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