Post-Operative Instructions: Piriformis Release

Pain Medications

  • In most cases local nerve blocks will provide 8-12 hours of numbness.
    As soon as you start to feel the numbness wearing off, begin taking oral pain medication.

  • Take Tylenol 500mg one tab every 8 hours.

  • Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.

  • If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).

  • If you still have pain after all of the above, take a second Norco tab.

  • Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.
    DO NOT exceed 3500mg of Tylenol over 24 hours. 

  • It is illegal to drive or operate machinery with narcotic medications. 

  • Do not combine alcohol or other sedatives with narcotic medications.

  • You do not need to take pain medications once you no longer have pain.
    You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.


Other Medications

  • Take Aspirin 325mg one tab once a day for the first 4 weeks to prevent blood clots.

  • Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).

  • Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.


Activity

  • Use both crutches to assist with ambulation. Do NOT use only one crutch.

  • You may progress to putting all of your weight on your operative leg as tolerated.

  • You can stop using the crutches once you are walking normally with no limp. 

  • Elevate your operative extremity above the heart as much as possible to decrease swelling.

  • Avoid prolonged periods standing to prevent excessive pain and swelling.


Recovery Equipment

  • Keep your dressings on during the first 3 days after surgery.

  • You typically will not need any braces unless otherwise instructed.


Cold Therapy

  • We recommend cold therapy use as much as possible in the first two weeks. 

  • Cold therapy units may be used continuously as instructed.

  • Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.

  • Do not apply ice directly to the skin to avoid burning.


Recovery Exercises

  • You may perform leg bridges, heel slides (0-90 degrees), quad sets, and ankle exercises as instructed in your preoperative packet.

  • Your motion goal should be to have 0-90 degrees of hip motion at your initial postoperative visit.

  • You will start physical therapy two weeks postoperatively for hip motion and strengthening.


Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Post-Operative Rehabilitation: Piriformis Release

Therapy Plan: Twice per week for 0-2 months, once per week for 2-4 months


ROM Progression

Progress ROM as tolerated with an emphasis on hip internal rotation immediately after surgery with the goal of symmetric full motion at 4-6 weeks.


Weight Bearing Progression

Initial weight bearing as tolerated with crutches to assist as needed

  • Progress weight bearing over weeks 1-2 with the goal of removing crutches at 2 weeks

  • Do NOT progress to one crutch - gait must be pain free and non-compensatory to remove both crutches


Initial Post-Operative Physical Therapy Visit

  • Correctly perform normal gait cycle with full weight bearing without limping

  • Hip internal rotation stretching

  • Isometric exercises for core, glutes, quadriceps, hamstrings


Phase 1 Physical Therapy (2-4 weeks): protect the joint and avoid irritation

  • NO open-chain exercises

  • Manual therapy 20+ minutes per session

  • Stretching with an emphasis on hip internal rotation

  • Tactile and verbal cueing to enable non-compensatory gait patterning

  • Soft tissue mobilization, isometric exercises, core strengthening


Phase 2 Physical Therapy (4-6 weeks): non-compensatory gait and progression

  • Tactile and verbal cueing to enable non-compensatory gait patterning

  • Progress stretching for flexion-extension, adduction-abduction, and rotation

  • Soft tissue and joint mobilization, isometric exercises, core strengthening

  • Standing weight shifts, backward/lateral walking without resistance

  • Closed-chain strengthening and planks starting at 6 weeks advancing as tolerated

  • Elliptical may begin at 4 weeks


Phase 3 Physical Therapy (6-12 weeks): return to pre-injury level

  • Focus on functional exercises in all planes, advance only when fully controlled

  • Soft tissue and joint mobilization, closed-chain exercises, core strengthening

  • Strengthening: lunges, resisted side steps, planks

  • Slide board and hip rotation movements may begin at 8 weeks


Phase 4 Physical Therapy (12+ weeks): return to sport

  • Full return may take a full 4-6 months or more and requires functional assessment prior to return

  • Soft tissue and joint mobilization, closed-chain exercises, core strengthening

  • Agility drills and pool (or Alter G) running may begin at 12 weeks

  • Straight running and cutting may begin at 12 weeks

  • Plyometric and sport-specific drills may begin at 12 weeks