a different. In my case, I had no other obvious contributing factors. I am very thankful for the efforts of my doctor (Loren Fishman), although even, in my case, surgery is at best a gamble. As I noted in another reply, I am seeing encouraging results from a combo of Radial shockwave AND a protocol of glute isolation exercises. In situations like mine, you will often find the glutes are hypotonic, which may be part of negative feedback loop for PS.

      • November 27, 2015 at 11:29 am

        Thanks for your clarification(Summit1) and I agree there are cases like yours and others like you that have hypotonic glutes affecting the piriformis too even though SI joints are fine.In my personal case after I was stabilized in my SI joints with screw fixation, I then was able to sort out all my muscles and discovered an anatomical shorter left leg and contracted gastroc/soleus that needed lengthening and I wear a full foot lift to balance the mm of boney shortness of leg. Once standing in perfect balance, the piriformis along with Glute med insertions(did have a PRP injection to help heal it) all calmed down and now I can sit for hours with no nerve pain whatsoever from sciatica under piriformis. My prior EMG before any surgery showed that I was compromised. I elected not to have any piriformis release and in my case I’m so glad I never did.

  159. Elaine
    August 7, 2015 at 1:10 am

    I have asked 2 or 3 questions on this site but don’t get a response?? All I get are other peoples questions and answers via email. Am I doing something wrong??
    Thank you,

  160. John
    May 23, 2015 at 3:37 pm

    Hi the surgery sounds fantastic. I just wondered when you had hip and buttock pain (and sciatica) in one side were you also experiencing when sitting, pain going up on one side of the back to the neck.

  161. Judy
    April 10, 2015 at 11:19 am

    I am wondering if anyone out there has had a MRN by Dr. Filler in CA. I know you did Patti and your Dr, couldn’t read it. My diagnosis was same as yours, entrapment of sciatic nerve and possibly obturator internus. I had a positive provocative EMG before that. Piriformis and Botox shots did not work at all, not for a minute. Dr Filler’s MRN might explain why as I have a tenden lying directly on sciatic nerve but between piriformis so blocking shots as I understand it? I have seen 1 surgeon and sent the CDs out but the problem is no one can read them. Has anyone had a MRN and found a Dr, besides Filler in CA who can read them? I am willing to travel but not as far as CA. I live in VT and it would have to be a drive as I can’t sit but lie in back seat. Have made the trip to JH in Maryland and have been to NYC. Does anyone know who can read Dr, Filler’s CD aside from Dr. Filler? Would be so appreciative of any info anyone has. Going on 4 yrs and I am soooo desperate. Pain meds don’t work. So happy for all of you that are doing well and wishing the rest of you the best as well.

    Patti, how are you doing? I hope well. I haven’t seen any updates.

    Thank you and so hope I hear from someone.

    • Summit1
      June 13, 2015 at 7:11 pm

      There are now many radiology centers that can do a neurography. The neurography is typically categorized as an MRI and covered by insurance. The newer MRI machines (tesla 3.0) have 10x the power of the older units and can be tuned to produce scans of the nerves.

      • John
        November 26, 2015 at 11:52 pm

        Right that there are many MRN systems available. Wrong that it is covered by insurance like MRI. In fact, it is unlikely to be covered by many insurers at about 4K per procedure (see other posts). Wrong that it’s 10x power: first it’s magnetic field strength, and second 3.0 T has been available for some time; whereas, much older systems were around 1.5T. Also Judy was inquiring about finding someone who can competently read MRN, which is a bigger problem that others have pointed out. On a technical note, MRN uses different algorithms than MRI to reduce/enhance nerve signals.

      • Summit1
        November 27, 2015 at 9:59 am

        John, I’m just speaking from my own experience. In NYC there were several facilities offering MRN, and I had no problem getting it covered by insurance. My insurance plan is not particularly generous, but they covered this in the same manner as an MRI. The radiology center I used said they do dozens of these every month and I believe their lead radiologist was trained by Dr. Chhabbra (sp?). I too, thought this would be very difficult to obtain, but when you start talking with large radiology centers, this is a much more common scan than others would have you to believe.

      • john
        November 27, 2015 at 11:25 am

        Thanks for the clarification. What insurance company and plan do you have? Also does your prescription insurance plan cover Botox for PS? I have UHC in Texas; of course, there are many health care plans within UHC so it’s difficult to compare plans without details but my plan doesn’t cover MRN or Botox (Caremark), which they define as experimental. Caremark defines experimental according to clinical trials. The Neurography Institute is a company founded by Filler that has a number of facilities throughout the country but no radiologists are associated with those facilities other than Filler.

