Does this come with a guide on how to use it?

Yes, I've attached the video guide for you here for your convenience. Also, another thing to note, if for some reason the device feels too intense while using, you can try putting a small towel over the Glute Blade to provide a little bit of cushion for more comfort. Also, if you use the device while seated in a cushioned chair/couch the cushioned base would help reduce some of the pressure which would reduce the intensity of the massage as well. If you need assistance at any time, please don't hesitate to reach out to us here: https://amazon.com/gp/help/contact-seller/contact-seller.html?marketplaceID=ATVPDKIKX0DER&sellerID=A34DF56F4R6EI&ref_=v_sp_contact_seller

where to massage for piriformas syndrome?

Attached is a video that helps demonstrate how to best use Glute Blade to massage for Piriformis Syndrome relief.

How do I choose which density (Medium or hard)?

This is more personal preference depending on what you like better. The Yellow Glute Blade is slightly softer which may be more comfortable for some individuals. Alternatively, you could get the black (firm) Glute Blade and if for some reason the device feels too hard you can simple place a small towel over the device to soften the massage. Any additional questions, feel free to contact us here: https://amazon.com/gp/help/contact-seller/contact-seller.html?marketplaceID=ATVPDKIKX0DER&sellerID=A34DF56F4R6EI&ref_=v_sp_contact_seller

Product Dimensions	8.89 x 5.08 x 5.08 cm; 222 g
Color	ブラック///ホワイト
Material Type	シリコン
Special Features	。

グルートブレード Piriformis マッサージローラー 3つの異なるヘッド付き ターゲットトリガーポイントの圧力、腰と坐骨神経痛の痛みと緊張を和らげます(ハード密度)。

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グルートブレード Piriformis マッサージローラー 3つの異なるヘッド付きターゲットトリガーポイントの圧力、腰と坐骨神経痛の痛みと緊張を和らげます(ハード密度)。