Have you tried trigger point massage? It normally works well if combined with PNF stretches on seperate days.

Tight piriformis -> tilted pelvis. Check if he has it...

The muscles are not tight if everything is normal. And pelvic tilt is very common disorder... also called as SIJD, tilted pelvis, uplsip, anteriorly rotated innominate, misaligned pelvis and many other names to same disorder...

Here is just one of many resources:
[url]http://www.ultrafitness.net/pelvic%20alignment%20pdf%20(Sue%20Ironside).pdf[/url]

You can start by checking if the legs have equal leghts...

Here is an effective technique to ease piriformis strain.

1. The patient is prone. bend affected leg to ninety degrees (keep knee on table)
2. Grasp the foot with right hand and take leg into internal rotation (take leg across the body.)
3. Make a fist with left hand and place it at the hip bone. Roll your fist into the buttock. You will be on the piriformis.
4. As you bring the leg toward you, press your fist into the buttock. You should feel a tight , string of muscle...that is the piriformis.

This procedure will cause some pain. If it does, you are on the right place. You may have to move your fist around. As you bring the leg back toward you, you can identify the muscle.

Do this 3-4 times. You will know if the stretch is effective if the pain subsides and you can take the leg closer to your body...external rotation.

I use this technique with every athlete I treat and it is very effective.

This technique will greatly help sciatica-type pain as the piriformis lies either under, over or , in some cases through the sciatic nerve. If the piriformis is tight or inflammed, it will create that pain down the back of the leg.

Hi Mark!

Besides Active Release Techniques (www.activerelease.com, www.activerelease.net/providers/lim) which some of you are going to think I am a broken record playing, and I do think that is your best option,

Have you extensively stretched his IT band on the same side as the piriformis with the problem? That's just a guess, that you may have to work the glute maximus, and Tensor Fascia Latae as well.

God bless! Hope you cure your client!

Tze-wei Lim
Singapore

Following on from this issue, I've found that his same side hamsrirng is particularly tight, and when I do some deep tissue work on it, he gets the pain around his piriformis/sciatic nerve, so this could possibly be the cause of the problem?!

Any further suggestions?!!

Answer is SIJD.
There are thousands of pages telling about it...
There are millions of patients asking what to do after they have been diagnosed one...

Start there:
www.sidysfunction.com

If it is SIJD ,this is something I have suffered with and it can be fixed. If the pelvis is in the right position the piriformis won't freak out. Also if the pelvis is in the right position the hip flexors won't be tight, so stretching them can make it worse.

If you want to know what's happened read this:
www.kalindra.com/critical.pdf

To fix it do this:
www.kalindra.com/rounds.pdf