Piriformis Syndrome Diagnosis

After years of negative test results in the search for the cause of my chronic pain, I finally found the right physician to perform the right test. Or, more accurately, I was finally referred to the right physician. In February 2012 I had a Provocative EMG. I can’t stress this next point enough…a Provocative EMG is not the same test as a Standard EMG!

Standard EMG Failure

The Standard EMG I had on June 2, 2011 showed no cause for my chronic sciatic pain. In fact, the test results were very normal. The summary results were:

“The nerve conduction study showed a normal right sural SNAP. The bilateral saphenous SNAPs were unelicitable. The right peroneal and tibial CMAPs and F wave latencies were normal. The needle study of selected muscles in the right lower extremity and lower lumbosacral paraspinal muscles was normal.

The Interpretation: Normal study. There is no definite electrophysiologic evidence of a right lower lumbosacral radiculopathy, sciatic neuropathy, myopathy, or peripheral neuropathy in this study.”

You can read my complete Standard EMG Study. I removed the physician name to protect their identity, as well as other personal information. I don’t hold them accountable for not discovering that I had Piriformis Syndrome. It was no one’s fault; it was simply not the correct test. The neurologist that ordered the Standard EMG had never heard of Piriformis Syndrome. I’m reminded of the saying, “You don’t know what you don’t know.”

Provocative EMG Success

On March 1, 2012 I had a Provocative EMG. The test lasted about twenty minutes and the results were concrete evidence that I had Piriformis Syndrome. I wrote “had” versus “have” because on July 5th, 2012 I had two surgical procedures which successfully treated my case of Piriformis Syndrome. However, had I not had a positive Provocative EMG I may not have been an ideal candidate for the surgery.

“Standard nerve conduction studies are within fairly normal limits. The motor and sensory nerve distal latencies, amplitudes, and conduction velocities are all within fairly normal limits, indicating there is no focal nerve compression or peripheral neuropathic process present. F waves are also within normal limits. Special testing of the latent responses with the hip in various stages of hip flexion and internal rotation revealed progressive prolongation of the H and F wave latencies and diminution of the H wave amplitude to significant degrees. This is consistent with sciatic nerve compression at the level of the piriformis muscle. I would also note that I have not yet seen a patient that is as flexible as Mr. Stehling have a positive provocative test.  Needle EMG parameters are all normal, indicating there is no compressive radiculopathy or plexopathy present nor any denervation associated with the sciatic nerve compression.”

You can read my complete Provocative EMG Study.  Again, I removed the physician name and other personal information. My hope is that other people suffering from Piriformis Syndrome will get a Provocative EMG  as soon as possible.

An important Note: In the event you review the Provocative EMG Study, and you’re not sure what you’re looking at I’ll break it down.  The H Wave test results are the answers I was searching for for the last five years. Many physicians and MRIs didn’t or couldn’t detect what this simple test did in a matter of a few minutes.

H Wave Results from Provocative EMG

My H Wave Test Results

About Provocative EMG

H reflex is a monosynaptic reflex elicited by percutaneous submaximal stimulation of tibial nerve and recorded from the gastroe-soleus muscle.

The first row of data shows my test results when laying flat on my back without any flexing/bending of the legs (Note: this is the only position I was in for the Standard EMG). Rows 2 and 3 show my test results when performing the stretch shown below.

Provocative EMG Stretch

Provocative EMG Stretch

H Wave Latency is the first column of data (reading left-to-right). As you can see, the latency increased when performing this stretch, meaning the nerve signal speed slowed down (due to sciatic nerve compression at the piriformis muscle level).

H Wave Amplitude is the second column. As you can see the nerve signal strength decreased by 81%. Again, this is due to my sciatic nerve being significantly compressed at the piriformis muscle level when performing this stretch.

I’m unable to offer insight into the third column…sorry but I forget the significance explained by the physician.


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. Hardcore Cyclist
    December 2, 2020 at 10:16 am

    Can anyone recommend and piriformis syndrome knowledgeable doctors in the New Jersey / New York area?

  2. Kelly
    September 13, 2019 at 3:24 pm

    After reading all these comments, it seems like what my issue is (had a hip labral tear and FAI, which had hip arthroscopy to fix, but right buttock pain has come back) piriformis related, and this muscle removal surgery would be my saving grace. Is Dr. Tollestrup the only surgeon who is performing this? I live in IL, and would happily to fly to NV to have this pain go away, but just wanted to see if anyone else was qualified to do this.

    • mysijourney
      September 13, 2019 at 5:52 pm

      Dr. Tollestrup has trained to other Doctors to do this they way he pioneered it through a 2″ to 3″ incision . Dr, Aguila in Nebraska and Dr. Eric Williams in Baltimore, MD. they are the only three.

      • Ihavebilateralpiriformis
        August 20, 2021 at 12:16 am

        Do you know if Dr Williams uses the same method as Dr T for surgery? I’e read Dr T uses a special tool for the surgical site that he’s created. Does Dr William use the same tool?

  3. John M
    June 9, 2019 at 3:57 pm

    There’s a lot of discussions here about how only certain doctors in the US can successfully perform Piriformis release using the standard posterior surgical technique for hip arthroplasty. The only difference between total and partial release as in arthroplasty is disconnecting the tendon from the sacrum. So I don’t understand why that addition step is beyond a skilled/experienced hip surgeon. Does anyone really know why that’s so difficult, as in surgeons have explained why they would t do it or what’s involved to make it risky?

  4. Shannon
    May 7, 2019 at 5:18 am

    After conducting years of research to find the answer to why after numerous procedures everything from Surgeries to Injections (every type you can imagine) to X-Rays MRIs CTs, P.T., Needling and the list goes on it wasn’t until I found this forum and it was here that I read the numerous comments about the successful surgeries at the hands of Dr Timothy Tollestrup. I was literally at the end of my rope and all out of any remaining alternatives.
    I decided to reach out to Dr Tollestrups office and see if he would consider seeing me as a patient.
    I was invited to go meet with Dr Tollestrup and long story short and a couple of month later, I underwent Piriformis Release Surgery. I can’t tell you what a difference it has made in my life… I have purposely waited and with hesitancy to write this review because after so many other procedures as you can imagine I was afraid that my relief would only be temporary and over time the intense, chronic and debilitating pain would return but as I write this my level of pain has gone from 8-9 out of 10 to a 4-5. Which I consider a complete miracle!!! I can walk without dragging my leg, I am able to sit with my family at the dinner table ( I previously could only stand due to the extreme pain) I can walk on a treadmill. My quality of life has been given back to me! I can’t help but to cry because I was seriously reaching that point of desperation which so many other Chronic Sufferers of pain often feel. At the young age of 52 I couldn’t possibly imagine living the rest of my life at that level of pain or the thought of not being able to even get out of bed because of the pain.
    I could go on and on about where I was mentally, you see I had always been an avid athlete up until my injury and to reach the point where I had basically become an invalid was more than I could process. I stand before you a walking miracle. First let me begin by saying that through my Faith in God, all the prayers of family and friends and at the hands of Dr. Tollestrup my life has been given back to me. In just a few months my only Daughter will be getting married and I am now able to prepare and help coordinate her Wedding which prior to my surgery I honestly didn’t believe that I would be able too. Thank you Dr Tollestrup and Thank you Thank you for this Forum because I wouldn’t have ever heard about Dr. Tollestrup.
    Dr Tollestrup you are a Wonder Doctor ! I hope and pray that others who seek to find relief of their chronic pain find you!
    May God continue to bless you and your hands as you seek to help all those suffering!

    • mysijourney
      May 7, 2019 at 1:01 pm

      I am so happy for you Shannon!

      Only correction is, Dr. Tim Tollestrup does complete REMOVAL of the piriformis muscle, not release. There is a BIG difference.

      The release surgery is highly damaging, the removal surgery is highly successful.

      • Shannon
        May 8, 2019 at 8:32 am

        Yes! I stand corrected. It was the complete removal, thank you so much 😊

      • John
        June 9, 2019 at 3:37 pm

        Sorry I’m confused about complete removal. Do you mean removed in the sense that both tendons were disconnected, from sacrum and trochanter? Or are you saying that he actually removed the muscle, which puzzles me since sacral nerves insert into the muscle.

    • Edward M.
      June 24, 2019 at 12:21 pm


      When you said your leg was dragging, was it due to weakness? How are you now? Still doing well?

      Ed M

      • Shannon Robles
        July 26, 2019 at 1:36 am

        I believe that my leg was dragging due to several reasons, the pain and also fatigue. I also noticed that there was significant muscle tone loss in my calf muscle as well.
        I am doing excellent, thank you for asking!! Typically on an average day my pain level is between a 5-6 which is so much better than before when my pain level was usually 8-10 depending on the weather as well.
        My pain level elevates when there is impending bad or a weather change… I will say that the Surgery gave me my life back, literally!!!

    • Peter
      July 11, 2019 at 3:37 am

      Hey Shannon, prior to surgery did you have do diagnose injections to the piriformis muscle or mrn showing nerve compression?

  5. Venkat
    March 13, 2019 at 11:00 am

    Hi, I hurt myself 3 years back while playing volleyball. Few days after I experienced hamstring and glute pain on my right side. Later experienced sciatica pain and this was going on for a while. I had epidural steroid injection, 2 piriformis injections and SI joint injection. Nothing helped. When they had an MRI done to my lower back and pelvic 2 years back. They found nothing in the lower back. But the only thing they found was a labrum tear to my right hip. So, I did lot of PT, Chiropractor, dry needling and massage sessions. They gave a bit relief. But, nothing really helped. So my doctor had a contrast injection and MRI done to my labrum to confirm the tear and then 3 weeks back I had my Arthroscopy surgery done to fix the labrum and they did trim the bone. I am currently doing PT 2 times a week. But, I still have the same pain in my glute, hamstring, groin and sciatica nerve.

    • March 13, 2019 at 12:05 pm

      You need to try and get a MRN. One with Dr. Chhabra’s program at a university hospital. That may show your piriformis muscle compressing the nerve. Also reach out to Dr. Tim Tollestrup or Dr. Eric Williams, they do muscle removal which is highly successful vs. the old highly unsuccessful way of doing the release. Dont make the mistake the majority has. I have only found two people that had complete success with a release. Matt who owns this blog and one other done by a neurosurgeon 10 years ago. They have no other issues.
      But it took them a while to rehab afterwards.

      My sicatic nerve was completely healed and at 7 weeks post op.

      Also the sooner you get it done, the less risk you are for other damaged nerves from over compensating. That is what I am seeing in the support group.

      • Venkat
        March 13, 2019 at 1:34 pm

        Thanks a lot for the info, This is my Doctor Visit History .First I went an orthopedic spine doctor and he ordered an L5-S1 injection after seeing the symptoms and it dint help. After few months of PT, Dry needling and chiropractor session I went the doctor again and he ordered a lower back and pelvic MRI’s and a piriformis injection. The Lower back MRI was normal and has no disc herniation. The pelvic MRI has shown a small tear in the labrum and nothing else. So he referred a sport doctor who does hip surgery and he saw my MRI and did a cortisone injection and that gave some relief but not much in the groin. Later I started getting pain in my groin, glute, hamstring and sciatica nerve. So the doctor ordered for contrast labrum- Right Hip MRI which should only the labrum tear and everything looks ok other than that. So he recommended the arthroscopy Hip labrum tear fix and FAI (trim bone) surgery and I had it done 3 weeks back. He said as they can only see the labrum tear and everything looks normal. This may ease the other pains. It’s been 3 weeks and I’m still having Glute and Sciatica Pain. So just curious to know if this labrum repair will fix the pain. Its 3 years that I’m suffering from this pain. Do you think its Piriformis Syndrome that is causing my glute and sciatica pain ? Because they found nothing in the nerve test or the both MRI’s they have done to my Hip

      • Venkat
        March 13, 2019 at 1:50 pm

        My Doctor Visit : First I went to a orthopedic spine doctor and he ordered an L5-S1 injection after seeing the symptoms and it dint help. After few months of PT, Dry needling and chiropractor session I went to the doctor again and he ordered a lower back and pelvic MRI’s and a piriformis injection. The Lower back MRI was normal and has no disc herniation. The pelvic MRI has shown a small tear in the labrum and nothing else. So he referred a sport doctor who does hip surgery and he saw my MRI and did a cortisone injection and that gave some relief but not much in the groin. Later I started getting pain in my groin, glute, hamstring and sciatica nerve. So the doctor ordered for contrast labrum- Right Hip MRI which should only the labrum tear and everything looks ok other than that. So he recommended the arthroscopy Hip labrum tear fix and FAI (trim bone) surgery and I had it done 3 weeks back. He said as they can only see the labrum tear and everything looks normal. This may ease the other pains. It’s been 3 weeks and I’m still having Glute and Sciatica Pain. So just curious to know if this labrum repair will fix the pain. Its 3 years that I’m suffering from this pain. I did try 2 Piriformis injections and SI joint injections nothing helped and Both the Hip MRI’s and Nerve Test I had showed nothing in the Piriformis or hamstring at all. Do you think this is a piriformis issue?

      • David Lourenco
        April 9, 2019 at 6:20 am

        “Mysijourney” where did you get the information on dr. Williams and hi Piriformis method. I know that there is plenty on the web about Tollestrup but I am interested in learning more about dr. Williams method, as in, is the incision the same etc.. thanks

      • Brooke
        June 18, 2019 at 4:21 pm

        After having Dr Williams evaluate and refer me for an MRN, it was confirmed that my sciatic nerve directs the piriformis bilaterally. It makes complete sense, as my pain is extremely specific. After you muscle was removed and the nerve healed, how long are you able to sit without pain? What type of exercise and activity intensity can you handle? I have been in contact with Dr Tollestrup’s office, but have dragged my feet on an evaluation. I am doing it in the next few weeks (sending my films, etc.) I’d just like to be able to travel, work and run again!

      • Shannon Robles
        July 26, 2019 at 1:53 am

        I would say within 2 weeks and the length of time that I am able to sit continues to improve…prior to my surgery I literally was in excruciating pain all the time, just sitting to use the bathroom was sheer agony, which as a female poses serious problems but this is no longer as issue either. My greatest advice is this; I was in so much pain I had reached the point where I asked if it was possible to amputate my leg!!! Dr Tollestrup and God truly gave me back my zest for life. Please let me reiterate that I still have bad days and my back still isn’t 100% but I am very patient and I’m trying not to over-do anything. I wake up everyday around 6:00 am and I’m literally on my feet going until 11:00 pm, in other words I’m not laying down several times throughout the day in order to find relief. The medicine I am on is considerably less and definitely not as strong as it once was, I only take it as needed..
        I hope that this gives you the incentive to go in……
        Make that appointment and stop procrastinating! God bless you

      • Peter
        July 11, 2019 at 3:41 am

        Is mrn good standard to diagnose piriformis sydrome?

