Piriformis Syndrome: Causes, Symptoms, and How We Can Help

All information in this blog is supported by peer-reviewed research. There is currently no dedicated NICE guideline for this condition, so current evidence is used throughout. Reference numbers appear throughout, with the full list at the bottom of the page.

What Is Piriformis Syndrome?

Deep in your buttock, underneath the larger gluteal muscles, sits a small but important muscle called the piriformis. It connects your sacrum (the base of your spine) to the top of your femur (thigh bone), and its main job is to rotate and stabilise the hip.

The sciatic nerve, the longest nerve in the body, runs either directly beneath the piriformis or, in some people, directly through it. When the piriformis becomes tight, inflamed, or goes into spasm, it can squeeze the sciatic nerve at this point, causing pain, numbness, and tingling down the leg that feels very similar to sciatica from a disc problem in the lower back. ¹

This is exactly why piriformis syndrome is so commonly mistaken for lumbar disc herniation or a trapped nerve in the spine, and why getting an accurate diagnosis really matters before treatment begins.

How Common Is It?

Piriformis syndrome affects around 2.4 million people annually, predominantly women in their 40s and 50s. ¹ Research estimates it accounts for anywhere between 0.3% and 36% of patients presenting with low back and leg pain, a wide range that reflects how challenging it is to diagnose consistently. ¹

What Causes It?

The most common causes fall into two main categories:

Trauma or physical stress to the muscle: around 38% of piriformis syndrome cases have a history of a direct blow to the buttock or pelvic area, or significant muscle stress from vigorous physical activity or sport. ² This could be a fall, a sports injury, or a sudden forceful movement that causes the muscle to spasm and tighten around the sciatic nerve.

Overuse and repetitive hip movements: repeated hip rotation, prolonged sitting, uphill walking, running, or activities that repeatedly contract the piriformis can all cause the muscle to become chronically tight and irritated over time. ³ Patients may also develop symptoms during downhill running or sprinting specifically, because the piriformis works hard to control the leg during these movements and can become overloaded. ³

Anatomical variation: some people are simply born with a slightly different relationship between their sciatic nerve and piriformis muscle, where the nerve passes through or closer to the muscle rather than beneath it. This makes them more susceptible to compression even with relatively normal levels of muscle tightness. ³

Prolonged sitting: this is one of the most significant day-to-day contributing factors. Sitting for long periods compresses the piriformis region and can gradually tighten the muscle, which is why desk workers, drivers, and students are commonly affected. ⁴

Common Signs and Symptoms

• Deep buttock pain, often described as a dull ache or sharp pain sitting deep in one cheek

• Pain that spreads down the back of the thigh and sometimes into the calf, mimicking sciatica

• Pain that is noticeably worse after sitting for a long time, particularly on hard surfaces

• Pain with climbing stairs, hill walking, or squatting

• Tenderness when pressing directly over the piriformis muscle in the buttock

• Occasional tingling or numbness down the leg if the sciatic nerve is being compressed

• Pain that eases with movement and gentle walking

Risk Factors

• Female sex, women are significantly more commonly affected than men ¹

• Age between 40 and 60, the most commonly affected age range ¹

• Prolonged sitting, whether from desk work, driving, or a sedentary lifestyle ⁴

• Previous trauma to the buttock or pelvis ²

• Participation in running, cycling, or activities involving repetitive hip rotation ³

• Anatomical variation in how the sciatic nerve passes relative to the piriformis muscle ³

• Leg length discrepancy or altered walking mechanics, which can cause the piriformis to overwork on one side

Is This Really Piriformis Syndrome, or Is It Something Else?

This is a genuinely important question, because piriformis syndrome shares its most obvious symptom, leg pain, with several other conditions that are far more common. Before concluding the piriformis is the problem, it is worth knowing that lumbar disc herniation, facet joint referral, sacroiliac joint dysfunction, and greater trochanteric pain syndrome can all produce very similar symptoms.

The key distinguishing features of piriformis syndrome are:

• Buttock-dominant pain rather than lower back-dominant pain

• Tenderness directly over the piriformis muscle belly in the deep buttock

• Pain brought on by sitting but not by lumbar movements like bending forward

• No neurological findings on a lumbar spine assessment (normal reflexes, normal strength)

• A normal lumbar MRI in the majority of cases

When Should You Be Concerned? Red Flags to Watch For

Piriformis syndrome is a benign, non-emergency condition. Please seek prompt medical assessment if you experience:

• Loss of bladder or bowel control

• Numbness in the groin or saddle area

• Rapidly worsening weakness in the leg

• Significant pain following a direct trauma to the back or pelvis

• Unexplained weight loss alongside buttock and leg pain

How Is It Diagnosed?

There is no single definitive test for piriformis syndrome, which is part of why it can be tricky to diagnose confidently. Diagnosis is based on a combination of your history, where and when you feel the pain, alongside specific hands-on examination findings. ¹

The FAIR test (flexion, adduction, and internal rotation of the hip) is the most commonly used clinical test, placing the piriformis muscle under stretch and reproducing the familiar buttock and leg pain when positive. ⁵ Direct tenderness over the piriformis on palpation of the deep buttock is another key finding. Imaging is sometimes used to rule out a lumbar disc problem or to confirm piriformis muscle changes on MRI or ultrasound, but these are supportive tools rather than essential for making the diagnosis.

