The aim of this review was to identify and evaluate the evidence for the non-surgical management of Piriformis Syndrome. A systematic review of electronic databases was carried out up to February 2006. This was supplemented by hand searching journals and snow-bailing from reference lists. Strict inclusion/exclusion criteria were applied. Five independent observers reviewed the methodological quality of the core studies using the published Physiotherapy Evidence Database (PEDro) critique tool. Differences were resolved by consensus. Two studies met the inclusion/exclusion criteria. PEDro scores were 6/10 and 10/10. Both studies demonstrated positive effects for Botulinum toxin type A (Botox) injections compared to a placebo or control treatment. One study identified this positive effect in addition to a physiotherapy protocol. Evidence implies that Botox is a potentially successful treatment for Piriformis Syndrome; however, a paucity of high-quality clinical trials limits evidence of its overall efficacy. Further clinical trials of the effectiveness of non-surgical measures in the management of this syndrome are indicated.

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