Piriformis Massage for Better Sleep.

How to Sleep With Piriformis Syndrome (7 Doctor-Approved Tips)

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This article has been written by Dr. Darshan Shingala (M.D, MPH) – a qualified and practicing medical doctor – for maximum factual accuracy and reliability.

Piriformis syndrome is a condition that is characterized by symptoms of pain, spasms, numbness, and tingling in the buttock region where the piriformis muscle is located [1, 2, 3].

Due to the location of the piriformis muscle, it can often be difficult to get to sleep due to the way in which pressure naturally increases in this area when lying down.

So how can you sleep better when you have piriformis syndrome?

The most effective way to sleep more comfortably with piriformis syndrome is to lie on your back (or side if you are pregnant) – possibly at an incline to reduce pressure – whilst taking doctor prescribed NSAIDs, applying ice and heat, and performing light stretches before bed.

The rest of this article unpacks these ideas in more detail to give you 7 actionable ways to tackle piriformis pain so that you can sleep better.

I have used my knowledge as a medical doctor to ensure these tips are medically sound.

However, you should always talk to your own doctor first before starting or modifying your existing treatment plan – especially if you have underlying medical conditions and/or are on medication.

Related: 21 ways to sleep better with sciatica and lower back pain.

7 Ways to Sleep Better With Piriformis Syndrome

Here are 7 ways to tackle piriformis syndrome so that you can sleep better at night:

1: Sleep On Your Back, Side, or In a Reclined Position

How To Sleep With Piriformis Syndrome And Sciatica (Best Sleeping Positions)

I usually tell my patients with piriformis syndrome to sleep on their back or side because these positions align the spine and offer support to the upper back, shoulders, lower back, and hips [8, 9, 10].

The best and worst sleeping positions for piriformis syndrome are as follows:

Flat On Your Back

The supine position (lying flat on your back, facing the ceiling) is perhaps the most suitable sleeping position for most people with piriformis syndrome – unless you are pregnant.

Sleeping on your back offers maximal support to your spine, with the vertebral column well-aligned, without adding unnecessary stress to your shoulders, back, or hips.

If you have trouble sleeping on your back, try to replace your mattress with a medical-grade, orthopedic mattress, so that the curvatures of your spine can conform in a better way to the contours of your mattress. 

Personally, I recommend the Puffy Lux Hybrid mattress because it has an adaptive memory foam top layer and it helps alleviate my back and shoulder pain at night.

Click here to read my full review.

Side Position

If you are pregnant, or if you have a specific injury that does not allow you to sleep on your back, then you may consider sleeping on your side.

Side sleeping is also a good position for people who are dealing with sleep apnea and loud snoring at night because this position helps to keep the airways open.

While sleeping on your side, I recommend that you try to keep your legs only slightly bent, and tuck your chin into your neck for optimal spinal support.

I advise my patients to avoid fully bending their knees while sleeping on their sides, as it may promote an uneven distribution of bodyweight, which later leads to sleep-related back pain and joint soreness.

It is also recommended that you try to switch sides a few times through the night, so that you can avoid putting excess stress on either side of your body, and also so that you can identify which side is more comfortable for you, depending on the intensity of your physical activity during the day.

Reclined Position

If it is uncomfortable for you to sleep on your back, or on either side, I suggest you try to sleep in a reclined position on an adjustable bed.

Sleeping in a reclined position can be especially beneficial for you if you have pain that tends to feel worse when you are standing up straight, and feels somewhat better when you bend forward.

I would also suggest that you consider upgrading your pillows, or perhaps opt for a wedge pillow, to find comfort while sleeping in a reclined position.

Click here to see the best adjustable beds for back pain.

Stomach Position (Worst)

It is important to take note of the most unsuitable sleeping position for your recovery.

Most sleep doctors state that sleeping on your stomach could be the worst choice for your health, especially while you are dealing with piriformis syndrome.

I usually tell my patients to refrain from sleeping on their stomachs, because it puts unnecessary pressure on almost all the joints and muscles of the body.

Sleeping in this position also requires you to turn your head to one side, which tends to add additional stress to your neck and spine.