      • Summit1
        November 27, 2015 at 11:50 am

        My ins. company is associated with a regional hospital network in New York. They do not provide out of network coverage, and they are not outside NY state. The radiology center is Lenox Hill in NYC. My copay was $40 for the MRN. Botox is not covered by the plan for PS (been there, done that). I also spoke to Neur. Inst., they wanted something like $3K for an MRN, I think they are actually part of NY Presby. Hosp.

    • Patti
      September 8, 2015 at 4:45 pm

      Judy, my surgeon could read them but disagreed with the findings of Dr. filler. My surgeon does not see enough cases however to be experienced in reading these images.

    • Tracy
      September 15, 2015 at 2:46 am

      Judy…have you found anyone to read your MRN? Dr. Chhabra at UT Southwestern in Dallas Texas
      specializes in the MRN’s. I can’t say enough about him.

      • September 15, 2015 at 9:03 am

        Agree w/Tracy. Dr. Avneesh Chhabra is a highly regarded expert in his field and the one Dr. Adam Starr, orthopedic trauma surgeon (hip), refers you to for the MRN. Dr. Chhabra called me personally to get more info so he could order the MRN and has communicated w/me via e-mail. He went in to great detail in explaining the MRN. He’s the one who actually did the CT guided injection into my husband’s piriformis muscle. My husband is scheduled for piriformis release surgery with Dr. Adam Starr, UTSW @ Parkland/Dallas, TX, Sept 28th. It cannot be soon enough!! You cannot go wrong with this group – they are a God send and again, I cannot thank Matt enough for starting this blog, continuing to read everyone’s post; and for Brian sharing his journey and physician here in Dallas, Dr. Adam Starr. Thanks guys for continuing to help those who are desperate for relief. I encourage everyone to continue sharing, as had this blog not been there, I’m not sure what our path would look like right now. Thanks again!

      • Jim
        September 15, 2015 at 7:18 pm

        Hi Sharon, I was wondering if Dr. Chhabra was able to identify the point(s) of entrapment? I had an MRN done in NY at a facility with a radiologist possibly trained by him, but despite a positive finding of PS with provocative EMG, the radiologist could not locate entrapment, consequently surgery doesn’t seem to be an option.

      • October 5, 2015 at 8:56 am

        Jim – there wasn’t a “reply” button above your or my comments, so I’m responding to Tracy’s in hopes you see this. Dr. Chhabra was not able to identify the points of entrapment. He was able to identify that my husband’s piriformis muscle was small, atrophied. However, all of the previous 7 months tests ruled out what it was not. Dr. Chhabra was not able to do the botox injection because of the size of the piriformis muscle/tendon. So he would not inject with botox, he used an anesthetic, which lasted one day. What I understand is that there is no objective test that says “you have piriformis syndrome”, it’s about ruling out what it is not. Dr. Adam Starr (UTSW @ Parkland) is highly recognized (top 29 traumatologist in USA in 2012) in his field and is used to putting crushed hips back together. I understand he’s designed surgical techniques and is a “master” and well respected. Dr. Starr does the open technique as he really doesn’t know what’s going on until he opens you up. My husband had piriformis release surgery last Monday, Sept 28th. Dr. Starr said my husband’s piriformis muscle was STUCK to his pelvis and that the sciatic was behind it, obviously being smashed. Explains why no amount of therapy/stretching/walking, EVER made a difference. Dr. Starr also said my husband had a large tendon (don’t remember the name of it) and he clipped that was well. So the surgery is deep, deep, invasive and I won’t kid you that it is painful. What my husband does know is he no longer has shooting nerve pain when he coughs, sneezes, or puts on his t-shirt. Hard to tell about his hip because of the extent of the surgery and the healing of the muscles; however, everything is positive thus far. And, actually six days post op and he was walking with a cane yesterday. Walking, walking, and more walking is the rehab, and he got in a mile yesterday. So, we are excited of the results thus far!! Thankful for this blog, for Matt and Brian for sharing, and continue to share. And, we will continue to share as well. Getting the word out there for those who are suffering is our mission. Showing the incision scar is our mission, as well, as it is a 12″ “track”!!