    • April 23, 2019 at 8:01 pm

      Vincat, I have seen several folks in my support group whose doctors told them to get the laberal tear fixed and it would help, but it didn’t. I have heard that is a tough surgery to rehab from.

      I also know some people that had Piriformis Syndrome and laberal tears. They got their muscle removed and the pain is gone.

      I have heard some folks needed both surgeries.

      Most people (including myself) think the glute is involved when its not. I know theres a doctor in Texas that is trying to rename PS as Deep Glute Syndrome, HOGWASH. it has nothing to do with the Glutes.

      Its other damaged nerves, trust me, I have lived it and now doing well.

      My superior cluneal nerve (SCN) disconnect surgery took away pain over the top have of my buttock.

      My posterior femoral cutaneous nerve (PFCN) disconnect surgery took away the pain at my lower buttock and a little ways down the back of my thigh. I have talked to alot of folks that had bad falls and damaged this as well.

      My iliohypogastric nerve disconnect took away pain on the lateral side of my hip and thigh.

      My LFCN ( lateral femoral cutaneous nerve) took away pain on the top of thigh, hip, side of thigh and under the butt crease.

      MY peroneal nerve decompression by my knee on my calf took away drop foot from having sciatic nerve pain for so many years.

      The first four nerves I mentioned all overlapped my damaging release scar. They were all cut during that surgery.

      My damaged nerve pain ranged from very deep to close to the skin nerve pain.

      My piriformis muscle removal surgery took away very deep buttock pain and sciatic pain.

      I was damaged beyond belief, but I can sit now and truly feel so much better, like a new person. I am currently healing from the LFCN surgery.

      You mention hamstrings, a whole lot of folks with PS have hamstring issues and leg length issues when they go to the chiropractor. I had them myself. One person in my group stated that after muscle removal surgery her leg length was fine.

      You should reach out to Dr. T and ask him to review your case. He will do that before scheduling an appt. He doesnt make anyone come to see him unless he thinks he can help them.

      You can email Patients@Tollestrupmd.com and request a patient summary. That is what I filled out to have him review my case before I went out there.

      He is actually a Doctor that has a passion to help people, he is brave, and with my complex case, the only one in the world that could take my pain away.

      • Shannon
        May 7, 2019 at 5:30 am

        I completely agree with you! Dr Tollestrup did the removal of my Piriformis and I feel as though it was successful. I am cautiously optimistic until I am able to go a full year at my current pain level without my 8-9 level of pain returning. So far so good! I would return to see Dr Tollestrup in a split second rather than any of the other numerous Drs I had previously seen. He is by far the most knowledgeable and most successful at performing this procedure .

      • May 7, 2019 at 1:03 pm

        Yes, Dr. Tollestrup will be publishing his REMOVAL procedure soon!
        So happy you have relief!

  6. Barb
    October 12, 2018 at 6:32 pm

    Christin, did you have the piriformis release done
    By Doctor Keppler yet? I am scheduled this month
    With him, and would love to know how you are doing, and if you after the procedure the pain
    Is better? Really interested in how you were
    Treated in the hospital that he did it in also?


    • newwmn3
      October 16, 2018 at 8:07 pm

      Hi Barb! No, I have chosen to not move forward to surgery just yet. I still have a couple of things that I feel are worth trying before I make the move to going forward with surgery. I’m also not sure if release is the best choice. I have heard a lot about the release causing additional complications down the road and this makes me nervous. I would love to keep in touch with you and it would be so helpful to me to hear how the surgery and recovery goes for you. My email in case you’d be willing to share your experience with me is cbarone777@gmail.com . I wish you a very successful surgery, speedy recovery, and many pain-free days in your near future!


    • April 23, 2019 at 7:41 pm

      Did you have your surgery with Dr. Keppler or did you go to Dr. Tollestrup. I spoke with you on the phone and was wondering how you were doing.

  7. Christin
    September 7, 2018 at 1:31 pm

    I recently saw Dr. Keppler in Cleveland and he has recommended surgery to release the piriformis tendon. For those who have had this surgery by him or another surgeon, how are you doing now? How long is the “typical” recovery period? I went from being an athlete and Personal Trainer 3 years ago to one who can’t sit or walk for more than 5 minutes without excruciating pain. The docs have ruled out all spine issues and, after an upcoming injection into the hip joint itself, the hip itself will be ruled out as well. Any advice or words of wisdom would be much-appreciated. Thank you!

    • Elizabeth Snyder
      October 17, 2018 at 12:27 am

      I am in a Facebook group with people who have had piriformis releases and all of them say it’s the worst thing you could possibly do and they recommend don’t doing it it just made their pain and conditions worse. The ones who were damaged by the releases as well as other people with this condition, along with myself are all being treated by Dr. Timothy Tollestrup in Las Vegas Nevada. He’s an excellent surgeon and has perfected the surgery to remove the piriformis muscle. Please look into this before having that surgery the doctors website is http://www.nevadanervesurgery.com

      • October 17, 2018 at 6:47 am

        Release worked perfectly for me.

      • msijourney
        October 17, 2018 at 10:02 am

        But you had to rehab your way out of the surgery, correct? You werent healed in 6 weeks, right? Possibly your muscle was smaller than most and after it shrank you healed completely?

        Please know you are the only one I know of that claims healing from a release, but it did take you more than 6 weeks to heal from what I remember.

        Most release doctors will tell you up to a year. Feel blessed, its not worth the rest of us trying to get a release. scar tissue is a huge factor. I had to have alot banged off my sciatic nerve. Recurrent piriformis syndrome is way to risky for anyone to take a chance on now that the surgery has been perfected by removal.

        You are one in a Million! Trust me!

      • October 17, 2018 at 12:41 pm

        Perhaps I am lucky. I hope everyone that suffers from this life draining condition finds whatever works for them.

  8. May 16, 2018 at 2:19 pm

    It’s been 3 years and still absolutely no relief. I just went in today for my 6th MRI at the request of Dr Tim Tollestrup in Henderson, Nevada.
    He requested a more recent MRI before he will commit to seeing me since I live in Texas..
    I’m keeping my fingers crossed and praying that he will accept me as a patient. I wanted to thank everyone for sharing their information it is here that I found his name.

  9. victoria
    May 14, 2018 at 4:08 pm

    I’m in San Diego – Scripps. Seeing Spine Ortho next week to review MRI of lumbar and pelvic for what I think might be PS. Anyone know a good doc, still confused if I should see Ortho or Neurologist and what kind of of Neurologist to see? and What kind of doc does hips? Thanks!!

    • May 26, 2018 at 2:15 pm

      Dr. Aaron Filler in Santa Monica can diagnose you properly. His website is http://www.nervemed.com

      Also Dr. Timothy Tollestrup in Las Vegas is amazing, and is helping many people. His web site is https://nevadanervesurgery.org and his FB group is Piriformis Syndrome & Peripheral Nerve Solutions.

      Good luck to you. I think you should join the FB group.

  10. January 17, 2018 at 4:49 pm


    WHEN: 01/18/2018 @ 8:00 PM, EST


    On Thursday, January 18th 2018, at 8:00 pm, Eastern Standard Time, Dr. Tim Tollestrup, MD Nevada nerve surgeon will be hosting a live video session to discuss piriformis, gluteal and peripheral nerve issues. There will be a portion of the video dedicated to answer questions. In an effort to use this time efficiently, if you have a question for Dr. Tollestrup, please forward them to Gina Limbert via Facebook Messenger.

    Timothy W. Tollestrup, M.D., graduated from the University of Utah’s School of Medicine. Prior to this, Dr. Tollestrup also received a Master’s in Public Health from the same institution. In the years following medical school, he went on to complete his residency training in general and trauma surgery at Saint Louis University Hospital in St. Louis, Missouri. After garnering an additional year of experience practicing as a trauma surgeon, He furthered his surgical training as a fellow for one year at the Dellon Institute for Peripheral Nerve Surgery.

    Following his time in St. Louis, Dr. Tim Tollestrup continued his training in Houston, Texas where he completed a fellowship in hand, reconstructive and microsurgery at the Baylor College of Medicine. Dr. Tollestrup currently runs his own clinic in Las Vegas, Nevada, focusing primarily on hand/extremity surgery and peripheral nerve surgery, which includes issues stemming from such conditions as diabetic neuropathy, compression neuropathies (carpal tunnel, cubital tunnel, tarsal tunnel, etc.) nerve trauma, chronic joint pain, chronic groin pain and migraines.

    Outside of the operating room, Dr. Tollestrup is an adjunct assistant professor at Touro University, Nevada. He also devotes his time to lecturing, researching and writing about peripheral nerve surgery and related topics. Recently, he co-authored a research article that appeared in the Journal of Reconstructive Microsurgery. Also, he currently continues to collaborate with Dr. Lee Dellon, founder and director of the Dellon Institutes, on surgical procedures and other relevant practices in the field of peripheral nerve surgery.

    Dr. Tollestrup helps patients in Nevada with nerve surgery that provides long-term solutions.

    Dr. Tim Tollestrup is a surgeon based in Southern Nevada that helps patients resolve nerve issues that often have been misdiagnosed or considered untreatable.

    Nerve surgery procedures done by the Tollestrup team can provide permanent relief and long-term solutions to a myriad of chronic pain problems, previously considered to be untreatable. These procedures have led patients to call him a “life saver” and a “quality of life saver.”

    This specialized field of peripheral nerve surgery is the missing piece in the chronic pain puzzle and unknown to 99.9% of medical professionals that do not possess a detailed knowledge of peripheral nerve anatomy or have any specialized, comprehensive training in recognizing, diagnosing, or treating these kinds of complex pain problems.

    The efforts, and accompanying results for patients that have been helped by Dr. Tollestrup are best summed up by those he’s helped overcome pain and quality of life issues through peripheral nerve surgery.

    Dr. Tollestrup’s website is: https://nevadanervesurgery.org


  11. January 15, 2018 at 4:28 pm

    Hello! I had left a comment yesterday re: my husband’s journey with PS and it seems to have disappeared. Are comments moderated? Could it have been deleted?


  12. Jessica
    October 17, 2017 at 2:11 pm

    I just had an EMG done yesterday. The neurologist at the Cleveland Clinic told me that it is not possible to test the piriformis with an EMG because of where it’s located. He said there are Docs that claim they can but it’s nit possible. I called the office of Dr Thomas Ellis about a month ago and asked if he treated Piriformis Syndrome and they said yes. I have an appt in about 3 weeks with him. Anyone have any updated info or treatment on PS that worked for them? I’m so disguisted with the lack of informed Dr’s and run around I’ve gotten for 8 years now.


    • Jim
      October 18, 2017 at 8:18 am

      His comment on EMGs is partly correct, the method of testing for poriformis irritation of the sciatic nerve is called a “Provocative EMG” and is a comparison of a standard EMG to an EMG done with the patient in the F.A.I.R. position. The test was developed by Dr. Lorin Fishman


    • John
      October 18, 2017 at 8:38 am

      Jessica: Look up Loren Fishman in NYC regarding EMG – he’s responsible for the piriformis studies and has trained a number of MDs. He may know someone in your area.


  13. Birdie Houck
    September 12, 2017 at 8:26 am

    Boy oh boy am I thankful to have came across this information. I’ve been suffering for 7 yrs in constant pain. I can barely walk a block before having to sit down. After all the main stream treatments failed I find myself hopeful just maybe there’s a chance I may actually have a quality of life. I currently live in Jacksonville NC and haven’t found any providers that treat this syndrome. If there is anyone here that may help point me in the right direction I would greatly appreciate it. Thanks Birdie


    • October 10, 2017 at 9:35 pm

      The only ones that I know of that are close to you are Dr. Byrd in Nashville, TN.
      And I went to Dr. Louis Keppler in Cleveland.
      I know there is one in Texas, CA. and I believe there is one in Vegas.


      • newwmn3
        September 27, 2018 at 10:46 am

        I am considering having Dr. Keppler do my piriformis surgery and would love to hear how you are doing now since you had your surgery. I’d be so grateful if you’d be willing to share what the experience was like and anything else you think may be helpful. In case you’d prefer to contact me via email, I can be reached at Newwmn3@aol.com . Thank you!

  14. Lorraine Martin
    June 11, 2017 at 10:58 am

    I am suffering as well. Thank you for the forum


  15. B
    June 1, 2017 at 5:59 am

    Does anyone know a doctor in the Boston area who can diagnose or treat possible piriformis syndrome?


    • Lorraine Martin
      June 11, 2017 at 10:59 am

      I am wondering the same thing. I live in RI


    • Meaghan
      October 1, 2017 at 9:18 am

      Hi I am from the Boston area as well, for diagnosis and non-surgical treatment you need to go to New York City to Dr.Loren Fishman in Manhattan. He first described PS and is the expert. We got a provocative EMG test and a MRN which both showed piriformis syndrome. They have great physical therapy regimens, but you need to live in the area. It is well worth the trip. Now we just need to find a surgeon….


      • Hardcore Cyclist
        December 2, 2020 at 11:10 am

        Hi Meaghan, Did you ever find a surgeon in the area who helped you address this? Did you get bettter?

  16. Shannon
    May 22, 2017 at 9:50 am

    Thank you so much, I can’t tell you how informative your writing was for me. I have an appointment tomorrow with my pain management and rest assured I will be requesting this test to be done right away. Thank you again and congratulations on the success of the proceedure!
    God Bless you!


  17. mr pain
    January 16, 2017 at 2:21 am

    how do you explain this to a doctor to have them diagnose it? most have said they don’t see anything, or don’t even look for ps. I have had mildly for 10-12 years, but in the last few months i have bottomed out. i am in so much pain that its unbearable. I now have so much leg weakness and pain, I can barely lift my legs. I have been to er as well and of course no help there. my wife used to be a nurse and can’t believe the medical system right now with all the “sorries”. i need help immediately but don’t know what to do if no one sees anything. so frustrating

    • February 12, 2017 at 4:36 pm

      I highly recommend that you get a provocative emg. You can read about it in my blog. In addition, you should consider getting an injection under CT into your piriformis muscle to see if it reduces your pain, if even for just a couple of days. If both the injection and the provocative emg have positive results, then at least you know you are on the right track, and will have the information needed to have a surgeon take you seriously as a candidate for surgical treatment. That being said, please do your homework before making the decision to have surgery. I personally had excellent results, but some others have not been so lucky.

  18. Shannon Robles
    January 12, 2017 at 1:19 pm

    I am soo thankful for this forum! It has been a wealth of information!

  19. Shannon Robles
    January 12, 2017 at 1:18 pm

    Thank you Louise for all your help, I am scheduled to see Dr Starr in Dallas on January 17 and 28th. His Nurse Assistant Corrine is absolutely wonderful in taking care of scheduling on my behalf since I’ll be flying in for the procedures. I’ll post soon how everything went!!!
    You are an angel for all your help!!
    God Bless you!