Sleeping on your stomach increases the pressure on your abdomen, while your hips and back remain unsupported, resulting in poor body posture.

Thus, I do not recommend sleeping on your stomach, unless specifically advised to do so by your medical practitioner or sleep therapist.

2: Try Light Stretching to Reduce Stiffness and Pain

5 Best Sciatica Stretches for Piriformis Syndrome – Ask Doctor Jo

Certain physical activities, such as targeted stretching, can be beneficial for you while recovering from piriformis syndrome.

First of all, before you begin stretching the piriformis muscle, I suggest you apply hot packs or cold spray for about ten minutes on the sore parts of your buttocks, back, and legs.

Studies show that temperature therapies, such as the application of hot and cold packs on inflamed areas, can be very helpful in reducing pain, especially when applied before stretching [6, 11].

After the application of hot or cold packs, I recommend you begin with gentle stretches targeting the piriformis muscle, which can be executed in several ways, as listed below (also see the video above).

Please note that I strongly encourage you to contact your physiotherapist for a detailed demonstration of how to perform these stretches by yourself.

  • Lie flat on your back in a supine position, and then slowly raise your hips with your hands, and try to pedal with your legs like you do when you are riding a bicycle.
  • Roll from side to side, along with flexion and extension of your knees, while you lie on each side.
  • Rotate from side to side while standing with your arms relaxed. Perform this for about one minute, and repeat this exercise after every few hours.
  • Do knee bends with about six repetitions. Repeat this exercise after every few hours.
  • Stretch the piriformis muscle in a FAIR position. In the FAIR position, you must lie supine with your hip flexed, adducted, and internally rotated. Then, bring the foot of the involved side across, and over the knee of the uninvolved leg. It is strongly recommended that you perform this stretch under the guidance of your physical therapist.

I would like to emphasize that the road to full recovery is a long journey, and you may need some practice in order to properly learn and master the abovementioned techniques.

I usually tell my patients to perform these stretches on a regular basis during the daytime, so that they can obtain a restful night’s sleep.

Click here for 10 strategies to help you sleep better after intense exercise.

3: Avoid Aggravating Your Symptoms to Sleep Peacefully

In order to recover quickly from piriformis syndrome, it is important to ensure that you avoid unnecessarily worsening or aggravating your symptoms.

If your symptoms become aggravated, you may delay your healing process, and also find it extremely hard to sleep peacefully at night [8, 9, 10, 11, 12].

You can follow these tips to avoid the aggravation of your symptoms, and obtain a restful night’s sleep:

  • Avoid sitting in the same place and posture for extended periods of time. Try to stand up and take a walk every twenty minutes, in order to stretch and relax your muscles and joints.
  • Avoid activities which require you to maintain a strict posture while sitting, such as driving. However, if you have to drive, try to take shorter drives on smooth roads, and make frequent stops to stand and stretch.
  • Make sure that you prevent any macrotrauma or microtrauma to the gluteal region, by avoiding further offending activities.
  • Try to perform gentle stretches on a daily basis to reduce the discomfort, and avoid the recurrence of piriformis syndrome.

4: Take Doctor Prescribed Pain Medications Only

After diagnosing you with piriformis syndrome, your doctor will most likely prescribe medications for pain management.

Please make sure that you disclose your health status, medical conditions, pregnancy, comorbidities, and current medications to your doctor so that they can make an informed decision regarding the medical management of your diagnosis.

It is strictly recommended that you refrain from self-prescription or altering the prescription without the knowledge of your doctor.

I strongly encourage you to freely discuss your treatment plan with your doctor and follow their advice.

In general, your treatment plan for piriformis syndrome may include several pharmacological agents, such as NSAIDs (non-steroidal anti-inflammatory drugs), muscle relaxants, and neuropathic pain medications.

I would advise you to adhere to your prescription and make a conscious effort to take your medications in a timely manner.

It is likely that your doctor will recommend that you combine your pharmacological treatment with other conservative therapies, such as lifestyle modifications, physical therapy, and psychological therapy.

Such conservative therapies can be quite effective for pain management and speedy recovery, especially when used in conjunction with accurate pharmacological therapies [8, 9].

Try these 10 ways to sleep better with carpal tunnel.