      • Patti
        October 5, 2015 at 12:24 pm

        Sharon I’d be really interested to know what the other tendon was if you ever get the name of it. Best wishes to your husband!

      • Jim
        October 5, 2015 at 1:00 pm

        Sharon, that is valuable feedback, thanks — I had sort of expected the MRN would provide a definitive picture of the entrapment, and when it showed nothing, it was a letdown. Nonetheless, both the provocative EMG and botox trials were fairly solid confirmations.

      • Patti
        October 5, 2015 at 4:09 pm

        Would this doctor re read an MRN if I sent the disc to him from Canada do you think?

      • Judy
        October 5, 2015 at 7:03 pm

        Tracy, I have seen 4 very reputable surgeons here in the Northeast and only one could read Dr. Fillers’s MRN and wasn’t convinced he ageed with it. He DID offer me surgery with very low odds but said it’s POSSIBLE he could help me. Wouldn’t know till he got in there, open of course.

        Tracy and Sharon, thank you so much for the info on Dr. Chhabra. I called his office and was told to send all my info, MRIs, MRNs, records etc to his attention and I would hear from him. So hoping he sees something concrete or enough to help me. I have not responded to numerous piriformis shots or botox though did have a positive EMG with Dr. Fishman.

        Good luck to your husband Sharon. Tracy, I’m not sure what your story is but wish you well and thank you so so much for responding to my post.

      • October 8, 2015 at 10:41 am

        Jim – I wanted to clarify my earlier comment re the MRN . All of my husband’s issues were on the LEFT side. So based on what was discussed with us re MRN, nothing showed up on the LEFT with exception that the piriformis was small due to some atrophy. Interesting that the RIGHT side, which is not symptomatic, showed a split right sciatic nerve. My husband had L-4/5 herniation, symptoms being on Left side, and surgery in April 2013. We were very much aware, from MRI of spine and SI, that the changes to his spine were all on the RIGHT side, which did not correlate to his symptoms being on the LEFT. The MRN confirms changes on the RIGHT. All of Dan’s symptoms were on the LEFT.
        Dr. Chhabra’s findings: IMPRESSION:
        1. Mild left L5 and right S1 neuropathy.
        2. Multilevel degenerative changes of the lumbar spine, most notable at L4-5 where there is severe narrowing of the central canal.
        3. Right piriformis hypertrophy with a split right sciatic nerve which demonstrates a variant intramuscular course.
        4. Minimal bilateral trochanteric bursitis, right greater than left.

        Again, it is our understanding there is no objective test that says you have piriformis syndrome. The journey is ruling out what it is not and bottom line, they don’t know until they filet you open what is going on in that area. This is why Dr. Starr does the open technique, about a foot long incision, so that when he gets you open, he can see and feel everything. Dr. Starr said my husband’s LEFT piriformis muscle was STUCK to his pelvis and that the sciatic nerve was running behind it, neither of which we understand, showed up on the MRN. Dr Starr clipped the piriformis muscle as well as a tendon that was large. So, basically it’s exploratory surgery until they open you up and see what all is going on. This is why Dr. Starr sends you for an MRN, and a botox injection, to rule out what it is not.

      • Jim
        October 8, 2015 at 2:54 pm

        Sharon, your comments are very helpful. In my case, I have the nerve sensitivity issues in butt, thigh, feet. My provocative EMG was positive, but no other test, xray, MRI, MRN, shows anything abnormal. I met with surgeon who has done release surgery and understands PS — he said I could move ahead with release surgery and he would trace sciatic nerve to see if it is tied down by anything else, but he doesn’t know if it will help or not. He also said sometimes it can take a year or more after surgery before there is improvement. Also mentioned that a typical sign would be atrophied piriformis such as your husband (but not in my case, both sides look normal).

      • judy L
        November 18, 2015 at 1:10 pm

        Tracy, did you have sedation with your shots? I am going to have a sciatic perineurial injection along with a Botox piriformis shot with Dr. Chhabra. I sent him my records and he suggested I have those procedures. Thank you for filling us in with such valuable info. Good luck to you with your surgery.