    • Shannon
      November 26, 2017 at 12:37 am

      I called Dr Starr’s office at Parkland. They said they don’t see patients from outside Dallas County. How did you reach him? How was your experience? Thank you!


  20. Shannon Robles
    December 30, 2016 at 9:50 pm

    Sometimes, in the morning when I wake up in my left foot where the pain occasionally will radiate down but gradually the numbness will dissipate..the pain runs down from my left buttock thru my hamstring to the back of my knee and usually stops there.

  21. December 29, 2016 at 9:20 pm

    7 years of looking for answers and relief from this dreadful piriformis syndrome. I have done everything conservative and now have exploratory nerve surgery that will be scheduled next week. The sugeon told me exactly what I researched, never know what you will find until you get in there. Surgeon is Dr. Louis Keppler at St. Vicente Hospital in Cleveland, Ohio. Was going to go see Hal Martian, but then. Cleveland Clinic Doctor told me Keppler did this surgery on his friend and fixed him. Praise God, I can’t wait to have this done!

    • December 29, 2016 at 9:22 pm

      Sorry , St. Vincent Hospital.

      • ed
        December 30, 2016 at 2:11 pm

        Did you by any chance have weakness or numbness in either of your feet?

  22. Katia
    December 14, 2016 at 5:16 am

    Thank you for the article. Who is the health professional you initially visited? Is it a neurologist? An orthopedic doctor?

  23. Melissa
    November 13, 2016 at 6:56 pm

    I called orthopedic one and was told Dr Ellis no longer sees patients with Piriformis and they set me up with Dr Brandon Thomas.

  24. Melissa
    October 13, 2016 at 5:43 am

    Mizzzyp@gmail.com is my email thank you

  25. Melissa
    October 12, 2016 at 6:51 pm

    Have had joint checked and spine but not femoral ace tabular impingement or labrum tears checked. Was told at Cleveland clinic that it was piriforimus syndrome

    • Gina Suppa
      October 13, 2016 at 5:00 am

      Melissa. I am in Cleveland. I got the run around at the clinic. You may want to reach out to Dr. Michael Salata at University. You can have him look at your hips and rule out femoral acetabular impingement and labrum tears. If he does not suspect hip issues, and it really is piriformis muscle syndrome, he usually refers patients to Dr. Hal Martin in Baylor Texas. I have heard good things about Dr. Adam Star in Dallas Texas too. He does open surgery. Martin does scope. It’s my personal opinion that open surgery is more successful, as they can see all the nerves. If you want to send me a personal email, I can talk with you and tell you what I learned along the way. For instance, loose sacroiliac joint ligaments, or the si joint can become in stable an cause piriformis muscle pain. Weak glutes from hip structural issues can cause piriformis muscle to over function. Or, you can just have a hypertonic piriformis muscle. But, my experience is that the piriformis muscle is usually a symptom of something else.

    • Gina Suppa
      October 13, 2016 at 5:00 am

      Melissa. I am in Cleveland. I got the run around at the clinic. You may want to reach out to Dr. Michael Salata at University. You can have him look at your hips and rule out femoral acetabular impingement and labrum tears. If he does not suspect hip issues, and it really is piriformis muscle syndrome, he usually refers patients to Dr. Hal Martin in Baylor Texas. I have heard good things about Dr. Adam Star in Dallas Texas too. He does open surgery. Martin does scope. It’s my personal opinion that open surgery is more successful, as they can see all the nerves. If you want to send me a personal email, I can talk with you and tell you what I learned along the way. For instance, loose sacroiliac joint ligaments, or the si joint can become in stable an cause piriformis muscle pain. Weak glutes from hip structural issues can cause piriformis muscle to over function. Or, you can just have a hypertonic piriformis muscle. But, my experience is that the piriformis muscle is usually a symptom of something else. G

      • ed
        November 11, 2016 at 10:45 pm

        Gina, have you or anyone you know from this site ever heard of someone having piriformis syndrome with foot weakness that causes you to “trip” over your foot while walking or running? -Ed M.

      • Khrissy
        November 12, 2016 at 4:29 am

        Hi Ed, I had foot drop, which is what you are describing. Although my situation is better described as deep gluteal sydrome. I had scar tissue pressing on the sciatic nerve although it was partially connected to the piriformis. I had endoscopic surgery where the scar tissue was removed weeks ago. The foot drop was fixed immediately. I was very surprised because it can take nerves a very long time to heal. I still have some numbness in my theigh though and I’m about the same amount of pain. I am hoping this goes away with time but there may be permanent damage. It seems foot drop is pretty uncommon from dgs or ps…but it can happen.

      • josh
        October 10, 2017 at 2:13 pm

        I have been researching for Surgeons that perform Piriformis release and I have had any luck. Could you coach me as to where I should go to start over with new evaluations and diagnosis?



      • Gina
        October 10, 2017 at 2:51 pm

        Dr. Adam Star in Dallas Texas
        Dr. Tim Tollstrup in Nevada
        Dr. Hashemi in Washington DC, Nerve Bone and Joint institute


      • October 10, 2017 at 9:28 pm

        Dr. Louis Keppler in Cleveland, Ohio. St Vincent Hospital does piriformis muscle release surgery too. I had mine done last February. I took all my test results and history over 8 yrs to him. He knew right away he needed to do open incision, nerve expoloratory surgery. He found the piriformis muscle had scar tissue strangulating my siactic nerve. He cut it loose, and the tendon. I have some surgery scar pain now (7 months later) that aches when the weather fronts come through. My therapist and surgeon tell me it will get better with time. I just got an injection in the scar yesterday. At least this pain is not as bad as the PM pain before surgery. I am stronger and can sit much longer now.


  26. Jessica
    October 9, 2016 at 7:55 am

    Dr Ellis at OSU ?

    • Gina
      November 13, 2016 at 2:44 pm

      I did not have foot drop issues. I have been talking with Alex R. on the Piriformis Facebook group and he mentioned that he is experiencing foot drop. Perhaps Ed can fill him in some?

      Jessica – Dr. Thomas Ellis is located at Orthopedic One now in Dublin, Ohio

    • Gina
      October 10, 2017 at 2:52 pm

      Dr. Ellis does not due piriformis muscle release surgery anymore.


  27. Melissa
    October 8, 2016 at 9:58 pm

    Oh my that sounds like me and I have been searching for almost 5 years for answers!!!!! Wish I could find a doctor in Ohio or West Virginia that could help me with this!!!!

    • Gina
      October 9, 2016 at 12:29 pm

      Thomas Ellis at Orthopedic One in Dublin Ohio.

      • Melissa
        October 12, 2016 at 3:21 pm

        I contacted orthopedic one in Dublin Ohio and he doesn’t treat piriforimus syndrome.

      • Gina Suppa
        October 12, 2016 at 4:04 pm

        After my surgery, and my difficulty getting better, he must have stopped performing surgery. Have you had your hips checked to rule out femoral acetabular impingement and labrum tears? Have you checked your spine and sacroiliac joint? Piriformis muscle syndrome is rare and usually a symptom of hip structural issues, spine and or sacroiliac joint dysfunction.

  28. July 11, 2016 at 6:15 pm

    Dr Hal David Martin in Dallas

  29. July 11, 2016 at 5:25 pm

    Hi i read your article and I to have been suffering with pirformis sydrome in 2007 and had many doctors who could not find where the pain is coming from. I had mri’s, emg’s (standard i believe, am in no better shape than when i experience this trauma in a fall. Long story short if u can direct mecto a doctor or doctors who know what they r doing and is familiar wirh this i really would be grateful. I had another mri done about 6mths now and this doctor saids its not pirformis sydrome its spinal scoliosis, i said what, then why am i having this pain in my right buttocks, going down the back of my leg. I cant sleep or sit for a long time, i cant walk far with out the leg goung weak and now my lower back hurts. I live inHouston,Tx . Thank you

    • John
      October 8, 2016 at 10:25 pm

      Yolanda, I live in Houston as well and found that few docs know how to differentiate the source as piriformis, Sacroiliac,or lumbar spine. I found only one neurologist that was familiar with proactive EMG but not experienced enough to unequivocally diagnose PS. I also found that most physicians weren’t very competent with typical spine EMG. I finally went to Loren Fishman in NYC, who’s one of the most experienced physician that diagnoses and treats PS. My problem is a bit more complex than the typical PS patient so I’ve made a couple of trips there, not just one. He’s trained some other physicians but no one close to Houston, one is located in Lubock. Fishman is incredibly curious and smart, and thorough.

  30. Kay Borkowski
    May 19, 2016 at 4:13 pm

    My daughter’s MRN was ordered by an orthopedic surgeon and was read by 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 . Dr. Chhabra, an interventional radiologist in Dallas, Texas did not require her to repeat the MRN.

  31. Daniel
    December 21, 2015 at 6:19 am

    Thank you for the blog information and everyone sharing their experiences. I have had many of the same experiences with chronic pain in my right hip for 6 years. For me I believe I have more than one issue in the hip as I have had pain directly in the hip joint, IT band issues and buttocks/hamstring pain. I was recently diagnosed with a small labral tear and had a cortisone injection which releaved much of my hip joint pain. Getting intimate with a foam roller and lecrosse ball and research on my own has lead me to believe I also have piriformis syndrome. Does anyone know and recommend a Dr who does these tests and surgeries in California?

  32. Cindy
    October 25, 2015 at 6:01 pm

    I’ve been in PT for my piriformis since May. It improved greatly. But just 2/weeks ago it came back with a vengeance. Pain in the middle of the buttock, pain down to my ankle on both side of leg. Sharp pain in hip. Steroids, opiates, muscle relaxants– nothing is helping. I am an invalid due to this. I can’t walk, can’t stand, sit on ice all day. I crawl at home and can’t go anywhere. Is there a surgeon in the Akron/Canton/Cleveland OH area?

    • Gina
      October 25, 2015 at 8:24 pm

      Get your hips looked at by a good hip specialist. Femoral acetabular impingement and labrum tears cab cause piriformis muscle to be hypertonic. Michael Salata University of Cleveland. For piriformis, the closest doctor is Thomas Ellis, orthopedic one, Dublin Ohio. Cleveland Clinic has Rosneck, but he missed my hip problems for almost three years. I like Salata and Ellis the best. Salata does not treat piriformis.

    • Jim
      October 25, 2015 at 8:34 pm

      Have you had a provocative EMG? It is critical to rule out other possible causalities, and also get a more definitive read on the source of pain. The importance of getting an exam by a physician with thorough knowledge of PS and other hip/pelvic structural issues cannot be underestimated.

  33. Carlos A Selmonosky,MD
    October 20, 2015 at 12:58 pm

    Drs Ghazi and Dr Hurdle in the Jacksonville Florida Mayo Clinic are well versed in the diagnosis and treatment of the Piriformis Syndrome

  34. Jim
    September 18, 2015 at 10:18 am

    John, I have pretty ‘typical’ PS symptoms — sitting causes ‘sunburn type’ nerve pain from lower back to side of thighs, feet, etc. Standing for much time also becomes a problem, particularly as the day progresses. I have found relief with botox for up to 6-8 weeks, but this is expensive to do ($5-6K). ‘Triangle’ poses in yoga have found to be beneficial – Dr. Fishman did an extensive seminar on this earlier this year which is available on DVD.

  35. Jim
    September 18, 2015 at 6:15 am

    John, I had the provocative EMG test and it indicated bilateral PS. However the provocative EMG does not actually identify where the entrapment is located. I also had an MRN, however the entrapment did not show up on the MRN (which is sometimes the case) , so without knowing exactly where the entrapment is, surgery does not seem to be an option.

    • September 18, 2015 at 8:54 am

      Jim I disagree, my Provocative EMG results, which I’ve posted for all to read, states that I had nerve entrapment at the piriformis level.

      • Jim
        September 18, 2015 at 9:18 am

        Matt, I should add that despite the positive P-EMG, my MRN read completely normal–my doctor said he has seen this in the past, but felt that without knowing the precise source of the PS, surgery would exploratory and not advisable.

      • September 18, 2015 at 9:41 am

        If he/she was my physician I would find a new one that didn’t consider the surgery exploratory, for example, Dr. Heinrich. Even my insurance company didn’t consider it exploratory surgery.

      • jason
        December 11, 2015 at 9:26 am

        13 years after a hip dislocation with about 6 hrs until put back in place, It has been a nightmare. While reading the symptoms of Ps for the first time, I cried of joy when I realized it could be cured through priformis release.

        My question is, I have full mobility, I can surf, run whatever but stairs and distances in a car or walking clearly set the symptoms into motion.
        Could I run, jump, surf normally if it is Ps?
        Thx in advance

      • Jim
        December 11, 2015 at 11:16 am

        Jason, no way to know or diagnose PS unless you have it evaluated by a knowledgeable Dr. Only thing that occurs to me is that, in my case, most activities that tend to activate the piriformis (e.g. ballroom dancing) which involve side-to-side movement or rotation usually cause problems for me (this is in addition to sitting or standing in place for any length of time). So, when you mention surfing, which requires balance–I would have guessed that to be a pain trigger. There are a lot of ways the sciatic nerve can be irritated in the pelvic region which may or may not involve the piriformis and/or other tendons and muscles.

    • September 18, 2015 at 9:47 am

      Hi Jim, I completely agree with you in that EMG does not image nerves. At the same time, finding someone that has experience reading MRN is not that easy, as in finding someone in PMR for provocative EMG. And as you experienced, the methods themselves have limitations, making it more difficult. Did you or do you have back pain?

    • Gina
      September 18, 2015 at 12:27 pm

      Jim, I agree with Matt. if your pain gets too bad, you may want to consider a consult with a different doctor and exploring options of “open” surgery. I was not diagnosed with a MRN, I was diagnosed with lidocaine/cortizone injections, and manual tests. I am hyper mobile and I had a negative provacative EMG too. However, when Dr. Thomas Ellis went in, my sciatic nerve was entrapped in the deep rotator muscles, as well as the priformis muscle and also attached to the trochanter and acetabulum. For me, I am extremely thankful I had open surgery, as I don’t believe all of my issues would have been fixed with scope surgery.