5: Try Topical and Oral Pain Relief Medications for Instant Relief

While you are recovering from piriformis syndrome, there may be some instances when you need instant relief from pain.

To achieve instant relief, I suggest trying the following methods:

Topical Pain Relief Medications

Pain relief medications which can be applied topically on the painful areas – such as legs, lower back, thighs, and buttocks – are available in the form of ointments, creams, gels, sprays, and patches [1, 2, 9].

These medicines are usually available easily over the counter and must be applied to the skin directly.

I would suggest you perform a patch test on a small area of skin prior to applying any topical medications, in order to check for sensitivity, allergies, skin irritants, and adverse skin reactions.

Some examples of topical pain medications which may be effective for instant pain relief are listed below:

  • Topical non-steroidal anti-inflammatory drugs (NSAIDs) – like diclofenac – are easily available as a spray, cream or gel. They are effective at reducing pain, swelling, stiffness, and inflammation.
  • Topical lidocaine is a local anesthetic medicine which induces a temporary numbness to the area of application when applied topically, in a cream or gel form. It helps in minimizing the sensation of pain, and it is commonly indicated in several musculoskeletal conditions.

Oral Pain Relief Medications

If you do not receive optimum relief with topical medications, then you can opt for oral pain medicines for better relief [1, 2, 9].

The choice of medication would depend on the type and severity of your pain, as advised by your doctor.

While you can purchase some medications easily over the counter from any pharmacy, others would require you to provide a prescription from a board-certified medical doctor.

In general, the following medications may be helpful for pain relief, and can be consumed orally, in the form of pills, capsules, and liquids:

  • Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are helpful in reducing the symptoms of inflammation and pain.
  • Muscle relaxants, such as cyclobenzaprine, can be helpful in relaxing the tense muscles in the gluteal region.
  • Opioids, such as tramadol, are strong, pain-relieving drugs, which are available by prescription only. The risk of misuse and abuse associated with opioids is very high, hence, their prescription is strictly regulated and supervised by health care providers.

Please make sure to be safe when using medications, and be aware of the potential side effects of any that you use.

I recommend that you always consult your doctor prior to consuming any drugs, follow the prescribed medicinal dosage, take your medicines at the advised time of the day, and report immediately to your doctor in case of any adverse side effects.

Try these 10 tips to use lavender to help you sleep.

6: Try Massage Therapy to Encourage Active Repair

How & When to Perform Self-Massage for Sciatica & or Piriformis Syndrome

After you obtain an accurate diagnosis and detailed medical assessment from your doctor and physical therapist, you can ask them if massage therapy would be a suitable adjunct pain management option for you.

Massage therapy will not only help you to relieve the symptoms of pain and spasms, but it will also encourage the active repair of deep tissues so that you can sleep better at night and recover more quickly.

Massage therapy is most effective when it is used in conjunction with other forms of treatment modalities, such as pharmacological medications, physiotherapy, stretching, etc. [9, 10].

However, it is important that you include massages in your routine only when it is safe for you to do so, as advised by your doctor.

Your therapist may choose to perform different types of massages on you, depending on which one is most suitable for your condition.

The most common massage techniques are as follows:

  • Deep tissue massages usually include deeper and slower strokes, which tend to apply concentrated pressure on the innermost tissue layers in the areas of concern. Deep tissue massages relax the muscles and release unnecessary pressure from muscles in the lower back, buttocks, and thighs – including the lumbar, quadriceps, hamstrings, gluteal, and piriformis muscles.
  • Soft tissue release is usually performed to assist in the reduction of adhesions and scar tissue. It is a specific form of massage therapy which helps in strengthening and realigning the distorted muscle fibers through assisted stretching techniques.
  • Trigger point therapy is a mixed type of massage therapy, as it targets not only the muscles, but also the trigger points of the peripheral nervous system. It is claimed to be a very effective massaging technique, which encourages the nervous system to relax the tension which has built-up on the muscle due to excessive wear and tear.

7: Seek Urgent Medical Help in Certain Situations

On your journey to recovery from piriformis syndrome, there may be certain situations when you need immediate medical attention, and you must seek medical help at the earliest possible moment, to avoid any adverse events.

