Piriformis Syndrome

The speed of the treatment response for Piriformis Syndrome depends on the duration of adhesions, the degree of nerve compression, and whether lifestyle changes have been made. Generally, pain reduction is felt within 5 to 8 sessions during the acute phase, which is primarily characterized by muscle spasms; however, chronic Piriformis Syndrome with established adhesions requires 2 to 3 months for fibrous detachment and tissue regeneration. At 3 to 4 sessions, the muscle is still in the relaxation stage, and temporary worsening (treatment response) may occur during this period. If there is no change at all after 5 sessions, it is necessary to re-evaluate the treatment direction with the assigned therapist. From a Korean medicine perspective, the longer blood stasis and Qi stagnation accumulate, the thicker the layer of Qi and blood blockage becomes, requiring more time for circulation. The first 3 to 4 sessions are a stage to open the superficial Qi and blood; this is followed by the separation of deep adhesions using needle acupuncture and thread embedding, and finally leads to the internal treatment stage of regulating organ functions. At Dongjedang, we objectively evaluate the stage of progression by checking changes in piriformis muscle thickness and echogenicity using ultrasound at the 5th session. Understanding this three-stage flow can reduce treatment dropouts and increase the cure rate.