      • Jaime Lackner Mimnaugh
        January 6, 2016 at 2:09 pm

        Hi. How long did you suffer before getting the surgery? I am meeting with a surgeon on Monday for what I believe is PS, but have not been diagnosed (yet) that I for sure have it. Ive been suffering almost 3 years and I want the surgery (I think) because nothing else is helping. I am hoping the surgeon I meet with on Monday will know of the correct tests to be able to diagnose me and let me know if I am a good candidate for the surgery. thanks

      • Jim
        January 6, 2016 at 3:35 pm

        Hi Gina, I’ve been doing glute isolation/activation exercises & radial shockwave therapy for about 2 months now and seeing slow but gradual improvement. I am down to 1x per week of RST and doing the glute exercise protocol 3x/week. This is not easy–serious muscle building, but the fact that it is providing slow but gradual improvement is nonetheless encouraging. Haven’t used painkiller in over a month now. The PT feels hypotonic glutes are a significant contributing factor for non-structural/non-traumatic PS. He said he even sees hypotonicity among long distance runners as they rely on quads for running. Once the glutes weaken enough, they stop activating, and then you’re introducing stress on other muscles such as the piriformis.

  36. Andrea
    September 16, 2015 at 7:13 am

    I have spent the laat 5 wks in agony and unable to walk. My massage therapist said he thought I should be tested for PS. My hip, and spinal surgeons told me it couldnt possibly be PS. After 2 more wks of agony and a 4 day stay in the hospital I was told I have PS. They dissmissed me with no referral so now I am waiting 3 weeks to see a specialist. Any advice on how to speed this road to treatment up? I cant even sit on the toilet without litterally feeling like I am being stabbed. I am miserable.

    • John
      September 16, 2015 at 11:13 am

      some advice – Call or email Loren Fishman, MD regarding PS diagnosis; he may know of someone in your area that is competent with the FAIR position EMG. He’s one of the most knowledgeable and experienced MDs in this specialty. He developed the provocative procedure for diagnosis and compared results with Filler’s MRN data – about the same in terms of PS diagnosis if Fishman does the procedure. For some people, the FAIR method is tricky and maybe misdiagnosed. You can also find his books on Amazon, which are well written, to get a better idea how to perform self-diagnosis as a starting point. The books are worth reading since there are few specialists (PMR) that have any specific knowledge and experience in this area – usually their first comment is that PS is over diagnosed so they rule it out and start with the back and never make it to the Piriformis. This is because they were trained this way and they probably don’t read journals. According to Fishman, his techniques for rehab work for more than 80% of the people he diagnosis for PS (I think he now claims a better percentage).
      Hope this helps.

      • Jim
        September 16, 2015 at 2:38 pm

        John’s advice is ‘spot on.’ Only comment I would add, is that the provocative EMG is an effective method to diagnose PS (yes/no), however if PS therapy is not helping, the MRN is usually a follow-on step to attempt to identify where the nerve is impinged or entrapped in the event surgery is to be considered. Despite the fact that Matt required surgery, there are other therapies (which must be considered before surgery–many of which Matt described in his own journey) that can resolve PS.

      • John
        September 17, 2015 at 10:41 pm

        Hi Jim
        The FAIR position is the position used for the provocative EMG, where the leg is Flexed, Adducted, and Internally Rotated while in a side lying position. It’s similar to the image above except the patient does not have the upper back rotated in a stretch position. For those with serious interest, “Functional Electromyography: Provocative Maneuvers in Electrodiagnosis,” is more than anyone could possibly want or need to know. I could only find one person in Houston that was familiar with the FAIR EMG; they struggled to provoke a response but were unable to get the test leads into a suitable position. I went to Fishman who diagnosed PS with his FAIR test technique, which wasn’t that easy for my case. I then received Botox. It was worth the money and time for me. So yes, the FAIR provocative EMG is effective when a skilled professional is familiar with the technique.

      • September 17, 2015 at 11:00 pm

        Dr. Scott Hardin performed my Provocative EMG within 20 minutes. He had no issues doing this. It was a cake walk. I posted his report on my blog in Diagnosis page.

      • John
        September 17, 2015 at 11:31 pm

        Hi Matt
        I think you were lucky that you found someone that knew what he was doing. I could find only one doctor in Houston that knew of the procedure, and that person, wasn’t very experienced in performing the FAIR position EMG – it’s something that isn’t performed very often so getting experience is somewhat difficult. It could also be due to my specific condition, which is bilateral with suspected spinal involvement.

        BTW, thanks for starting the website to share names and personal experience to help others. John

      • September 18, 2015 at 8:51 am

        John, I disagree with your opinion that I was lucky. I suffered for five long years, and I never gave up searching for an accurate diagnosis and cure. Persistence, knowing my anatomy and pain triggers were key to my success.

      • Gina
        September 18, 2015 at 8:23 am

        Just a heads up: Individuals, like myself, who are hyper mobile, may not get positive results from the provocative EMG and still have entrapment of the piriformis muscle, or other deep rotator muscles. My sciatic nerve was entrapped in the deep rotator muscles and physically attached with fibers to the trochanter, yet my provocative EMG was negative. The reason for this is that in order to get a positive reading, my hypermobility prevented it.

      • September 18, 2015 at 8:45 am

        Gina, I’m also hypermobile and Dr. Scott Hardin had no problem with the Provocative EMG. He actually wrote about my hypermobility in his report which I link to on my Diagnosis page.

      • John
        September 18, 2015 at 9:36 am

        “lucky” referred to the fact that you found someone to diagnose your problem and successfully treat it. I agree that “persistence” and learning are extremely important but you still have to find someone skilled in this area to diagnose PS correctly before treating, and then you have to find someone that will treat it successfully. Unfortunately there are no “good” clinical trials, or sufficient data, to help practitioners diagnose and treat extreme cases of PS. In fact, PS is controversial among the MD community. The trend has been to investigate spinal problems first since PMRs have been trained that PS is over diagnosed. The more recent data of Filler and Fishman suggest otherwise. Personally, I have spent over 5 years with PS and was misdiagnosed repeatedly. So yes, I believe that you were “lucky” to find someone that could treat you for your condition.

      • September 18, 2015 at 9:38 am

        Thanks for clarifying John. I understand better now where you’re coming from.

      • Gina
        September 18, 2015 at 12:20 pm

        Matt – Thankfully because of your blog, I made the 9 hour trip to see Doctor Hardin and Doctor Henrich too. Dr. Hardin said that because I was so hyper mobile he could not get a positive reading on my impinged nerve and could not conclusively say that I had PS. I am sure you are aware that there are different degrees of hyper mobility. I am extremely hyper mobile. Dr. Henrich believed I had PS. However, I elected to have open surgery with Dr. Thomas Ellis. If I would have only relied on the Provacative EMG that Dr. Hardin performed, I would have thought I did not have PS. Fortunately, I went to Dr. Ellis and had open surgery as my surgery was quite extensive and involved removing the sciatic nerve from several of the deep rotator muscles, as well as the pirifomris muscle, shaving bone away from the trochanter and acetabulum, so that the nerve would not catch on the bone, etc…. A lot of was done, may not have been performed had I had scope surgery with Henrich and I would still be in pain, wondering what was wrong with me. It wasn’t until Dr. Ellis moved my leg during surgery and physically saw with his eyes, that the sciatic nerve was catching on bone that I had the sciatic nerve attached to the bone. During scope surgery, there is lots of air in the hip joint and fluid; therefore, this most likely would not have been caught as the movement of the leg could not be performed. This is not a simple walk in the park surgery and individuals must rule out spine and hip issues before thinking it is their piriformis muscle, as both spine and hip issues can contribute to piriformis issues. I am very thankful Matt for your blog and that yours was a condition that both Hardin and Henrich were able to treat and diagnose, but everyone’s situation is different and everyone should really take caution before jumping into this kind of surgery. I know people who have had this surgery, to only find out that they did not treat the root cause of their prifiormis pain, which was the hip structural issues.

    • Sue
      January 16, 2017 at 10:16 pm

      Thank you for putting this information on the internet as a resource. I have an EmG but do you know if the different kinds have different CPT codes so I could find out which one was ordered.

  37. Brooke
    August 8, 2015 at 5:15 pm

    I think I have piriformis syndrome gone crazy. I have battled this vicious pain for almost 3 years now but have been unable to bear weight on my right foot for 5 months without dissolving to tears and spasms, usually ending up in the ER.. Also, my leg feels strangled when I try to take a step.i have heard recently that no one in Utah does the surgery. Has anyone else run into this issue?

    • May 24, 2016 at 12:10 am

      I am in Utah. Did you by chance find anyone? And if so, could you share your experience?

  38. June 30, 2015 at 10:07 pm

    Who is responsible for the lack of knowledge of the physicians that are unable to diagnose or consider piriformis syndrome as the cause of the patients complaints.It may be that 15% of the operations for back pain have misdiagnosed piriformis syndrome as the sole cause or associated with lumbar spine disease.Medical Schools or Residency Programs.
    This is a Piriformis Syndrome Shuffle as it also occur with Thoracic Outlet Syndrome patients.

    • Summit1
      July 4, 2015 at 1:06 pm

      Excellent question, but without a clear answer. I went to a neurologist who swore there is no such thing as PS and whenever he had encountered someone with symptoms, he had identified another cause. Needless to say, after try a battery of various meds with him, none of which helped much, I moved on. My current dr. specializes in sciatica and PS and has been more helpful.

  39. Elise
    May 1, 2015 at 4:31 pm

    Last week I received a diagnosis of PS through EMG/NCV and an unremarkable CT of my lumbar spine. Loads of good information here. I plan on seeing a doc in the DFW area ASAP.

    • May 7, 2015 at 11:36 am

      Just had surgery in DFW. Would love to share my doctors information with you.

      • Sue
        January 16, 2017 at 10:36 pm

        Please share with me! I am headed to Dallas in February. I have waited 4 moths to get in with Dr Martin

  40. surveyor1953
    April 24, 2015 at 3:52 pm

    Just got back from Wisconsin seeing Dr. Heinrich. Let me say it was worth the trip and the expense. I arrived 40 minutes early and immediately shown to a room. I expected to sit there for a while. Within a few minutes Dr Heinrich greeted me with enthusiasm. He gave me the most thorough exam I’ve had since my problem began. He said he wanted X-rays of both hips. Immediately after they were done he reviewed those, did further manipulation and said my problem was not PS. I was totally bumbed and he was too. He really felt bad. I was scheduled for a provacative EMG with Dr Hatdin the next day and then a follow up with him the following day. He was very certain and felt the other two appointments were not needed.
    He then explained my pain was way two low in the hip and my response to several of the tests would have evoked pain from the piriformis muscle. He explained what he felt the problem may be which went over my head because I was so disappointed. He felt Dr Hal Martin from Dallis was the guy to see. PA is going to email what I missed. My journey continues. He strongly recommend Dr Martin and that’s good enough for me. A truly assets to his profession.

    • Tom
      September 14, 2016 at 5:01 pm

      Hi Surveyor,

      I just had a similar diagnosis from a different doc Are you still watching this email? If so would love to connect with you.

      They said I had sciatic adhesions more down towards the Ischial Tubularity.

      Did you ever meet with Dr. Martin?


  41. Amparo
    April 14, 2015 at 11:07 pm

    I’m suffering with this syndrome which was actually identified by a chiropractor. The studies conducted before i saw the chiro were “normal”. I’m going to look into the Provocative IMG because the massage, stretches and accupunture help but I’m still in lots of pain. Thanks for posting this information.

  42. surveyor1953
    April 14, 2015 at 5:18 am

    Thanks! That great advice. Wow! I really appreciate that and will let you know what’s going on.
    My email is edbrowne@reagan.com

  43. Summit1
    April 13, 2015 at 8:37 pm

    Ed/Josh, I would encourage you to read the following article carefully, it may be helpful in resolving your coverage issues.

    • Summit1
      April 13, 2015 at 9:00 pm

      The link discusses coverage issues pertaining to specialists for eating disorders, but the coverage issue pertains to any specialized treatment procedures including non-spinal sciatica. It’s worth talking with your insurer to ask them for their help in identifying providers of treatment for PS within their network.

  44. surveyor1953
    March 25, 2015 at 3:29 pm

    Thanks for your help and this blog. Shortly after reading it I contacted Dr Heinrich and he responded to my lengthy emails and replied. I can bear the cost of his visit and provacative EMG but can’t do $20 Gs out of pocket for the surgery. I just pray Aetna will if it is needed which I feel strongly it is.his group does accept Aetna so I hope me being out of state isn’t a problem. Gina in the blog mentioned a Dr Thomas Ellis in Columbus which I am interested in knowing more. Im hoping John can do it all.
    Thanks for the prompt reply as to EMG cost.
    Ed Browne

    • josh
      April 13, 2015 at 7:43 pm

      Hi Ed, I also need to see Dr. Heinrich and am out of state as well with Aetna insurance. Can you let me know when you find out if Aetna is going to cover any of your visits, provocative EMG and/or surgery? Thanks so much and good luck

      • surveyor1953
        April 13, 2015 at 8:26 pm

        I sure will. Dr. Heinrich said Aetna is one of his providers but made no promises. He did say getting approval could be a lengthy process because it’s a relatively new procedure. Leave soon.
        Can’t wait. How long you been suffering? Mine is all in my but and got me pretty much defeated.

      • surveyor1953
        April 19, 2015 at 6:02 pm

        Here is the reply from Berni at Dr. Heinrich regarding my Aetna Insurance concerns.

        Ed – “we are network providers for Aetna. Out of network should not be the issue. “

    • Trina
      April 24, 2015 at 3:06 pm

      I had surgery with Dr. Heinrich last October. I found him from reading this website. I am located in Wisconsin and have Blue Cross Blue Shield for insurance. I had the same 3 things Matt had done on the left side. It was around $20,000 alone for Heinrich’s surgery fee, but there is also a hospital charge and anesthesia charge. Total for all 3 of these charges came to around $50,000. I am not sure what your insurance coverage is, I am just telling you what I was charged and my insurance covered a portion of it. I also had the provocative EMG from Dr. Hardin, but it could not prove I had piriformis syndrome because I was already too flexible to begin with. Dr. Heinrich went off of my results with the piriformis injections before he proceeded with surgery. I had relief of my piriformis pain for about 2 weeks from the injections.

      • josh
        December 14, 2015 at 3:20 pm

        Hi Trina, roughly how much did BCBS cover of the $50,000 charge for everything? I also have BCBS so was just curious of a rough estimate how much I might need. Thank you so much

  45. March 25, 2015 at 3:11 pm

    I have an appointment with Dr Heinrich next month to be examined and his office is also scheduling a provacative EMG. Haven’t heard if my Aetna Insurance will cover any of the visit or EMG but the pain is so intense I will figure away to pay for this part, if surgery is required I’m wondering if I’ll have to stay in state (Ohio). Live between Pittsburg and Cleveland and no one knows what a provacative EMG even is. I’d like to know more about Dr Ellis is Columbus if someone would be so kind. edbrowne1953@gmail.com and the costs of the EMG or surgery.

    • March 25, 2015 at 3:17 pm

      My Provocative EMG cost around $1,300. The surgery all-in was approx. $20,000. However it was covered by United Healthcare.

