Have you ever felt a deep ache in the buttock, as though something were burning its way down your leg? The longer you sit, the worse it gets — sometimes you have to stand up because you cannot bear it. And what if it did not go away for months? This is the story of an office worker who fought that pain for 8 months, almost to the point of giving up, and who finally found a way through at PYONG Rehabilitation Clinic.

8 months of suffering

An office worker who had to sit for long hours. It began as a deep ache in the buttock, then gradually started radiating down the back of the leg, sometimes with numbness reaching the calf. She described it as "like someone pushing a screwdriver into my buttock and twisting it back and forth."

She did not simply put up with it. She had already tried every route:

  • Chinese acupuncture, several courses — temporary relief, then the pain returned
  • Pressure-point massage, pressed so hard it bruised, and still the same pain
  • Chiropractic adjustment at several places, but it never "finished"
  • Painkillers, until she began to fear the side effects
  • General physiotherapy, better for a while, then back again

After 8 months this office worker began to feel hopeless. She started to think she might have to live with the pain for the rest of her life. Work was suffering, sitting at a desk had become torture, and her quality of life had dropped sharply.

Finding the root of the problem: Piriformis Syndrome

At PYONG Rehabilitation Clinic, a rehabilitation medicine physician carried out a detailed assessment — physical examination, movement testing, and high-frequency sound-wave imaging (Diagnostic Ultrasound). The finding was that she had Piriformis Syndrome, known in Thai as "salak phet jom".

Understanding Piriformis Syndrome

The piriformis is a small muscle lying deep in the buttock, around the hip, which helps rotate the leg outward. The problem is that the sciatic nerve — the major nerve carrying signals to the leg — runs beneath this muscle, and in some people runs straight through it.

When the piriformis muscle is tight, swollen, or inflamed, it "pinches" the sciatic nerve, producing:

  • Deep buttock pain in the middle of the buttock
  • Pain radiating down the leg, down the back from the buttock to the calf
  • Numbness along the leg, especially at the back
  • More pain the longer you sit, because the muscle is compressed directly
  • Pain climbing stairs or during activities that use the hip

Why does it not get better?

Several treatments had been tried without success because:

  1. The treatment missed the target: superficial massage or needling cannot reach a muscle that lies deep.
  2. The nerve was not treated: the focus was only on muscle tightness, without "releasing" the nerve that was caught.
  3. The tissue was not repaired: chronically injured tissue needs stimulation to recover from within.

The treatment that changed her life: 2 key techniques

The physicians at PYONG Rehabilitation Clinic designed a plan that addressed both the "structure" and the "nerve" at the same time, using 2 main techniques.

1. AP-PRP (Activated Purified PRP), premium-grade PRP technology

PRP (Platelet-Rich Plasma) means taking the patient's own blood, separating out a highly concentrated platelet fraction, and injecting it into the injured area. At PYONG Rehabilitation Clinic we use AP-PRP (Activated Purified Platelet-Rich Plasma), a premium grade of PRP technology developed specifically for this purpose.

What makes AP-PRP different from ordinary PRP?

There are clinics today offering PRP for several thousand baht less, but the quality differs greatly. At PYONG Rehabilitation Clinic we use AP-PRP, which has 3 clear advantages.

1.1. Purified (highest purity)

Ordinary PRP still contains red and white blood cells, which cause more pain and swelling after the injection. At PYONG Rehabilitation Clinic we use dedicated equipment to filter out almost all the red and white cells, leaving a clear golden-yellow PRP. The result is far less pain and swelling after injection, inflammation kept at an appropriate level, and full use of the growth factors by the body.

1.2. Concentrated (highest concentration)

We use 20-30 ml of blood (more than the 10-15 ml of ordinary PRP) and separate it through a special process, so the platelet concentration is higher than standard, the greatest possible quantity of growth factors can be extracted, and the result is clearer and faster.

1.3. Activated (stimulated immediately)

This is the point that differs from PRP everywhere else. We treat it with LED light at a specific wavelength (photobiomodulation) to prompt the platelets to release growth factors immediately. It also raises working efficiency by 30-40% and begins repairing tissue the moment it is injected.