If you experience any new symptoms which were absent before, such as signs of infection, like redness, warmth, swelling, or fever; debilitating pain; worsening weakness or numbness in your lower body; or other unexplained health changes which may not seem to be related to your condition such as sudden weight loss, then contact your medical provider urgently.

Find out if taking Mucinex can keep you awake here.

Conclusion: Try Multiple Techniques

Piriformis syndrome – often also referred to as deep gluteal syndrome, extra-spinal sciatica, or wallet neuritis – is a painful musculoskeletal condition that is characterized by symptoms of pain, spasms, numbness, and tingling in the buttock region where the piriformis muscle is located.

Piriformis syndrome consists of a constellation of troublesome symptoms, which can substantially interfere with one’s ability to obtain a peaceful and restful night’s sleep.

To sleep better while recovering from piriformis syndrome, it is suggested that you consider changing your sleeping position, and try to opt for positions that would help to align your spine, and offer maximal support to the upper back, shoulders, lower back, and hips.

The best sleeping positions while dealing with piriformis syndrome would be back, side, and reclined positions.

It is a good idea to refrain from sleeping on your stomach because it will add unnecessary pressure on your joints, muscles, and abdomen – which often results in body aches, and poor body posture.

To further help with your sleep, you may try to incorporate gentle targeted stretching in your daily routine, and avoid the aggravation of your symptoms as much as possible.

It is important to ensure that you strictly adhere to your prescription, for appropriate medical management of piriformis syndrome.

For obtaining instant pain relief, you can try topical and oral pain relief medications, along with specific stretching exercises, such as piriformis cross-leg stretch, and hamstring chair stretch.

At the discretion of your doctor and physical therapist, you can consider combining your ongoing medical treatment with massage therapy, to encourage the active reparative mechanisms in your body.

I strongly advise you to seek urgent medical help in certain critical situations, such as the presence of new symptoms, signs of infection, debilitating pain, worsening weakness or numbness in your body, or any other unexplained health changes.

It is important that you seek medical attention in a timely manner to avoid being subjected to any unnecessary complications or adverse events.

Up next: 7 ways to get to sleep at night after napping in the day.

Sources and References

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[2] Cramp F, Bottrell O, Campbell H, et al. Non-surgical management of piriformis syndrome: a systematic review. 2007. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK74304/

[3] Parziale JR, Hudgins TH, Fishman LM. The piriformis syndrome. Am J Orthop (Belle Mead NJ). 1996;25(12):819-823.

[4] Tonley JC, Yun SM, Kochevar RJ, Dye JA, Farrokhi S, Powers CM. Treatment of an individual with piriformis syndrome focusing on hip muscle strengthening and movement reeducation: a case report. J Orthop Sports Phys Ther. 2010;40(2):103-111. doi:10.2519/jospt.2010.3108

[5] Siddiq MAB. Piriformis Syndrome and Wallet Neuritis: Are They the Same?. Cureus. 2018;10(5):e2606. Published 2018 May 10. doi:10.7759/cureus.2606

[6] Boyajian-O’Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008;108(11):657-664. doi:10.7556/jaoa.2008.108.11.657

[7] Hopayian K, Danielyan A. Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features. Eur J Orthop Surg Traumatol. 2018;28(2):155-164. doi:10.1007/s00590-017-2031-8

[8] Halpin RJ, Ganju A. Piriformis syndrome: a real pain in the buttock?. Neurosurgery. 2009;65(4 Suppl):A197-A202. doi:10.1227/01.NEU.0000335788.45495.0C

[9] Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat. 2012;34(6):479-486. doi:10.1007/s00276-012-0940-0

[10] Keskula DR, Tamburello M. Conservative management of piriformis syndrome. J Athl Train. 1992;27(2):102-110.

[11] Warren CG, Lehmann JF, Koblanski JN. Heat and stretch procedures: an evaluation using rat tail tendon. Arch Phys Med Rehabil. 1976;57(3):122-126.

[12] Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain. 2020;33(4):305-317. doi:10.3344/kjp.2020.33.4.305

[13] Hicks BL, Lam JC, Varacallo M. Piriformis Syndrome. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448172/

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