  46. Ace
    March 25, 2015 at 10:31 am

    Hello I need to have a Surgury …Does anyone heard of dr dieter mortier

    • angela
      May 8, 2016 at 7:15 am

      hi – did you find anything out about Dieter Mortier?

    • allyson427
      May 22, 2017 at 8:06 pm

      He is a German surgeon who has a YouTube on doing the piriformis syndrome surgery.


  47. John
    February 8, 2015 at 10:52 pm

    In one the comments, someone asked about the tendon release procedure. Did the doctor not tell you whether they cut the tendon or removed bands of adhesions? Detaching the muscle from the tendon is brute force simple. Also, did the doctor determine if the sciatic nerve passed through your piriformis, or was it completely outside of the muscle?

  48. Ed Browne
    January 18, 2015 at 2:13 pm

    Is there a surgeon in Ohio who does the release?

    • Gina
      March 6, 2015 at 12:23 pm

      Ed Browne – I am going to Columbus Monday to meet with Thomas Ellis to discuss this issue. He does open surgery. He is the only one I know of. http://www.orthopedicone.com/our-physicians/thomas-ellis

      • Summit1
        March 10, 2015 at 11:32 am

        Gina — can we talk (or email?) You are probably a couple months ahead of me in the process of interviewing surgeons, but it would be very helpful to compare notes. For forums like this, my email address is: 9d406036@opayq.com Hope your trip was insightful. Thx!!!

    • Gina
      March 10, 2015 at 12:02 pm

      I had my meeting with the orthopedic surgeon, Thomas Ellis, Orthopedic One, Columbus, Ohio. Yes – I have piriformis muscle syndrome and YES, he will perform the surgery. It is scheduled for March 31, 2015.

      A lot of good information came from the meeting. Two things were clarified for me. 1) It is common for people with piriformis muscle syndrome to have a break of the sciatic nerve pain. Apparently, it depends on which branch of the sciatic nerve is being impinged by the muscle. In my case, I have butt and ankle pain, no other pain. Consequently, as I guessed, it looks like the perennial branch of the sciatic nerve is entrapped, causing the ankle/butt pain correlation. (See article I found below) 2) The reason exercise gets me out of pain is that the muscle gets warmed up, stretches and I am getting it away from resting on the sciatic nerve. – If I had to guess, I am one of those people where the sciatic nerve is under the piriformis muscle and not through it. Which is good news!

      Going to an orthopedic hip/trauma doctor, who understands piriformis muscle completely, was such an easy visit to compared to all of the other doctors’ visits I have been to before. I was there 2 hours talking to his Physician Assistant, going through a physical exam and reading x-rays, MRI’s and doctor’s notes. Then, he came in and did another exam, went through my history and said I have to options. 1) do the surgery open, and if I want through him, or 2) go to Milwaukee and have Dr. Henrich perform the surgery orthoscopic. Without hesitation, because of this group and educating myself so much on the pros and cons to both surgeries, I scheduled open surgery with Dr. Ellis for March 31, 2015. Besides, a three hour car ride, is much easier than the 9 hours to Milwaukee…..

      It is going to be a long two weeks wait, but I am so excited to get this over! He said I will be sore for four weeks and I will likely not want to sit. (Shoot – I haven’t sat normal in 7 years, that’s no issue…..) He said, no walking without crutches or driving, until I can walk without a limp and/or narcotics. He does not want me developing additional compensation issues. He said that should be until week 4-6. After week 6, I can begin physical therapy to strengthen my posterior muscles, specifically glutes. He said that I should consider working from, until the posterior pain goes away and as long as work will permit. He said I should begin seeing significant improvement at 3 months and will continue to get better until six months. Which based upon my previous hip surgeries, already understand that. smile emoticon

      Excited and pumped up to get this over with!!! By June 2015, this darn piriformis muscle thing will be a thing of the past! I am looking forward to no more pain, no more butt massages, grabbing my butt in public, standing on one leg and putting the other up on the kitchen/bathroom counter or the shopping cart. Essentially, I am looking forward to getting my life back!

      YAY! GINA

      • March 10, 2015 at 12:11 pm

        So happy for you Gina. Good luck.


      • Summit1
        March 10, 2015 at 1:11 pm

        That sounds awesome. We will all be rooting for you and praying for a speedy recovery. Would you consider talking (emailing) me as I have kind of a laundry list of questions? Thanks/JIM 9d406036@opayq.com

      • Summit1
        March 11, 2015 at 3:09 pm

        I’m having a problem with email, so if you care to reach out, feel free to email me at summitview66@gmail.com thx/JIM

      • Gary Manis, Jr.
        March 17, 2015 at 9:43 am

        Hi, Gina I hope your surgery, goes well for you! I have some of the same issues. I live in Ohio could you tell me afterwards tell about your experience. And what you think your surgeon? seventit@hotmail.com

      • March 26, 2015 at 8:28 pm

        I’m seeing Dr Heinrich next month. Please let me know how surgery with Dr Ellis went.

      • surveyor1953
        March 27, 2015 at 3:45 am

        Please explain why you feel open surgery is better than the orthoscopic approach used in Milwaukee?

  49. Constance Hudson
    January 4, 2015 at 1:17 pm

    Looking for doctor to perform proactive EMG

    • Ed Browne
      January 18, 2015 at 2:16 pm

      These comments are frustrating because people name doctors with no mention of state. For newcomers looking for help, please be specific. Thanks.

  50. Annette lynch
    December 1, 2014 at 1:44 pm

    There is also a piriformis support group on Facebook that might reach more people for the person from Florida who was asking who can doa a provocative EMG. I would start with a physiatrist and see if they know of anyone. They are better at diagnosing ps anyways. I am from Massachusetts, have Spain mgmt doc at Massachusetts general hospital and have had no luck finding people in Boston to treat me. I flew to NYC to see dr. Loren Fishman who wrote sciatica solutions and created the provocative EMG testing so I went straight to the source. Insurance covered it and though they didn’t help he also did a few injections while I was there. I thought it well worth the trip!

  51. Denise
    November 24, 2014 at 11:02 am

    I live in central Florida and am desperately trying to find where to have a provocative EMG as well as a physician familiar with PS. My current physician strongly thinks PS is causing my excruciating pain in my leg. Does anybody know of a physician specializing in PS?

    • Julie
      April 15, 2015 at 6:23 am

      Denise, did you ever find someone in central Florida? I’m on west coast FL and am very curious. Thanks!

    • Jason Doyle
      October 20, 2015 at 12:30 pm

      Denise/Julie did either of you find a doctor with Provocative EMG experience in central florida, I to have had piriformis syndrome for about a year, please let me know if you found a good doc who provides the test, thanks, jason

  52. Summit1
    November 12, 2014 at 2:32 pm

    I’ve been down similar path for past 4yrs dealing with neurologists who argue PS doesn’t exist. However, I can report that I have found a medical group in NYC, led by Dr. Loren Fishman, that specialize in PS/Sciatica issues. I had the provocative EMG performed by Dr. Allen Wilkins and can recommend them to others seeking this type of test/confirmation of PS.

  53. October 26, 2014 at 7:32 am

    Dr.Israel Chambi performed surgery in2013
    Found I had bifid piformas muscle damage compressing the sciatic, pfcn, pudendal, peroneal. Pain is still debilitating. He decompressed the nerves I mentioned.
    He is a nueorsugeon. I flew to Ca.twice for surgery on each side. I also had surgery with Dr. Antalok here in Mn. for pudendal decompression. I have had this hell for 7 years. My EMGs come in normal for sciatic. I am going to be scheduled for a stimulator in Dec.2014.
    My question is will it be of any help? Dr.David Schultz is my Dr.for this rocedure. I really wanted a pain pump, but he wants to try this first. I am 78 years old. I have not been able to sit for the past 7 years the pudendal and what I thought was sciatic pain have gottenthe best of me. Please Matt any advice will be welcome. Ellie

    • Scott Morss
      December 3, 2014 at 9:01 pm

      Hello Ellie I read your post and something caught my eye. You had a Dr. Antalok in Minnesota? I am looking fora competent surgeon in the twin cities your response would be great I have Piriformis syndrome and I want explore sciatica release surgery.

      Best wishes Scott

    • Summit1
      March 6, 2015 at 10:55 am

      Dr. Israel Chambi Venero is listed in the “Bad Doctor Database” (google it) which is well worth examining.

      • Kandace Compton
        March 20, 2015 at 1:13 pm

        What is this “Bad Doctor Database”? URL?

  54. Gina
    October 24, 2014 at 10:32 am

    Hi Matt,

    You are correct. I took it for 5 days and have stopped. It is doing nothing for me. Besides, I have a road trip planned in my future, November 12, 2014, to see Dr. Henrich! Totally excited! I just know, or least hope, this is the final step in be becoming pain free! I don’t want the medication to scew any test he may perform. Dr. Henrich read the EMG I had performed in April 2014, and he said the doctor who did it, did not EMG my piriformis muscle! I am in total shock considering, that was my primary reason for going to him. He diagnosed me with sciatic nerve pain, but assumed that the path was generated form my back. UGH! So, for the last six months, I had multiple back injections, another MRI and a sciatic nerve imblasion, which only made things worse, and wasted more time & money! Soooooooo pissed, to say the least.

    On November 12, 2014, I have an appointment with Dr. Henrich, then on the 13th, I have an EMG scheduled and on the 14th, I go back to Dr. Henrich for the results and hopefully a treatment plan.

    I am very very hopeful that I will have a pain free 2015! Thank you for your blog. It helped me validate everything I have been feeling. My hip doctor recommended me going to see Dr. Hal Marin in Texas, but Milwaukee, WI is only an 8 hour drive, so I am going to see him first. If things don’t work out there, I have an appointment and trip planned to see Dr. Hal Marin in Texas. However, I am hopeful Dr. Henrich is my final stop!

    Can I ask you, or others a few questions? If I stretch my piriformis muscle by doing yoga, I can find relief for about 2 hours; however, it returns. Is that normal? Also, if I exercise, do the elliptical, then do a bunch of glute exercises, and finish with yoga, I am good to go for an evening. The whole routine takes 2 hours though, and it is not possible to do every day, so the rest of the time I am walking around with a pain in my piriformis muscle and in my ankle. I have no other pain. Just my buttocks, ankle and that is it. My muscle cramps up and sometimes spasms. It a terrible pain. I am 99% that it is caused from being undiagnosed from femoral acetabular impingement, labrum tear from 2008-2011. My thoughts are that my glutes became weak and then I started over using my piriformis muscle and getting that all in a rage. Thoughts? I know you are not a doctor, but would love a little incite if anyone has any. Thanks! Gina, Cleveland, Ohio

  55. October 9, 2014 at 6:33 pm

    Ps. They gave me gamabetin today to try.

    • October 24, 2014 at 9:28 am

      Gina, the medication they gave you is probably gabapentin. For me it was not effective, but I am wishing you good luck with it.


  56. Gina
    October 9, 2014 at 6:32 pm

    I had a provocative EMG and it came back positive. Doctors are trying to blame my back, which a no significant issues. Nerve block and imbalssion did nothing. Can some help me find a doctor. I am in Cleveland. Nobody is listening to me. sos. I had fai labrum surgery in 2010 and I am positive that my piriformis muscle was shortened from compensating, while waiting to be diagnosed.

  57. Julie Pritchard
    August 28, 2014 at 7:34 am

    Matt, this blog has been so helpful and I’m glad to have read so much. I live in FL and I don’t know how to go about finding someone who does Provocative EMG test? How do I look for that? I had bi-lateral hip replacements 3 years ago. My left hip dislocated in the PACU afterwards. Since I had the surgery, I have had pain in buttocks, in hamstrings and down to calf and foot. Standing for too long is painful and sitting especially on hard surfaces is a real pain in the butt. No one will listen to me when I say I think it’s piriformis. Of course MRI’s of lumbar I have L4, L5, S1 issues but who really doesn’t. The doc says with my symptoms my MRI should look a lot worse. I recently had again a Transforaminal ESI for L5 and that doesn’t work. I have self referred myself to a Interventional Medicine for Pain and see what they can do. I’m just getting so tired of this. My 50th birthday is next month and we are going away for a nice trip and sure would like to enjoy it for a change.

    • September 16, 2014 at 6:25 pm

      Sorry for slow response. I would call around to find out who does normal EMG studies. Then start screening them as to whether or not they know how to do a Provocative EMG. Be sure to see the details above on this page.

  58. Patti
    May 12, 2014 at 11:09 pm

    Why doesn’t Dr. Hendricks website specify that he does piriformis release surgery?

  59. Patti
    May 10, 2014 at 7:50 am

    How can you be sure that your piriformis is the problem and not your sacroiliac joint? From what I’ve read, the piriformis can becomes chronically contracted as a result if sijd.

  60. Mary Jerome
    April 29, 2014 at 11:01 am

    Hi, My name is Mary, and I have suffered with Chronic pain for close to 7 years, I finally got diagnosed as having Piriformis Syndrome, I have had an injection in my piriformis, with a steroid, and that did not even fizz on my pain….Right now I am soo frusterated with not knowing what to do…I have been reading about releasing the piriformis muscle, and I do believe that is what I need….Right now I am asking my regular family doctor to send me to a back/spine doctor? and also an Orthapedic Surgeon. The wait list hear is soo crazzzy! I have been off work since middle of Dec, I just couldn’t do it anymore, putting up with the pain, tired of taking pain meds, when I am in pain every minute of the day!! Just wanting to know what kind of doctor does this release, and if I am doing the right thing, asking to get sent to those previous Specialists…..I live in Canada (Saskatchewan),

    • Patti
      May 10, 2014 at 7:46 am

      Since the piriformis injection didn’t help, have you been assessed for sacroiliac joint dysfunction?

      • Mary Jerome
        May 11, 2014 at 7:42 am

        Hi Patti,Thanks for your reply, What kind of Doctor do I need to be referred to for SJD? Maybe that is what I need to do……..:)

  61. Rodna Epley
    April 13, 2014 at 11:43 pm

    OMG I can’t believe I found you guys! I’ve been suffering for 4 to 5 years. It just seemed to come from no where. I did dance for 20 years off and on and wonder if that caused it but the symptoms came several years after I quit dancing so I don’t actually know the cause. Sucks getting old lol. I’m a 47 year old female. After getting passed around, ignored, disbelieved, misdaignosed by all kinds of doctors, several MRIs, last year I had 3, nerve testing, xrays, 5 steroid shots… and none of them showed anything or helped in the slightest, I am more the frustrated than ever to say the least, and mentally drained. My joy is hard to hold onto to say the least, although I’m basically a happy person in general.