The AP-PRP process at PYONG Rehabilitation Clinic

  1. Draw 20-30 ml of blood (more than ordinary PRP)
  2. Separate it with dedicated equipment, filtering out the other blood cells
  3. Select the highest-quality layer, giving a clear golden-yellow PRP
  4. Photo-activation, treated with LED light for 5-10 minutes
  5. Inject under ultrasound guidance, precisely to the point that needs it

Total time 45-60 minutes

The clear differences between AP-PRP and ordinary PRP

Ordinary PRP:

  • Red and white blood cells still mixed in, causing considerable pain and swelling
  • Uses 10-15 ml of blood, ordinary concentration
  • No special activation, result at 2-4 weeks
  • Lower price

AP-PRP at PYONG Rehabilitation Clinic:

  • Blood cells filtered out (clear golden-yellow), very little pain and swelling
  • Uses 20-30 ml of blood, highest concentration
  • Photo-activation with LED, result at 1-2 weeks
  • Higher price but excellent performance, better value than treating again and again

For this office worker's case

The physician used an ultrasound-guided AP-PRP injection into the piriformis muscle, the surrounding fascia, and the area where the nerve was compressed. AP-PRP works at 3 levels:

  • Repairing the structure — torn and chronically inflamed tissue is genuinely repaired
  • Reducing inflammation — adjusted to an appropriate level, not excessive
  • Building new tissue — stimulating the formation of collagen and strong tissue

This is why this patient's symptoms, which had not resolved in 8 months, began to improve within 2-3 days of the first session and had almost completely gone within 2-3 months.

2. Neurofascial Release: separating the fascial layers from the nerve by injection

This technique matters a great deal, and it is something many places do not do.

Understanding fascial entrapment

Fascia is the sheath around muscle, like a net wrapped throughout the body. With chronic inflammation the fascia thickens, hardens, and "binds" the nerve, so the nerve can no longer move freely.

In this case the sciatic nerve was "caught" in the fascia and the piriformis muscle. Treating the muscle alone was therefore not enough; the nerve had to be "released" as well.

The technique used at PYONG Rehabilitation Clinic

Neurofascial Release, or "injection to separate the fascial layers from the nerve," is a technique developed at PYONG Rehabilitation Clinic, building on the principles of hydrodissection, or ultrasound-guided interfascial hydrodissection (using fluid to separate tissue planes), and prolotherapy (injection to stimulate tissue recovery).

It differs from ordinary hydrodissection in these ways:

  • More specific, concentrating on separating the plane between the fascia and the nerve in particular
  • A special solution that does not merely separate the planes but also stimulates tissue recovery
  • The highest precision, with real-time ultrasound guidance

This is why many clinics perform hydrodissection without getting as good a result: they are not doing it as "neurofascial release," which demands a high level of specialist skill and understanding.

How neurofascial release is carried out:

The physician uses a special fine needle together with ultrasound guidance to reach the point where the nerve is caught. Then:

  1. Inject the solution (usually normal saline or a special solution) into the space between the nerve and the fascia
  2. Create "space" so the nerve has room to move
  3. Break down the scarring from old inflammation that had bound the nerve
  4. Stimulate blood flow to the area

This technique is called hydrodissection, using fluid to "inject and separate" tissue that has become stuck together.

The result is that the nerve is "released" and can move freely, so the numbness and the pain radiating down the leg disappear.

The result in practice

This office worker was treated with PRP together with neurofascial release. The result was one she could hardly believe:

2-3 days after the first session:

  • Pain down by roughly 40-50%
  • Able to sit and work for longer, without having to get up and walk about as often
  • Radiating leg pain clearly lighter

After the second session (2-3 weeks apart):

  • Pain down by more than 80%
  • Able to sit and work all day without being disturbed by symptoms
  • Able to start exercising again, something she had not dared to do for 8 months

After completing the treatment plan (about 2-3 months):

  • The pain had almost entirely gone, with only a mild ache left after sitting too long
  • Daily life back to normal
  • No fear of the pain returning, because the tissue had genuinely been repaired

Why do PRP and neurofascial release work better than other methods?

