Treatment protocols for piriformis sciatica vary, but most include
completely avoiding any exercise of the affected area for 3-4 weeks.
Gentle piriformis stretches can be useful, along with anti-inflammatories, and deep tissue massage.
After 3-4 weeks of rest, if the symptoms have resolved, a gentle conditioning program may be started. Focusing on stretching and strengthening exercises under controlled conditions, the regimen may be gradually progressed as long as you continue to be asymptomatic. If symptoms persist more rest is ordered.
"resulting in repetitive cycles"
Piriformis Syndrome can become a chronic problem for serious weekend athletes who are bothered by a pinched sciatica nerve. They often become impatient, and are unable to progress their activity gradually, resulting in repetitive cycles of activity-pain-rest, activity-pain-rest.
"holistic pain management techniques such as yoga, meditation, self-hypnosis"
In some cases people respond only very slowly after extended periods of rest, and experience flare-ups with any increased activity. If these people are not interested in pursuing more invasive treatment, they may be managed with sciatica home treatment techniques such as yoga, meditation, and self-hypnosis.
More intrusive sciatic nerve pain treatment may be considered in cases that fail to respond to conservative therapy. Injection with a combination of steroids and local anesthetic is considered to be diagnostic as well as therapeutic. If the pain resolves following the injection, this may be considered proof of the diagnosis, and the steroid will resolve the inflammation often bringing at least several weeks of sciatica pain relief.
The steroid medication that is injected will stay in place and get gradually absorbed over about 6 weeks, but how long the relief lasts is very variable. The best chance you have for lasting relief is to begin a stretching program at the time of the injection and then after a few weeks begin to gently progress your activity. If you have any return of the sciatic pain you will need to reduce your activity and continue your stretching for a few more weeks before another trial of increased activity.
"surgical release of the piriformis"
For cases that fail to resolve with less invasive sciatic nerve pain treatment, surgical release of the piriformis muscle may be considered. Although no long term studies have been done, these procedures appear to have a high rate of success, when performed by an experienced surgeon.
Sciatica from a pinched sciatica nerve is a condition that continues to be difficult to diagnose and treat, and some authorities doubt its very existence. It often becomes a chronic condition that people struggle with for years. When conservative treatments fail to provide sciatica pain relief, more aggressive therapy with injections or surgery may be effective.