    I diagnosed my self last year after searching for my problem on the internet, watching surgeries, examining anatomy, reading every article on the subject that I could find, and paying close attention to all the symptoms of Piriformis Syndrome. Finally a pain management doctor a couple months ago agreed with me and recognized that this could be my diagnosis, now i need to convince him or someone to refer me out for a Provocative EMG test. I live in the Oklahoma City area.

    Unfortunately, I have burning, stabbing, deep, excruciating pain on BOTH sides and in BOTH buttocks, down both hamstings and now after my last steroid shots, down both calves and into my ankles and feet. I know exactly where my sciatic nerve is because i can feel it burn all day long down both legs. I can following the trail easily. My symptoms are at their worst after sitting in any kind of chair or surface… and of course i work on a computer all day! After 8 to 9 hours I’m ready to cry. I can’t lie on either side because BOTH hips are excruciatingly soar. Can’t sleep on my back, too much discomfort due to pressure on the piriformis. can’t sleep on my stomach, hurts my lower back. i do have 2 slightly bulging discs but MRIs have determined the discs are not severe enough to be middle of the buttocks, and i can pretty much tell you that direct path my piriformis takes due to the pain down the length of it. Also I have pain when i press near my hip bone on either side, in the back; basically where the piriformis would connect to the bone. Very soar. If i lay on my side for any length of time, i have to adjust so that i’m laying on the front side and not the back side. ugh! the only rest i get is standing or walking. so resting for me is painful, and relieving my pain is unrestful.

    thank you sooooo much for creating this blog and for the great information Matt (and everyone). You have given me so much hope that I too can have my life back. I’m crying just considering the possibility of feeling no pain after at least 4 years.

    Can I ask you something Matt please? Is Pirifomis release, the severing of the muscle from the bone? what happens to the muscle after that? what happened to your ability to rotate of flex your hip (hips?). Did the surgeries cause any physical limitations?

    thank you again! and may God bless you for sharing your experience and giving us hope.


    • April 29, 2014 at 8:26 pm

      It is the severing of the muscle tendon (at the sciatic notch for me). The muscle remained connected at the greater trochanter. Not exactly sure what happens to it, that is a good question. I actually have more flexibility now than I did before the surgery in that area. No limitations as a result of the surgery.


      • Patti
        May 10, 2014 at 7:48 am

        I think there are several different techniques which can be used in piriformis release surgery, depending on the specific problem. It’s great to hear that one can be fully functional after the surgery!

      • Sue
        January 16, 2017 at 11:00 pm

        I was told by a hip surgeon that releasing the Piriformis affects the blood supply to the head of the femur and long term makes a hip replacement more likely. Was this information shared with anyone? Anyone with Piriformis syndrome ultimately knows the pain is so bad, there is little choice, but I am curious as to who else has heard this.

    • Shannon Robles
      December 27, 2016 at 1:18 am

      Your story sounds exactly like mine even your age when this began. My heart goes out to you as I can only imagine your desperation to find relief is as much as mine. I too am new to this journey of searching through and seeking out as much information as I can to find relief.
      I literally can feel years of my life being shaved off due to my increasing inability to find the strength to even get up in the morning and move through out my day. What we’re once such easy tasks ie…. showering, shaving my legs even getting dressed have become next to impossible. My quality of life is almost non existent. I pray daily that I will eventually find relief from this horrific pain, that like yours, began out of the blue. I hope that you too will find relief!
      God Bless you,

      • Sue
        January 16, 2017 at 11:14 pm

        I turned 49 the day you posted this and I am sure many 89 years olds function better than I am now. Your post had so many of the challenges well put. People who don’t understand PS think there are “good and bad days.” However, everyday is a struggle when you suffer with this. The only way to describe the diagnostic hell train is that drains ones spirit. I have been so touched by everyone’s willingness to help others through the dark times of this condition. These posts are helping me hold on that there is hope of getting to the right doctor who can successfully treat PS.
        Thank you for sharing your challenges and it looks like all of us have had to go to Google Med School to understand the difficult path in this is!

  62. Dan
    April 11, 2014 at 9:28 pm

    Hi Matt, how many treatments of acupuncture did you try? I am a wits end and going to try it as a last resort. Hoping I just get even 1% better.

    • April 11, 2014 at 9:33 pm

      Three to five and it wasnt effective for me. Good Luck.

  63. Carol Gill
    April 6, 2014 at 1:21 am

    I want to know what type of doctor finally helped you.
    I am in Dallas TX and I went to my GP and I got muscle relaxers; went to physical therapist and just got some stretches and balance exercises which didn’t work; went to a back specialist and he did an xray and said I might be getting arthritis but I might have piriformis in my left side since I couldn’t raise my leg or lay on my side and I needed to swim. and once I hurt so bad we went to “doc in the box” and I did get a cortisone shot in my hip but it wasn’t aimed at anything particular ..and I got some relief.
    Now all of a sudden it is back full force and on todays like today after 15=20 min walking I practically fall down.

    • April 6, 2014 at 10:01 am

      An orthopedic surgeon that specialized in repairing hips.

  64. Annette Lynch
    February 1, 2014 at 3:51 pm

    Sean in Boston….I’m sure Matt can answer your medical questions better than I can but just wanted to say I am in Massachusetts as well and if you want to e mail me privately will share as much info as I can with you about our area. annettedev4962@aol.com

  65. Sean
    February 1, 2014 at 9:05 am

    Hi Matt,
    Thank you for sharing your story and providing some hope to the rest of us. I am coming up on my 3 year anniversary of undiagnosed chronic pain in my right hamstring, butt, and hip. My pain began when I felt like I pulled my right hamstring at the gym. I did 3 months of physical therapy with no relief and began feeling pain in my right buttock. I used to drive a lot for my job and would get bad pain in the buttock, hamstring, and IT band on right leg on long drives (usually after 30 minutes). Over the last three years I’ve also done three months each with a chiropractor and acupuncturist with no relief. I had an MRI of my lower back which the doc said was normal. As you said, I have constant 2/3 level pain in my right hip and leg. If I exercise, my right hamstring will feel moderately pulled. I saw a neurologist but he was unhelpful and expensive so I’ve been reluctant to go back. One unique point to my pain is that if I cross my right foot over my left knee the entire right side of my right leg and hip tense up. I do not have groin pain. I can’t sleep on my right side without hip pain. I considered steroid injections but saw a lot of people post unsuccessful stories so have not. I don’t get pain in my butt from sitting at work all day, just the ever-present dull pain in the hip and leg. I really only get the butt pain from driving or exercise. Advil doesn’t help.

    If I don’t exercise or drive the pain is tolerable and I’ve grown to accept that this may be the case for the rest of my life.

    I’d really appreciate it if you could compare your symptoms to mine and let me know if you think the provocative EMG test is worthwhile for me or if my symptoms don’t really match up to yours.

    Thank you,

    Sean in Boston

    • February 2, 2014 at 4:15 pm

      Sean, I absolutely think you should explore getting a Provocative EMG. Your symptoms sound a lot like Piriformis Syndrome.

      • Sean
        February 2, 2014 at 6:41 pm

        Thank you Matt. I am going to call the doctor Annette recommended and try and find someone close to me so I can have the test done. I can’t do it until April but will check back in to confirm my results. Thanks again, Sean.

  66. Annette Lynch
    January 30, 2014 at 9:28 pm

    Find someone who does the provocative EMG. If you can’t get to NYC to go see Loren Fishman, then call his office or look up in one of his books to see if he gives names of other locations/doctors who know how to do it in your area. EMG tests can show normal and there can still be a nerve problem. The provocative EMG test though is a little different and somebody who knows what to look for in your physical exam like Fishman will be able to tell right away what your issues are. I know how discouraging it is to find people who know how to deal with such an unusual problem as piriformis syndrome/sciatic nerve entrapment. Good Luck.

    • Summit1
      March 2, 2015 at 9:10 am

      +1 also recommend Dr. Loren Fishman and Dr. Allen Wilkins in NYC

  67. Felicia
    January 30, 2014 at 6:49 pm

    Today, the neurologist had no idea how to do the provocative type. I showed her this link on my phone, she took offense to it, like I was trying to tell her how to do her job. So my suggestion to anyone needing this test… ASK BEFORE YOU GO if they know how to do it. If they don’t, then go somewhere else. I was certain that once I got there it would work out. It didn’t. My EMG showed normal. So now Im back to square one. This looks bad on paper. I now don’t know what to do. I did get a MRI done of lumbar today, which also wont show piriformis or S.I. joint dysfunction.

    • February 2, 2014 at 4:12 pm

      Dr. Scott Hardin’s office in Milwaukee, WI may know of a physician in your area Felicia. May be worth calling him. If you’re unable to find one, perhaps go to Dr. Hardin and have it there.

  68. laurel
    January 30, 2014 at 1:47 pm

    Thank you again Annette!

  69. Annette Lynch
    January 27, 2014 at 1:53 pm

    Dr. Fishman spent a good amount of time reviewing my history during the appointment. then he gives you a physical exam., then does the testing. After the testing he talks to you again based on the results, makes his recommendations for your next steps. He will e mail with your local Physical Therapist to make sure his protocol or recommendations are being implemented the way he wants. Dr. Hollis Potter at HSS in Manhattan will not read anyone’s MRN/MRI from another facility. You will not see Dr. Potter when you go there to have your MRI, she only reads the MRI and generates a report. I had no problem getting either of these doctors covered under my insurance which is a bluecross/blueshield PPO.

  70. laurel
    January 27, 2014 at 3:11 am

    wonder why I didn’t get notice about your reply until today; my email must be slow! Thank you for the info. It sounds like you packed a lot into one day! I live about 20 minutes from Trenton, NJ so I would probably take the train to NYC–which makes it a lot less expensive.

    That’s great that Fishman spent so much time with you; what did he do during that time/what was the goal of your visit? Besides the Provocative EMG, are there other tests Fishman runs?

    I found a place near me that does MRNs. They are not considered experimental by Medicare, so these tests would probably be covere–although I guess I would have to convince my doctor to prescribe this test for me. If I did get the test done, I could probably bring the CD to Dr. Potte ras I think she specializes in diagnostic radiology–is that correct? Or do you think there is a better way to utilize my time with her?
    Thank you again.

  71. Annette Lynch
    January 23, 2014 at 1:04 pm

    I was able to do my trips to NYC to Fishman’s and to HSS with Potter in one day. I fly from Boston though so its a short flight. Fishman spent a couple hours with me. Potter was running behind but got in and out in one day. If you do it in one day you just have to give yourself ample time to get back to the airport, etc. An MRN is Magnetic Resonance Neurography. It was a test developed by Dr. Filler in California, not that I recommend him whatsoever. The test is very useful as its able to detect and show nerve/tissue problems much more clearly than a regular MRI. If you do some google searches there are MRN places around the country in various areas. It costs a lot of money for that test and I don’t think insurance covers it, or not all of it. Dr. Potter and Dr. Fishman were both covered by my regular medical insurance, BCBS PPO, I think insurance will cover the MRI again if you check. I’ve had sometimes 3 MRI’s in one year.

  72. Felicia
    January 20, 2014 at 1:04 am

    I have severe pain in the upper butt cheek. My doctor thinks its s.i. joint, but symptoms suggest the piriformis muscle. My leg is now weak and causing me to fall. My primary doctor has ordered a normal EMG to be done, but after reading this Im going to call first thing and try to get it changed to a provocative EMG. My appt is with a neurologist. Are all neurologists capable of performing this test? The problem is determining WHAT the problem is. I have severe muscle spasms/twitches in that thigh too. did you experience this? I just hope this neurologist will agree to do this type of EMG.

    • January 22, 2014 at 1:33 pm

      Felicia I had severe twitches in my gluteus muscle region not in the thigh. Don’t take no for answer, find a doctor that will do the Provocative EMG.

      • Felicia
        January 22, 2014 at 3:37 pm

        I told my doctor to order the “provocative” and they told me that the neurologist office had never heard of it, but it was the receptionist they spoke with. When I get there, I plan to request it again when I meet with the actual neurologist, which is the 30th. The leg is now contracting from lack of use and the twitches are horrible. The pain is terrible in the mornings, I can barely get out of bed and I can only bear minimal weight. Thank you so much for your response.

      • Felicia
        February 1, 2014 at 10:11 pm

        the neurologist I went to didnt know how to and was offended when I tried to show this page to her so she could see. I had 3 days of where I was totally unable to walk, pain so intense I was suicidal. My husband had to carry me and I couldnt even make it to the bathroom, my husband rushed a small trashcan to me before I urinated on myself. Its better now after a steroid shot and muscle relaxers and complete rest. Im scared it will happen again. Ive never had pain that intense. I truly thought my hip was fractured and my pelvis was twisted. My leg is still weak and its hard to walk. Im still fighting my long term disability company who claims I am able to work. Now I have a negative EMG they will use against me. Im so disappointed in doctors.

  73. jay amati
    January 14, 2014 at 12:07 am

    Ok will do kaydee, I contacted his office today and im getting my records together to mail to his office, then if I fall in the criteria to be seen to discuss surgery they will contact me to schedule an appointment, they said they would not be able to get me in until march or april

    • basheer
      August 4, 2016 at 5:14 am

      Hello Jay,
      Thank you for penning down your issues..long story short..did you get the piriformis surgery done. Could you tell me where and how much it’s coated.

  74. jay amati
    January 13, 2014 at 2:26 pm

    Dr nicholaus theodore md on 3rd ave in phoenix az

    • kaydee
      January 13, 2014 at 9:11 pm

      Thanks for the info. I came across Yeddu today and made him an appointment for next week.. Let us know if you end up seeing the neurosurgeon

  75. jay amati
    January 13, 2014 at 2:23 pm

    Dr nicholaus theodore md neurosurgeon on 3rd ave in phoenix az

  76. jay amati
    January 13, 2014 at 2:20 pm

    Hey I started with desert interventional spine consultants they are off of th 60 and mcqueen, dr ajay yeddu, he acknowledges piriformis syndrome which is the first step im finding out, he thinks my pain is related to my discs so im going along with it (injections) until the injections have failed, there is another dr I. Phoenix that I am calling today that supposedly performs the piriformis release surgery, I will get back to you with his name, I have to look it up I forgot his name

  77. annette lynch
    January 13, 2014 at 11:07 am

    Laurel not sure I have the answers for you but I too have a child with special needs and its a difficult road taking care of someone completely dependent on you when you suffer like this. Like Matt suggests on this blog, I think good diagnostic testing is a must. Provocative EMG testing like what Dr. Fishman did for me in NYC is invaluable. It is what proved I had nerve entrapment. I’ve also had MRI’s with Dr. Hollis Potter at Hospital for Special Surgery in NYC and her MRI’s were the best reports I’ve ever had. I’ve never had an MRN but that is an excellent test to consider having. I too have had to travel to have all this stuff done and make arrangements for my son to be cared for. He has autism and MR and functions at a 5 yr old level @ 20 yrs of age. so I know how difficult it is to find care, travel etc. but you need to figure out what is best for you. I wish you luck.