Let us look at why this approach succeeded in "cracking the code" of the pain:

1. It treats the real root of the problem

The older methods usually aim at relieving symptoms:

  • Massage relaxes the muscle, but the muscle tightens again because the tissue is still injured
  • Painkillers only mask the pain signal, without addressing the cause
  • Acupuncture and stretching are not deep enough to reach the real problem

The new approach at PYONG addresses both dimensions:

  • PRP repairs the structure: injured tissue genuinely recovers
  • Neurofascial release solves the nerve problem: the bound nerve is released

2. Technology is used for precision

Older treatment may amount to "putting the needle in and hoping it hits the spot." At PYONG:

  • Ultrasound guidance shows the structures in real time
  • There is certainty that the PRP reaches where it is needed
  • The release injection goes exactly to the point where the nerve is caught

3. It stimulates the body's own natural healing

PRP is not a drug from outside; it is a substance from the patient's own body. So:

  • No side effects or drug allergy
  • The body accepts it well and can make full use of it
  • The result lasts, because the tissue genuinely recovers rather than the symptoms merely easing for a while

Who should consider this treatment?

If you have the following symptoms you may have piriformis syndrome and should see a doctor:

Symptoms that point to it:

  • Deep buttock pain in the middle of the buttock, much worse when sitting for long periods
  • Pain radiating down the back of the leg, sometimes to the calf
  • Numbness along the leg, especially at the back
  • More pain climbing stairs or kneeling
  • Pain when driving for long periods, because of working the clutch or brake

Groups at risk:

  • People who sit at work for long periods, especially on a hard floor or an unsupportive chair
  • People with incorrect posture, such as sitting cross-legged or standing with the weight leaning to one side
  • Athletes, especially runners, cyclists, or those in sports that use the hip heavily
  • People with a hip injury who have fallen, taken an impact, or had surgery around the hip

Warning signs that call for prompt medical attention:

  • Pain lasting more than 3 months without resolving
  • Several treatments tried and the problem still recurring
  • Increasing numbness, or the leg muscles beginning to waste
  • Effects on sleep, work, and quality of life

Supporting techniques at PYONG Rehabilitation Clinic

Besides PRP and neurofascial release, the physician may use other supporting techniques depending on each person's symptoms.

1. Focused Shockwave Therapy

Focused Shockwave Therapy uses high-energy shockwaves to break down scarring in the tissue, stimulate the formation of new blood vessels, and reduce chronic inflammation.

2. Peripheral Magnetic Stimulation (PMS)

Peripheral Magnetic Stimulation uses electromagnetic waves to stimulate weakened muscle, improve nerve function, and reduce pain quickly.

3. Dry Needling

Western-style needling into tender points releases muscle knots, increases blood flow, and reduces tension.

Stop enduring the pain, start the change

This office worker's story teaches us that pain which has not resolved over many months does not mean you "have to live with it for the rest of your life." Sometimes what you need is the right diagnosis and treatment that reaches the target.

Piriformis syndrome is treatable with the right technique. Treatment with PRP together with neurofascial release has shown that it can "finish" pain that had not resolved for a long time.

At PYONG Rehabilitation Clinic we are committed to "cracking the code" of your pain, with the expertise of our physicians, leading technology, and close care.

Do not wait for it to get worse. Start the road to a pain-free life today

PYONG Rehabilitation Clinic

Management of pain and musculoskeletal disorders, by specialist physicians

Location:
999 Room BF-11, Floor L, Gaysorn Village
Ploenchit Road, Lumpini, Pathumwan, Bangkok 10330
(near BTS Chit Lom)
Free valet parking

Opening hours:

  • Monday-Friday: 16:30-20:00
  • Saturday-Sunday: 10:00-20:00

PYONG Rehabilitation Penthouse Clinic

Care for older adults and neurological rehabilitation, by a team of specialist doctors and allied health professionals

Location:
127 Room K, Floor 11, Gaysorn Tower
Ratchadamri Road, Lumpini, Pathumwan, Bangkok 10330

Opening hours:

  • Monday-Friday: 10:00-20:00
  • Saturday-Sunday: 10:00-20:00