Robert…
I am sure Lehmkuhler (sp?) will be able to give you plenty of advice, but wanted to chime in with personal experience of piriformis syndrome. First time it went out treatment was considerably longer, but each time I found what worked and recovery goes quicker.
====this is way long but wanted you to have some background of what to expect. If it isn’t serious, take it serious. If it is serious, take as much downtime as possible. Watch ALL positions that might aggravate it from climbing hills on the bike to even sex, and long distance driving without a break (or any combos there of).
I am VERY biased as for treatment. PT, Chiro and Massage is the combo that helps to keep my problem workable. Usually only if I am running on uneven surfaces (cobblestones usually set it off), overworking/fatigue, poor nutrition/stress triggers the cascade of problems. Get to the root of your problem and at least get it stabilized if you can.
Good news…Ironically my ITB holds up just fine, but my Piriformis first goes out followed by the peroneus muscles and then over contracted psoas major which ultimately creates dropped foot. FIX the piriformis now and don’t push through it. Whoever checks you out look for imbalances on the other side of the body (all the way up to the neck and down to the other toe). Muscles work in a cross pattern kind of way so look at your opposite neck and shoulder from the butt for problems. When my neck is out, my piriformis often seizes up. DO NOT SLACK ON RECOVERY!!! If you do you will leave way too much scar tissue and the next time will be even worse.
What worked:
Immediately during the events often a butt massage and stretches. IF a chiropractor is available I have them adjust my hip.
After event aggressive Chiropractic treatment including usually Electrical Muscle Stim to the butt (NOT pleasurable at all!!!). I have the luxury of getting adjusted as needed and find 3xs/week for 2 weeks usually is all I need to set the pelvis back to mobility.
Strengthening work includes one leg squats and step ups with flexion (utilizing a step bench). Once stability is re-attained (traditionally 2-3 week recovery from injury for me–worse case was a whole season until I figured out what kept pulling it) I up strength training and increase stretching. Depending on how bad the piriformis is injured, often I have to start out with balancing on one foot then move up to an uneven surface for balancing. Good PT can set up a program. I wouldn’t try it on my own.
Off season…I ramp up slowly. Watch my posture, and stretch daily. ICE my aggravated SI Joint on the involved Piriformis side after every run/long ride. Manual massage on the entire muscle and deep etching along the whole sacrum and greater trochanter -origin and insertion of piriformis–oh so enjoyable. If I feel it is going to catch–I skip all impact activity and stretch out in the pool for a few hours with only pulls.
ARNICA has truly helped my sore muscles and especially the bruising that is inevitable from the friction work on the glute.
As for X-rays…depends on what they are looking for. X-rays helped to show how off skew my hips were, but it won’t show you the muscle. Biased speaking, my hip X-rays were taken while standing versus laying down. I didn’t need an MRI to tell me how messed up my piriformis was, however had I not gotten better MRI was on the horizon to make sure everything was ok.
Hope you get yours fixed. If you have any questions feel free to PM me.