    • laurel
      January 14, 2014 at 1:46 am

      I am considering seeing Dr. Fishman to get a Provocative EMG, as I agree diagnostic testing would be helpful. Annette, did you need several appointments with Dr. Fishman (spend several days in NYC seeing him), or were you able to get all you needed done in one meeting? Also, what is a MRN? Dr. Domb (Chicago area) suggested I get a DGemric MRI. Is anyone familiar with this test? Any other tests that would be helpful?
      I”m not sure if my insurance would cover additional MRIs with Dr. Hollis Potter–as I have had so many MRIs already: Left hip, right hip, pelvis, lumbar–although the reports I got were not very helpful; sometimes I do wonder, however, if I should get an MRI of my left thigh (femur) which measures 1/2″ larger (around) than my right thigh; I can actually feel an area on the front of my left thigh–about 4″ long, and 2″ wide–that bulges out (maybe it is just inflamed?); when I had a massage therapist work on this “bulge,” it actually caused pain in my piriformis muscle–so everything seems to be connected..
      This week I’m having a piriformis trigger injection; and should get my post delivery (after pregnancy) surgery records in the mail–since they records are so old the office had to get them out of storage.
      Thanks for all your suggestions.

  78. annette lynch
    January 6, 2014 at 10:55 pm

    Laurel, I don’t have that exact problem but my problems started many years ago when I fractured my coccyx during childbirth and spent 31 hours in labor with a vacuum extraction and a 9lb8oz baby! They should have done a c section because I really could not deliver her vaginally but they did it anyways. Nowadays they would never do that. That is when my sciatic pain started, the next day after delivery I went to get out of bed to go to the bathroom and crumpled to the floor because my leg gave out on me, the sciatic pain was horrible. Anyways, everything is connected in that area so if one thing is out of whack it has a domino effect. My pubis symphesis never healed properly after delivery (it is supposed to spread and then go back together but my pubic bones are misaligned now) due to the size of the child and the traumatic delivery. this was the beginning of my problems so I can imagine that if you have a problem with your sacrum, tailbone, or anything else, that it is going to effect your piriformis and that whole area. there aren’t that many doctors who know about this condiiton, as you’ve probably found out so I hope you find someone who knows their stuff. Don’t be afraid to seek a second opinion if this appointment doesn’t turn out how you expect. It took me several years to find doctors to help me unfortunately. I wish you luck. Keep us posted how it turns out.

    • laurel
      January 7, 2014 at 12:39 am

      Thank you for your reply; it really helped. Sometimes I think because my symptoms are unique I can’t be helped, but I guess everyone’s are unique in their own way. Also, with multiple issues I sometimes don’t know where to start.

      I also had similar issues with my labor and delivery. They vacuum extracted my daughter (who is now fourteen), at 9pm, and her shoulders ruptured the birth canal–but no one knew until 6am the next morning. I bled internally all night, finally the injury ruptured, and I began uncontrollable bleeding; Had emergency,surgery, two blood transfusions, and five days in the hospital. My hips locked after that–though I am to this day uncertain the exact nature of my injuries (as trying to get my records), and four or five years later–after a car accident–my hips unlocked, and my sciatica began. I believe it started with a small tendon tear, followed by my leg getting jammed up further into my pelvis when I tried refinishing my stairs (by kneeling).

      MRIs have shown (on left side) torn glut medius muscle tear, femur/glut tendon tear, bi-lateral hamstring tendonitis, and torn hamstring on right side. EMG was negative. Then they did the MRI with dye, and told me none of these issues exist (as if they disappeared)! I have been told nothing can be done for partially torn tendons, and muscles anyway, but I don’t think that is true. I have also been told my piriformis is very tight, and I know I can’t put any pressure on it without pain. My primary dr. thought I had torn SI joint ligaments, but–although I tried therapy for that–doesn’t resonate with me.

      Massage of my gluts/piriformis muscles feels good at the time, but then makes the pain worse, can’t do PT as the stretches they gave me caused further injury; tried lifting weights–as I believe some pelvis muscles are weaker than others (not to mention my messed up pelvic floor muscles), chiro, a zillion injections, prolotherapy, yoga, trigger point therapy etc.. If I try to squat, or lean over the sink (to brush my teeth), I feel like something in my left hip is pulling like it is stuck. I also have interstitial cystitis which further complicates things. I have trouble sleeping at night as I am convinced there are so many different things wrong with me no one can help!

      Honestly, I would call Dr. Zager–I think that was his name, but I have no idea what I would say to him; as he is not a physiologist; don’t you think I need someone who can diagnose the dysfunction of the way my body functions/moves; or just someone to diagnose the pain pattern? I do hope someone near by can help though, as travel would be really difficult for me–I am a single parent of a special needs teen with no family nearby, and I have legal and financial issues. Thank you again!

  79. Annette Lynch
    January 1, 2014 at 4:08 pm

    Laurel, I went to NYC to have the testing done by Dr. Fishman. He is a very nice doctor and it was worth the trip since none of my issues showed up on regular MRI’s. You are on the East Coast so you do have options. I would make a trip to see him if you can’t find anybody to take you on. There is Dr. Belzberg and Johns Hopkins, Dr. Lee Dellon at Johns Hopkins, and Dr. Eric Williams at Johns HOpkins who all do the surgery for this condition. Dr. Zager whom I referred you to before has written a lot of research papers/articles on it and does do surgery on people with very complex nerve conditions. When I went to see Dr. Fishman for testing and evaluation it was all covered by insurance. He will most likely recommend a very specific physical therapy protocol for you to try before you try surgery. Dr. Fishman has written two books on sciatic nerve pain if you google his name on amazon, you will see his books. He talks about his test (which he invented) and piriformis in both books, though not entirely. He may be able to recommend a doctor in your area……he couldn’t recommend anyone for me up in Boston. I’m sure he’s heard of all the names I mentioned above. The most likely scenario is you will have to travel to see a specialist……they are few and far between like Matt says….not too many doctors even know about these conditions. With the exception of Dellon, they all take insurance so hopefully you will find one who will take you. Good luck.

    • laurel
      January 6, 2014 at 9:27 pm

      Thank you for all the info; I did receive the name of a doctor about an hour away who does surgery to release the piriformis muscle. Right now I am trying to get my records together to go to a consultation.

      I do not know if my symptoms are consistent with PS though: Have you (or anyone else) experienced their sacrum being pulled out of place by their piriformis (or other muscles attached to the hip/femur)? I can feel it bulging out on one side. It keep getting stuck. This is making me quite anxious; I have this fear (irrational–I hope) that I will fold over to one side! My chiropractor gave me an adjustment, but the next day my sacrum returned to the same (dysfunctional) position!

      I also think my left leg (which is where my problem is) is shorter than my right one; due to compressed muscles, and a torn glut tendon. I did read some place that if your piriformis muscle is causing you problems–and is not properly treated–your gluts will soon have issues; I would think the entire pelvis area would suffer from these imbalances.

  80. laurel adelman
    January 1, 2014 at 2:03 am

    I will certainly try this also!

  81. laurel adelman
    January 1, 2014 at 2:00 am

    Don’t know what CT is, but the injection is going to be done with x-ray and dye–in an operating room. Does that sound right? Thanks!

  82. laurel adelman
    January 1, 2014 at 1:26 am

    Thank you. I will follow up. I am scheduled to have a piriformis injection in a couple of weeks so at least that is some what of a diagnostic tool. Thanks again.

    • January 1, 2014 at 1:35 am

      I recommend the injection being done by CT to ensure it goes into the muscle for sure.

  83. laurel adelman
    January 1, 2014 at 1:08 am

    Thanks for the name of the doc in Philly. I went to another dr. this week, and asked about the provocative EMG, and he looked at me like I had three heads! When I asked for a referral–to a dr. who could do the surgery Matt had, my doctor–who specializes in pain management–was clueless.

    • January 1, 2014 at 1:19 am


      I wish that I could say I’m surprised by your pain doctor’s reaction, but I experienced the exact same thing myself several times over the course of my five year search for a definitive diagnosis and treatment. I’m going to be very straight forward with you because I wish I would have had someone like me to do the same. You do not have many options to get a clear diagnosis or treatment. But, there is hope so don’t give up. A provocative EMG is also called FAIR test. You can research it. It was perfected by Dr. Loren Fishman in New York. Perhaps contact him to find out if he or someone he knows of can perform the test on you. Likewise, perhaps he can also recommend a surgeon that can perform a piriformis tendon release.


  84. Annette Lynch
    December 31, 2013 at 9:15 am

    Someone just said on your blog they are from the PA area….I found this doc online. He has written and done a lot of research on complex nerve cases. Not sure if he can help but thought I’d pass the name along. good Luck.

  85. jay amati
    December 30, 2013 at 8:08 pm

    Laurel, I went the route of googling “piriformis syndrome” followed by the state you live in, I live in tucson ax and I found a pain mngmt dr in phoenix that discusses piriformis syndrome on his website, this at least got me to a doctor that acknowledges piriformis syndrome, that was half the battle was finding a doctor that believes in it, I could not find one in tucson

    • kaydee
      January 13, 2014 at 9:03 am

      Hi Jay,
      Trying to find help for my husband. We are in Mesa. Did you find someone in AZ to help you with your piriformis issue?

  86. laurel adelman
    December 28, 2013 at 2:48 pm

    I am having trouble finding a doctor to help me. any suggestions? Been in pain for five years, but the last year has been unbearable. Don’t know where to turn. Live in the Philadelphia area. Already been to two orthopedic surgeons, had PT, prolotherapy, numerous injections, chiropractic therapy, EMG, MRI hip, pelvic, lumbar, thoracic, etc. the same ordeal you went through. Can’t seem to find anyone who can diagnosis/treat me–so I can get a provocative EMG, and surgery if needed. It spounds as if you were refered to the right doctor, but I had not been; so how would you suggest finding the right doctor–any online sources you can suggest, or someone I can contact? One leg is beginning to lose sensation–due to lack of blood circulation from tight muscles. Can’t take much more of this.

    • December 31, 2013 at 9:27 pm


      I recommend getting a provocative EMG from Dr. Scott Hardin at St. Luke’s in Milwaukee, WI. If he finds that you have compression at the level of the piriformis muscle you can then take the next step which would be to get an actual steroid injection into the muscle itself. If the injection provides you even a day or two of relief you know you are on the right track, and may likely be a candidate for surgery. The only surgeon I can recommend for this procedure is Dr. John Heinrich in Milwaukee, WI. Goof Luck.


  87. jessica
    November 27, 2013 at 10:51 pm

    For those that have had a regular EMG out there, did you have increased discomfort in the affected body part for a few days after ? I didn’t have a piriformis EMG but one for the LCFN in my anterior thigh (which was abnormal) and it was a very unpleasant experience to say the least ! Just wondering if this is common ?

    • November 28, 2013 at 8:18 am

      Jessica I do remember the painful experience of the traditional EMG. But I don’t recall how I felt the days following it. I can tell you that the Provocative EMG was not as painful an experience and I didnt experience any other new pain as a result of it for the days immediately after.

  88. jay amati
    November 26, 2013 at 9:12 pm

    Hey matt, I have throbbing in my lower back and legs every night, I can feel my heartbeat through there, is this something you experienced too? Could you possibly explain briefly whats going on? I think I know but I would like to hear it ftom someone with experience?Matt how are you feeling now after your surgeries? Thanks again for your help-jay

    • November 28, 2013 at 8:21 am

      Jay I remember feeling my heartbeat through my lower extremities on many occasions. I am now cured from Piriformis Syndrome chronic pain. Please read my other posts about recovery and physical therapy.

      • Jay Amati
        December 16, 2013 at 3:14 pm

        Hey matt, I recently discussed the piriformis muscle with my physical therapist, she did some piriformis tests on me for example, laid on my back, brought one leg up knee raisef but foor still on the table, she pushed on my leg, asked me to push back I did push back without pain and she said its not piriformis syndrome, is this accurate? On Nov 28, 2013 6:21 AM, “Piriformis Syndrome” wrote:

        > mstehling commented: “Jay I remember feeling my heartbeat through my > lower extremities on many occasions. I am now cured from Piriformis > Syndrome chronic pain. Please read my other posts about recovery and > physical therapy.”

      • December 16, 2013 at 3:49 pm

        That test is useless IMO.

  89. jay amati
    November 26, 2013 at 8:42 pm

    Hey matt I scheduled an appointment today with a spprts medicine dr, my appointmemt is dec 27, thats the soonestthey could get me in, now for the interventional radiologist can I self refer or do I have to be referred by a doctor,

    • November 28, 2013 at 8:12 am

      I didn’t get a referral.

  90. Lina
    November 26, 2013 at 3:20 pm

    I think find the right surgeon is the arduous part, Where could I find Dr. Hardin and Dr. Heinrich.

    • November 28, 2013 at 8:11 am

      Both physicians are located in Milwaukee, Wisconsin. You can find their contact info online. Good luck Lina. Keep me posted.

  91. jay amati
    November 25, 2013 at 9:09 pm

    I am so sorry that you, and anyone else has had to go through this struggle, its inhumane, I have already found an interventional radiologist and sports medicine md I will be contacting tomorrow, thanks again matt you are doing a great service

  92. jay amati
    November 25, 2013 at 9:01 pm

    Matt thanks alot man you are giving me hope, I swear if I ever get rid of this pain I am going to cry, a happy cry, I am having so much trouble finding doctors that believe in PS, and my doctors are messing up my codes and united healthcare doesnt even want to cover my tens unit because of codes, I have heard before if a doctor knows what he is doing you wont have problems with insurance, I am in tucson az and I will continue to search for a doctor with good intentions, who is sincere in wanting to save my life, you had the same battle right?

    • November 25, 2013 at 9:06 pm

      It took me five years to find Dr. Hardin and Dr. Heinrich. I didn’t bother getting my TENS Unit covered by insurance, I just bought one from Amazon for around $100.

