can often be treated by regular stretching exercise of that muscle, no matter the cause of the pain. Stretching is recommended every two to three waking hours. Anterior and posterior movement of the hip joint capsule may help optimize the patient's stretching capacity. The muscle can be manually stretched by applying pressure perpendicular to the long axis of the muscle and parallel to the surface of the buttocks until the muscle is relaxed. Another stretching exercise is to lie on the side opposite of the pain with the hip and knee of the upper leg flexed and adducted towards the ground while the torso is rotated so that the back of the upper shoulder touches the ground. Physical Therapists may suggest stretching exercises that will target the piriformis, but may also include the hamstrings and hip muscles in order to adequately reduce pain and increase range of motion. Patients with piriformis syndrome may also find relief from applications of ice which will help reduce inflammation and so may help limit pressure on the sciatic nerve. This treatment can be helpful when pain starts or immediately after an activity that is likely to cause pain. As the length of time progresses, heat may provide temporary relief from many types of muscle pain and will temporarily increase muscle flexibility. Local injections Failure of conservative treatments such as stretching and strengthening of the piriformis muscle or a high level of immediate pain intensity may bring into consideration various therapeutic injections such as local anesthetics (e.g., lidocaine), anti-inflammatory drugs and/or corticosteroids, botulinum toxin (BTX, Botox), or a combination of the three, all of which have a well-documented effectiveness at relieving muscle-related pain. Injection technique is a significant issue since the piriformis is a very deep-seated muscle. A radiologist may assist in this clinical setting by injecting a small dose of medication containing a paralysing agent such as botulinum toxin under high-frequency ultrasound or CT control. This inactivates the piriformis muscle for 3 to 6 months, without resulting in leg weakness or impaired activity. Though the piriformis muscle becomes inactivated, the surrounding muscles quickly take over its role without any noticeable change in strength or gait. Such treatments may be more or less curative (with no return to pain), or may have limited timespans of effectiveness. Surgery For rare cases with unrelenting chronic pain, surgery may be recommended. Surgical release of the piriformis muscle is