The piriformis is a small muscle that crosses the hip joint. It is primarily responsible for outward rotation of the leg at the hip, and also helps stabilize the hip and lower leg. It is connected on one side to the sacrum, at the base of the spine, and on the other side to the greater trochanter of the femur, the large bone in the upper leg. Piriformis pain can be caused by an acute injury, an "overuse injury" due to muscle imbalance or other factors. The best technique for relieving the pain depends on the cause of the injury and whether it is acute or chronic.
Loosely follow the RICE acronym. "R" stands for rest. Take a break from all activities that cause pain and allow yourself time to heal.
"I" stands for ice. Apply cold compresses to the piriformis, 20 to 30 minutes at a time, several times a day as needed. This will help reduce pain and inflammation.
"C" stands for compression, which can help reduce inflammation. Because the piriformis is a deep muscle beneath the gluteus maximus, this step is less practical than with, say, an ankle sprain. However, if you choose to wrap the injury, use a soft elastic bandage and start wrapping around your hips, working down the leg to about mid-thigh.
"E" stands for elevation. While it is not practical to elevate the piriformis above the level of your heart, lie down instead of sitting or standing; this will help reduce any swelling and alleviate pain.
As the injury begins to heal, gently stretch your piriformis and the surrounding muscles. Inflexibility makes muscles significantly more susceptible to injury, and keeping the muscles loose will help prevent a recurrence.
Cut down on all activities that aggravate the pain. Piriformis pain is especially common in runners because of the stabilization required to jump quickly from one leg to the other while moving forward. If you are a runner, in addition to reducing the intensity of your workouts, consider temporarily replacing running with swimming or biking.
Release the tension in the piriformis and surrounding muscles. Chronic pain in the piriformis usually results from the muscle being too tight, which reduces its function and makes it more susceptible to overuse. Try techniques that stimulate blood flow, such as massage or myofascial release (applying pressure to the muscle with a small ball or foam roller). While this pressure will initially be uncomfortable and perhaps even painful in spots, the pain will decrease significantly over time.
Stretch the muscle. The best time to do this is when your muscles are warm, such as after a workout. Lie down on your back with your resting leg bent and your foot on the floor. Cross the stretching leg over the resting leg so the ankle of your stretching leg rests on the knee of your resting leg. Press the knee of your stretching leg away from you. Try to hold at least 30 seconds.
Use cold and heat therapy as needed. Apply cold compresses for 20 to 30 minutes at a time when you have pain to help reduce inflammation. Once you have significantly reduced or eliminated the pain, heat therapy can help relax the muscle and facilitate stretching.