How We Can Help

Conservative treatment is the recommended first approach for piriformis syndrome, and the good news is that most people respond well to it. ¹

Deep tissue and sports massage: this is one of the most directly effective treatments for piriformis syndrome. Targeted release of the piriformis muscle itself, alongside the surrounding gluteal muscles, helps reduce the muscle tension compressing the sciatic nerve. Many people notice a genuine and immediate improvement in their symptoms following skilled soft tissue work to this area.

Osteopathic manual techniques and manual therapy: addressing any restriction in the hip joint, sacroiliac joint, and lumbar spine that may be contributing to piriformis overload and tension. Given how closely the piriformis sits to the SIJ, treating the pelvis and hip as a whole system rather than just the muscle in isolation tends to produce the best results.

Cupping and gua sha: both genuinely useful for releasing the deep muscle tension in the gluteal region that often proves stubborn and resistant to other treatment approaches alone.

Medical acupuncture: used to reduce the local muscle tension and nerve sensitivity around the piriformis, supporting overall symptom management as part of a broader treatment plan.

Exercise and Stretching

Alongside hands-on treatment, specific stretching and strengthening exercises play an important role in both recovery and preventing the problem from returning.

Piriformis stretching

These exercises place a gentle stretch directly on the piriformis muscle. Hold each position for 30 to 45 seconds and repeat 3 times on the affected side.

• Lying piriformis stretch: lying on your back with both knees bent, cross the ankle of the affected side over the opposite knee and gently pull the thigh toward you until you feel a stretch deep in the buttock

• Seated figure-four stretch: sitting in a chair, cross the ankle of the affected side over the opposite knee, sit upright, and gently lean forward until you feel the stretch

• Knee to opposite shoulder: lying on your back, gently draw the knee of the affected side diagonally across toward the opposite shoulder

Strengthening

Strengthening the surrounding hip muscles reduces the workload placed on the piriformis during daily activity and sport.

• Clam shells: lying on your side with knees bent, slowly lift the top knee like a clamshell opening. Targets the gluteus medius and reduces over-reliance on the piriformis for hip stability

• Side-lying hip abduction: lying on your side with the leg straight, slowly lift the top leg to around 30 degrees and lower slowly

• Glute bridges: lying on your back with knees bent, squeeze the glutes and slowly lift the hips. Builds overall gluteal strength and reduces piriformis overload

Lifestyle adjustment

Alongside formal exercise, making simple changes to how long you sit and how you sit can make a meaningful difference. Getting up and moving every 30 minutes, using a cushioned seat, and avoiding crossing your legs for prolonged periods all help reduce the daily compression on the piriformis region.

What to Expect at Your First Appointment

We will take a thorough history of your symptoms, including exactly where the pain is, when it came on, and what makes it better or worse. We will carry out a hands-on assessment to distinguish piriformis syndrome from lumbar disc or nerve root pathology, using specific tests including the FAIR test alongside a broader examination of your hip, pelvis, and lower back. We will explain clearly what we find and build a treatment plan targeting both the muscle itself and any underlying factors contributing to it.

Frequently Asked Questions

Is this the same as sciatica? Not quite. True sciatica comes from nerve compression within the lumbar spine, typically from a disc pressing on a nerve root. Piriformis syndrome produces very similar symptoms, but the nerve is being compressed further down the leg in the deep buttock rather than at the spine itself. Treatment is quite different, which is why getting the right diagnosis matters.

Will this go away on its own? Mild cases sometimes settle with activity modification and stretching alone, but most people benefit from hands-on treatment to properly release the muscle and address the underlying cause. Without treating the root problem, symptoms often return.

Do I need a scan? Not usually. Piriformis syndrome is diagnosed clinically through history and examination. Imaging may be useful to rule out a lumbar disc problem if the diagnosis is uncertain.

How long will it take to get better? This varies depending on how long the problem has been present and how severe it is. Many people notice a meaningful improvement within a few sessions of treatment, with full recovery typically taking several weeks of consistent treatment and exercise.

Think this sounds familiar? Get in touch using the contact form and we will assess and build the right treatment plan for you.

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References

1. Piriformis syndrome: causes, inflammation and treatment. World Journal of Biology Pharmacy and Health Sciences. 2025;23(03):413-420. Available at: https://journalwjbphs.com/sites/default/files/fulltext_pdf/WJBPHS-2025-0870.pdf

2. Monteleone G, et al. Piriformis syndrome: a systematic review of case reports. BMC Surgery. 2025;25:468. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12512919/

3. Severe, Unremitting Piriformis Syndrome Following Yoga and Pilates: A Case Report. Cureus. 2025. Available at: https://www.cureus.com/articles/425112-severe-unremitting-piriformis-syndrome-following-yoga-and-pilates-a-case-report.pdf

4. Prevalence of Piriformis Syndrome in Bankers and Its Risk Factors. Journal of Health, Wellness and Community Research. 2025. Available at: https://jhwcr.com/index.php/jhwcr/article/download/1223/1168/0

5. Foam Rolling and Dynamic Stretching in Piriformis Syndrome. ClinicalTrials.gov. 2025. Available at: https://clinicaltrials.gov/study/NCT07278193