Firstly, are you sure that it is a Piriformis Syndrome? Piriformis Syndrome is caused by the Piriformis muscle being in spasm and catches/traps the Sciatic nerve. It usually starts with a dull pain that runs down the back of the leg, hamstring and also calve muscle. It can feel like a dull pain or lack of sensation when it is just starting. It develops to feel like as though your Hamstring or calf muscle gets weaker with increased exercise. I have not up to date seen a Piriformis entrapment that primary causes ITB pain. Piriformis Syndrome is caused by weakness or muscle inbalance of your Gluts. If the Gluteus Medius is weak( a primary stabilizer of the hip) the hip rotators (incl Piriformis) go into spasm to compensate for it. This muscle spasm is what causes the entrapment. Physio needs to obviously loosen the spasm and tissue that can cause it, but you will need to do rehab exercises to strengthen the muscle. Good core stability also plays a big role. Part of your treatment should be neural stretches to help the nerve release through the muscle. The ITB is also affected by weak Gluteus Medius. there are three muscle implanting on the ITB and if the front muscle is stronger, it pulls the ITB more on the front portion of the band and causes ITB syndrome. ITB is treated by loosen the ITB and in this case I advise to use that foam roller in the gym a lot and strengthen the Gluteus Medius. To avoid the nerve trapping during the day, rather sit on a pillow underneath your Hamstring almost keeping you buttocks slightly suspended in the air. The will take some pressure of the muscle and less pressure on the sciatic nerve. I would recoomend seeing a physio specializing in sport injuries and with either SPT1 or OMT1 qualification. she might give you good strengthen exercises. Otherwise consult a biokineticis for exercises as well. However, you will need to exclude your back. The position that you are experiencing pain can be causes by a bulging disc in your back. It will start with buttocks pain and radiate pain down the leg. A good physio will need to 1st exclude your back as the cause before only treating the Piriformis syndrome. Ever done a X-Ray for your back? Also, if your pelvis is asymmetrical it causes an imbalance in the gluteal muscles and will also affect muscles up and down. Cortisone will only release the inflammation on the nerve and might release the muscle, but in my opinion will be short lived... In a very small group of the population, the Sciatic nerve actually splits in two during development phase, before you are born, and can actually run through the Piriformis muscle. In these cases it is usually operated on. 1. Consult Good physio 2. Do X-Ray for back as well and test for disc 3. See othopeadic surgeon
