Piriformis Syndrome
The piriformis is a small deep muscle in the buttock that helps rotate the hip outward. The sciatic nerve runs directly beneath it (or occasionally through it). When the piriformis becomes tight, inflamed or in spasm, it can compress or irritate the sciatic nerve — causing pain in the buttock that may radiate down the back of the thigh and into the lower leg. This is called piriformis syndrome.
It’s often called “false sciatica” because it mimics the symptoms of sciatica from lumbar disc or nerve root problems, but the source is in the buttock rather than the spine.
Who Gets It?
- Runners (particularly those with a narrow stride and hip crossover)
- Cyclists
- People who sit for long periods, especially on hard surfaces
- Those with a history of hip or buttock trauma (fall onto the buttock)
- Athletes with leg length discrepancy or abnormal foot pronation
Symptoms
- Deep aching or sharp pain in the middle of the buttock
- Pain that spreads down the back of the thigh (usually not below the knee, unlike true disc sciatica)
- Worsens with prolonged sitting, particularly on hard surfaces
- Worse going up stairs, running or during hip rotation movements
- Tenderness deep in the buttock on palpation
- Pain reproduced by stretching the piriformis (hip internal rotation)
Treatment
Manual Therapy
- Deep soft tissue massage and trigger point release of the piriformis and surrounding deep hip rotators
- Hip joint mobilisation
- Sciatic nerve flossing (neural mobilisation) to improve nerve mobility
Dry Needling
Dry needling into the piriformis and related gluteal muscles is highly effective for releasing the tight, irritable muscle tissue.
Stretching
- Piriformis stretch (figure-four stretch) — a cornerstone of both treatment and prevention
- Hip flexor and hamstring flexibility
Strengthening and Biomechanical Correction
- Gluteus medius strengthening to offload the piriformis
- Running gait correction if stride width and hip mechanics are contributing
- Seated posture advice to reduce prolonged compression
