Many pregnant patients come to us with complaints of sacroiliac joint pain and/or piriformis muscle pain. Sometimes the pain refers into the buttock and down the back of the leg. One great intervention for pregnant patients with strained piriformis muscles is cryotherapy. Cryotherapy is cold application like an ice pack or ice massage. Here we chose to do an ice massage because the patient’s piriformis muscle was too painful for soft tissue mobilization/massage. Performing an ice massage to the region or muscle in a cross-friction like stroking approach quickly soothes pain and addresses inflammation. The ice massage is a medium-sized cup of water that has become ice. This is an athletic training approach for athletes and is incredibly effective. We sneak in the massage during the ice application via effleurage strokes to reduce lactic acid build up in the muscle. We can feel the knots or tender/trigger points through the movements of the ice massage on the muscles. The tissue (skin, muscle, fascia) turns red showing the nice influx of blood and oxygen. The venous return and lymphatic drainage also increases. We also correct the sacroiliac joint biomechanics such as alignment and mobility, resolve sciatic neural tension, and assist with stretching and strain-counterstrain. The 2 piriformis muscles (one on each side deep in the buttock region) attach to the anterior or front aspects of the sacrum. They are providing some support and counterforce to the uterus which is being pull into flexion by the weight of the baby and fluid during pregnancy. Many patients overwork the piriformis muscle in Barr classes. We advise those patients to discontinue class until the pain resolves or adapt the movements that cause piriformis pain. Our expert physical therapists fully address and resolve piriformis pain in our pregnant population.