  93. jay amati
    November 25, 2013 at 8:30 pm

    the treatments I received for the L5 S1 herniation were steroid injections,physical therapy, inversion, pain medication, electrical stimulation. My 2nd mri showed my disc had actually backed off from yhe nerve area thanks to the inversion I am assuming, but my pain had become alot worse, it had become a 9 on a 1-10. It made no sense so I started researching what else it could be and found my symptoms matched PS, I cant sit more than 5 minutes, I cant stand still, I have to keep moving or the pain sets in,

  94. jay amati
    November 25, 2013 at 7:24 pm

    Matt thanks for dedicating time to help other sufferers of PS, my doctors do not want to say its PS, one said it doesnt exist(my pain mngmt doctor), another said PS was overdiagnosed in the 70’s before MRI and that PS was not talked about anymore among surgeons, I feel hopeless, I am pretty sure united healthcare doesnt cover anything regarding PS, the only hope I have right now is to save up $15000 dollars and go to belgium to have the surgery performed by dr dieter mortier, in the us without insurance covering it will cost me $40000 -$50000. What insurance did you have? Who performed your surgery? Where do I get an provacative EMG and who if anyone has to order it? I have already done 2 mri’s because my doctors insisted it was my L5 s1 disc which was 5 mm herniated, but after treatment for that(no surgery) I am in a lot of pain

    • November 25, 2013 at 8:44 pm


      I had to calm down after reading your post. I get very emotional (in a bad way) when people who are suffering tell me that physicians (ESPECIALLY PAIN MANAGEMENT PHYSICIANS) claim that Piriformis Syndrome doesn’t exist. Please trust me, physicians do still talk about it, in fact, I had three tell me that I had a classic case of it. I can sort of understand if a physician doesn’t know about it, but for a physician to actually know what it is and then claim that it isn’t real is disgusting. I HAVE YET TO MEET ANYONE WHO HAS/HAD PIRIFORMIS SYNDROME THAT HAD IT DIAGNOSED FROM AN MRI. It DOESN’T present itself in an MRIs.

      You need to have two things done to get a definitive diagnosis for Piriformis Syndrome. First, get a CT-guided steroid injection into your piriformis muscle. If this temporarily relieves the pain (even for one day) it is a good sign that your piriformis muscle is suspect. Dr. Malcolm Hatfield, a Radiologist in Kenosha, WI did this. Next, get a Provocative EMG. The test results will show whether or not you have compression of the sciatic nerve at the piriformis muscle level. I had a Sports Medicine physician do this.

      United Healthcare does cover Endoscopic Piriformis Tendon Release and Sciatic Nerve Neurolysis, as well as a micro-bursectomy of the greater trochanter. I know this because I have United Health Care. The procedure will be “Uncategorized” meaning that it doesn’t have a code assigned to it. But, it was covered. The surgery was about $20,000 total and I only paid about $5,000 of that since the surgeon wasn’t a “preferred (Tier A) surgeon” in my plan.

      I got my Provocative EMG at St. Luke’s in Milwaukee, WI by Dr. Scott Hardin (I had an orthopedic doctor refer me to him). I had my surgery at the Milwaukee Orthopedic Hospital in Milwaukee, WI by Dr. John Heinrich (who has done well over 100 of these surgeries).

      I was also diagnosed many years ago with a disc problem in my L4/L5 as well because I had a slight bulge in a disc that presented itself in an MRI. THE SLIGHT DISC BULGE HAD NOTHING TO DO WITH MY SCIATIC NERVE PAIN.

      Good Luck & Keep Me Posted,


  95. Daniel
    November 21, 2013 at 11:27 am

    Hi Matt. I really enjoy your site and thank you for taking the time to put this out there for others. That’s something most people would not do, but then again most people probably don’t go through having PS. I was curious as to the symptoms, I started having what seems to be like PS about 2 years ago (I’m 27) after going through physical therapy for my hips. They had me perform a lot of external rotation exercises and gluteal strengthening. After that and since then I’ve had intense burning, stiffness, weakness, numbness from my glutes through my legs and to my feet. I’ve tried various alternative and conservative therapies except for injections and surgery although at this point with the lack of mobility and sleep I’d let them cut me open right now. Just curious though, were your leg muscles extremely stiff (hamstrings, groin, calves)? Mine seem to be bar tight. I notice that my legs seem to cave in quite a bit every since I started (excessive internal rotation and adduction), if I am not conscious of my gait it would appear as if I had cerebral palsy. I’ve been checked out by all sorts of specialists and docs and everything is negative. The provocative EMG test is interesting and am about frustrated that none of my doctors have ever considered that. Unfortunately I do not live in your neck of the woods or else I would go to the doctor you are recommending. I live in the San Francisco bay area and am going to be going to the UCSF pain management center, I can only hope they’ll have some idea of what is going on. Lastly, I see talk about obtruator internus pain (another external rotator), how do doctors decipher which tiny little intrinsic muscle is the problem? Would that be through the P EMG? Thanks Matt. Hope you are still feeling better.

    • November 22, 2013 at 10:00 pm


      Your symptoms are complicated. In my opinion I think you need to do two things. First, get the Provocative EMG. It will probably take you some effort to find someone that does it, but be stubborn and call around. Dont go to a physician that hasnt performed this exact test many times, because it is too important to be a guinea pig. One through I have is that you could call Dr. Scott Hardin’s office in Milwaukee to simply just ask him if he knows of anyone in your area that he recommends for this test. Second, is to get a steroid injection in your piriformis muscle under CT guidance. If you get relief even for one day that is a good indicator that the piriformis is the culprit.

      As for you other questions, I don’t recall recall intense stiffness. However, this doesnt mean that you dont have piriformis syndrome. One theory I have is that you could overcompensating for the muscle problem, and it is causing ill effects on your other muscles. I admit I’m simply taking a wild ass guess here. Note: Paid physicians took wild ass guesses when diagnosing me for years, so what’s the harm in me offering some thoughts, right?

      Please keep me posted, and I wish you the very best. Don’t give up your search for answers. You’re way too young to thrown in the towel and become dependent on pain medicine. Be very careful about pain management treatment. For me, pain management treatment helped for a while, but it wasn’t the answer I needed.


  96. Jason Simpson
    August 26, 2013 at 9:54 pm

    My name is Jason and Ive been dealing with this crap since 99. While in the Marine Corps it was hard to march with a loaded pack but I just had to suck it up. My pain got super intense in 04 and has gradually increased since then. Im on all kinds of narcotics and nerve pill and I feel like dying. I had to get out of the gym 4 years ago and my life went down hill. Its really killed my self esteem. Ive been to every doctor in town and had to convince and then prove by process of elimination that its not a dang disc or a joint or anything else. Ive had 4 spinal punctures in the journey to good health 3 steroid injections and a mylogram. Steroids gave me the worst acid reflux ever! These doctors only know how to treat the symptoms it seems. which means pills pills pills! Now I have an addiction because they don’t want to admit that I did my own research and I was right! A general practice doctor told me what my problem was in the first 10 minutes but it seems the other specialist don’t believe it. They don’t even know what it is. They just pass me around and charge the crap out of my insurance and me it seems. Im frustrated as all heck and Im lost as to what to do now. Im going to as for a provocative EMG because of this page. Thank you! The last pain management doctor was going to try to stick me in the spine again and inject something into my vertebrae to block the pain. I told him that wasn’t the right thing and he said “No No, its not PS” and that was it. I didn’t get the procedure needless to say. Whats with these people? Im thinking of writing my senator and voicing my concerns. It couldn’t hurt right? lol Thanks for the info but. Ill try to keep you guys posted.

  97. Debbie
    August 18, 2013 at 5:07 pm

    Matt, Thank you so much for sharing your experiences. I am going on six years of dealing with this pain. It is so hard to find a doctor who will listen. I finally flew to New York from California for a provocative EMG. Problem is I can’t even get my pain management doctor to recognize the results of the EMG Which showed severe entrapment. Does anyone know of a doctor in California Other than that one in Los Angeles that has such terrible reviews(it’s a shame). I finally talked to my pain management doctor into giving me Botox injections But he only does 15 units and doesn’t really make an effort because he doesn’t believe in it. Has told me several times it’s in my head and suggested biofeedback. I’m sitting here right now visiting in beautiful San Diego but was not able to go out and enjoy myself. Please help.

  98. June 27, 2013 at 4:45 pm

    I know you have posted some information, Matt, on recovery after surgery. I wondered if there is anything more you or others could post regarding experiences 1 month out with pain after piriformis surgery, what you could/ couldn’t do regarding things like walking, sitting, driving? I know many of us have some differences in the exact procedures and issues addressed, but it would be helpful to have an understanding of what others could do one month post-op and what things took more time to be able to do. Thanks for any input!

    • June 27, 2013 at 8:44 pm

      I recommend asking your doctor if he/she feels you are ready to start physical therapy and to start walking for exercise. Personally I was driving in my third week post-surgery.

      The most painful thing I experienced one month post-surgery was laying on my right hip. I couldn’t do it for more 15 minutes without HAVING to get off my hip. The second most painful thing was applying moderate pressure (using my fingers or fist) to my IT band. It was very sharp, stabbing pain (not the dull achy pain like PS). The ONLY way for me to stop the pain was to have my physical therapist massage my IT band and hip. I don’t recommend trying this yourself unless you know what you’re doing.


  99. tina
    April 4, 2013 at 6:46 am

    Hi again Matt!
    So glad to hear how well you’re doing. It makes me feel like there is hope for resolution of this condition.
    I’ve had bad PS for almost 18 months now. It’s really bad on my Left side but now I’m starting to feel it on my right side. I live in Connecticut and I’m hoping to get in with a really good hip surgeon soon. I’m trying to see whom in CT does Provocative EMG’s. The surgeon I’m trying to get in with does a lot of hip replacements as well as hip arthroscopys. He’s a big UCONN team doctor so he’s familiar with a lot of various sport injuries. His website states for Gluteal issues he does an “open” surgery. I’ve just had my records sent to him being his office won’t schedule me until he’s reviewed my current notes. So, my fingers are crossed that I get a call soon for an appointment. I’m not giving up and know that there is someone out there that can fix this for me. I will definitely come back and post info I obtain from this ortho doc. to share with everyone…. thanks again for creating this site, it’s GREAT!!!…. tina

    • April 4, 2013 at 5:06 pm

      The treatment I had to cure me can not be accomplished by an open surgery so please be careful. Endoscopic surgery is what I had. You can read more about it in my blog.

    • jessica
      May 11, 2013 at 10:24 pm

      Look up Dr. Hal Martin in Dallas or Dr. Thomas Byrd in Nashville. You want someone who does LOTS of arthroscopy and not necessarily replacements. Depending on your age, you want to make sure you are seeing a hip preservation center for the long-run. Just my 2cents and experience of dealing with no true diagnosis for over 18 months.

      • tina
        May 18, 2013 at 5:21 pm

        thanks Jessica, I hope all goes well with you and your visit with Dr Martin. Please keep us posted. I’ve had this issues basically as long as you have. I’m 42, so close to the same age as you. It makes you feel like your 90. Dr. Joyce, the ortho doc I’m currently seeng, does a lot of arthscopic surgeries too….. Tina

    • Helaine
      September 2, 2013 at 1:13 pm

      Hi Tina. My name is Helaine I live in Connecticut as well. I’m wondering if you were able to find someone to do the Provocative EMG. I believe I have either Sacroiliac Joint Dysfunction or Priformis Syndrome but can’t get anyone to give me a definitive diagonosis and my quality of life is nowhere. I am currently doing Prolotherapy and praying for a miracle.

    • Jaime
      April 9, 2014 at 12:55 pm

      Hi, Im Jaime. Im glad I came across this blog. It all started 11 months ago. I was running, training for a 5K…..when something happened and my right hip was KILLING me, and I had the numbness/tingling in my foot. After 2 months of doing nothing and just expecting it to get better I finally went to PT and they told me it was my back, not my hip causing the pain. A month of PT did nothing to ease the pain I was having in my hip. So I decided to see a chirpractor. Its been 6 months with the chirpractor and even tho he has helped reduce the pain in my hip tremendously, the numbess/tingly in my leg/foot has all of a sudden intensified. Its really bad. Finally went and saw an Ortho that specializes in hips….he said it wasn’t my hip, it was my spine, and sent me to get an MRI ( because for some reason no one would give it to me before).

      MRI results came back, the spine specialists said its fine. Absolutly nothing wrong with my spine. No disc problems whatsoever. I don’t think the guy believes me about my pain in the hip area, (even tho much better, still there) and the numbess/tingly in foot.
      He even went to say it could be someting in my hip. I told him that the hip specialist sent me to him! A spine specialits. ugh….exhausting.

      So now he’s sending me to get an EMG…..and said I should probably stop seeing the chiro. But the chiro has been the only one to have helped me so far!
      Im so done with this injury. I have 3 young kids and I work part time…..this is totally sucking.

      This annoying spine guy never mentioned Piriformis Syndrome….so only ordered me a standard EMG. Which I am realizing now probably won’t show anything.

      Anyway, my husband was the one who thought maybe I have this PS thing?
      I have been soing piriformis stretching for the past year.

      Tina, I came across your blog and saw that you live in CT. I also live in CT.
      For the past year: its your hip, no its your spine, no its your hip, its your spine…..why hasn’t anyone diagnosed me with Piriformis Syndrome? Especially when the hip & spine look apparently fine.

      So first, can you tell me who diagnosed you with this PS? And can you tell me if you found someone that does the Provocative EMGs?

      My case seems a litte different since its always been my hip that’s bothering me, and not so much the buttocks. And I know I am not as bad as some…..but still, Ive been popping Ibuprofen like candy on a daliy basis. Which isn’t good either.

      I ust dont want to live like this for the rest of my life ( Im 37 ).
      I just want to be normal again.

      Seeing a blog like this give me hope…..Im thinking acupuncture next if these Ortho people wont help me.

      Please let me know when you can.


      PS, Matt, its great you found a treatment that worked for you!
      If I hear one more person tell me its in my head……errr

  100. tina
    April 3, 2013 at 8:28 am

    Matt, so glad to hear you’re doing so well. I agree with you that surgery is probably the best long-term treatment option. This blog is great!!!

    • April 3, 2013 at 8:57 am


      Thank you so much for the kind words. I’m sitting here at work (which I do five days a week for eight hours a day) and I am pain free. All of the credit is due to Dr. Scott Hardin for proving that I had Piriformis Syndrome using a Provocative EMG test, and to Dr. John Heinrich for his meticulous surgical skills in releasing the muscle, and lastly due to my physical therapist Beth. These three people gave me my life back, gave my wife her husband back, and gave my kids their daddy back.

  101. Matt
    March 7, 2013 at 7:59 pm

    Matt: Is there any way you could give me the name of the physician who performed your provocative emg? I’m having difficulty finding one willing to perform one or who even believes in piriformis syndrome. I frequently travel to WI and would like to visit the one who diagnosed you. Thanks for your help and all of the information.

    • March 7, 2013 at 8:02 pm

      His name is Dr. Scott Hardin at St. Luke’s Medical Center in Milwaukee, WI. He is truly amazing.

  102. katbunker
    July 27, 2012 at 2:38 am

    This blog is brilliant. I will use it to help evaluate the treatment I get and what the docs say. Thank you !

  103. Annette Lynch
    July 25, 2012 at 11:48 pm

    Finally, a website that gives people suffering with PS guidance and information that is all up to date and accurate.

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