      • November 18, 2015 at 2:26 pm

        Dr. Chhabra did not sedate my husband either time on injections. The first time he injected an anesthetic to his piriformis muscle. Dr. Starr did surgery on 9-28-15. His piriformis muscle was adhered to the pelvic bone, something in Dr. Starr’s 20+ years of practice had NEVER seen, and the sciatic nerve was being smashed behind it. So who knows how long it’s going to take for the sciatic nerve to get to a new normal. He still has morning nerve pain, just like before surgery; however, with stretching and exercises, is able to work through it and have a reasonable remainder of the day. Tuesday last week, Dr. Starr referred him back to Dr. Chhabra; saw Dr. Chhabra on Wednesday; ordered another MRN which was done Friday, and Monday this week Dr. Chhabra did an si injection and then “covered” the sciatic nerve. No sedation for any of the injections, except local “stuff”. We knew going into the surgery, of the risk that it may not work. However, my husband has said many times if he had a check list of five things, four are gone. He no longer has the chronic, 24/7 nerve pain, so it’s been a trade off with the morning occurrences. He is SOOO much better and would do the surgery again to get some kind of relief. Love Dr. Starr and Dr. Chhabra!! Had a nightmare experience with 12 hours in recovery, but that is being addressed with top management at Parkland and they are on top of addressing the issue so that no family has to experience this again!!

      • November 18, 2015 at 2:52 pm

        Please tell your husband that he must exercise. I hit a ceiling in my recovery until I got my butt (literally) into the gym nearly every day. I broke through the ceiling due to building up my strength.

  162. Zac casey
    March 28, 2015 at 10:03 pm

    I Have suffered over 7 years and tried everything except surgery!

    • October 8, 2015 at 4:35 pm

      I am so sorry for your suffering. I don’t know how people go years with this chronic nerve pain. I can tell you people from other states (as far as Washington DC), are flying to Dallas, TX to see Dr. Adam Starr (UTSW @ Parkland). He fully understands the symptom. My husband had already seen six physicians and Dr. Starr was #7, and the very first one to stick his hand into my husband’s buttock, which made my husband almost rocket off the table. How much more confirmation does anyone need? This is my opinion…there are lost of doctors out there who are doctoring the symptoms, but not getting to the issue at resolving PS. We are sharing our story with the diagnosis and surgery, to every physician and therapist my husband has seen to educate them in this condition. Had my husband not found a youtube presentation by Dr. Aaron Filler, Neurosurgeon in California (who BTW developed and has the patent on the MR Neurography), and self-diagnosed, and had I not found this blog that Matt started, and comments from Brian in the Dallas area of a physician who could help us, we still would be going to doctors and having them doctor my husband…with no relief. This kind of bouncing from doctor to doctor, is being a guinea pig.
      My husband had piriformis release surgery on 9-28 and even though he’s still recovering from this massive surgery, he no longer has the nerve pain when he coughs/sneezes, puts on his t-shirt, lifts his legs, swings his arms (ie golf swings), etc., etc. He’s still a little “nervie” in the mornings for about 30 minutes until he gets warmed up, but it’s temporary and he’s only 10 days post op. Good luck in your journey and find someone who understands PS and can help you…Dr. Starr is a highly recognized hip trauma orthopedic surgeon. It is our mission to help others and pay it forward, like Matt, and Brian, and the others, are doing…the more we reach out and educate, the more power we have in getting our health back!!

      • October 8, 2015 at 5:34 pm

        Thank you Sharon. Please encourage your husband to be diligent with physical therapy. Without it he will suffer needlessly. PT is nearly as important as the surgery itself. I’m now over three years post op, and I feel like I never had PS or the surgery in the first place. The only scars that are left are emotional.

      • October 20, 2015 at 1:19 pm

        Thanks Matt for your encouragement. He started walking 3 times a day 4 days post-op; by 6 days post op, walked one mile (1/3 mile 3 times); 9 days post op, walked 3 miles (1 mile 3 x); had his staples removed 15 days post-op and started incorporating more exercises with his walking. He’s still having morning nerve pain and muscle cramps, but all due to surgery, nothing like before. Eighteen days post op, he mowed our front lawn, edged and blew it off; 19 days he mowed back yard (we have .4 acre lot). He asked our neighbor to reset blade, as he couldn’t reach down. However, he incorporated “exercises” in his mowing. He was determined not to have to get anyone to help him with the yard!!

        Jim – the other tendon was the obturator, that Dr. Starr clipped due to it being enlarged. Dr. Starr opts for the open technique so that he can examine and feel everything going on in that area, and take care of everything at one time.

      • Athena Fremstad
        December 3, 2015 at 2:45 pm